0603 Transforming Obstructive Sleep Apnea Treatment: Telehealth and Mandibular Advancement Devices

Abstract Introduction Effective obstructive sleep apnea (OSA) treatment can potentially reduce the risk and the public health burden of OSA. While continuous positive airway pressure (CPAP) therapy remains the gold standard for treating OSA, long-term adherence is suboptimal. Although adherence to mandibular advancement devices (MADs) is higher, long-term data is lacking. This study explores the potential of MAD to i) improve patient symptoms and clinically relevant parameters and ii) evaluate telehealth as a platform to increase MAD accessibility and address the public health burden of OSA. Methods The electronic medical records of patients administered a MAD for OSA at an academic medical facility from 2019 to 2023 were evaluated. Patient demographics and mode of healthcare delivery were extracted. For patients who received a MAD, variables from their diagnostic polysomnography, like the Epworth Sleepiness Scale (ESS) and the apnea-hypopnea index (AHI), were compared with those from follow-up polysomnography with the MAD. These variables were also compared between the in-person and telehealth cohorts. Results 176 patients received a MAD for OSA treatment (56 ± 16 years of age, BMI 31 ± 7 kg/m2, 59% female, 82 White, 20% Hispanic/Latino). 37% and 59% of initial visits used telemedicine or teledentistry, respectively. Insurance coverage included AHCCS (26%), Medicare (20%), and commercial insurance (79%) as primary or secondary. The baseline ESS was 8 ± 4 (range 1-24). Initial diagnostic sleep study noted an AHI of 18 ± 15/hour (range 5-109.9/hour; supine 22±18/hour, lateral 14±25/hour), minimum oxygen saturation of 81 ± 7, sleep efficiency of 74 ± 16/hour, and an arousal index of 24 ± 19/hour. In the follow-up polysomnography with the MAD, significant differences were noted in AHI (p=0.0062) regardless of the frequency of in-person or telehealth encounters. While significant differences were not noted in ESS for the overall cohort (p=0.11), ESS improvement was significant in the telemedicine (p=0.03) and teledentistry (p=0.018) cohorts. Conclusion MAD use can improve clinically relevant parameters in OSA. Telehealth can deliver clinically effective treatment of OSA. Support (if any) American Academy of Dental Sleep Medicine, American Academy of Sleep Medicine Foundation, National Institutes of Health, The University of Arizona.