Effect on Sleep Quality and Daytime Functioning with O2 Vent Optima Oral Appliance and Expiratory Positive Pressure Accessory (ExVent) in Obstructive Sleep Apnea Patients

Author(s): Sat Sharma, Antonella Conflitti, Hilary Reiter, Ivan Valcarenghi, Barry Weinstein, Shideh Pejman, Brian Smith, Adam Teo, Bob Gibbons

Study Objectives: ExVent is an optional accessory for the O₂Vent Optima mandibular advancement device that provides oral expiratory positive airway pressure (EPAP). Similar to nasal EPAP, oral EPAP results in passive upper airway dilatation and reduces flow limitation. Long-term benefits of combination therapy on sleep quality, excessive daytime sleepiness, daytime functioning and quality of bed partner’s sleep with the combination therapy require further study.

Methods: A retrospective survey was conducted of all patients who received O₂Vent Optima MAD and ExVent in Canada and Australia since 2019. Data collected included: demographics, duration and frequency of use, excessive daytime sleepiness, reported snoring, sleep satisfaction, morning and daytime functioning, daytime tiredness/fatigue and bed partner’s sleep interruption.

Results: Out of 480 patients, 168 (35%) contacted and participated. 31 (18%) had stopped using oral appliance. Out of 137 (81%) subjects, 118 (86%) were still using ExVent Accessory, 108 (92%) used medium strength ExVent. Mean use duration was 2.7±0.9 years, mean use frequency – most nights (91%) and mean use >6 hours/night (86%). Daytime sleepiness improved to none/mild from moderate/severe (96%, p<0.05). Reported snoring improved to none/mild from moderate/severe (94%, p<0.05). Participants slept very well/reasonably well compared to not well/not well at all (82%, p<0.05), woke up more refreshed most mornings compared to some/rare mornings (86%, p<0.05), functioned very well/reasonably to not well/not well at all (88%, p<0.05), felt fatigue and tiredness none of the time compared to some/all the time (83%, p<0.05), bed partner’s sleep interruption was none/some of the time from all the time (95%, p<0.05).

Conclusions: Majority of the patients with mild to moderate OSA treated with O₂Vent Optima and ExVent were compliant, experienced improved snoring, sleep quality, daytime functioning and uninterrupted bed partner’s sleep.