Use of the Complete Airway Repositioning and Expansion (CARE) approach in 220 patients with Obstructive Sleep Apnea (OSA): A retrospective cohort study

Objective/background: Obstructive sleep apnea (OSA) is a prevalent disease with significant health repercussions. While many effective OSA treatment modalities exist, Complete Airway Repositioning and Expansion (CARE) represents an emerging approach that leverages gradual airway expansion, with or without mandibular advancement. We conducted a retrospective study of patients who underwent CARE with a dental provider and examined how their sleep study data changed, with a focus on apnea hypopnea index (AHI).

Patients/methods: A retrospective database of 220 adult patients was examined. Demographic data and radiographic and sleep study data were compared in patients before and following at least 6 months of treatment with one of two possible dental devices.

Results: The median age of patients in this cohort was 50 years, and evenly split by gender. The median decrease in AHI was 49.0%, with a median pre-treatment AHI of 17.3 and median post-treatment AHI of 9.6 (p<0.001). Most participants (63.6%) demonstrated an improvement in their OSA severity class. Fifty-seven (25.9%) participants had complete resolution of their OSA. Post-treatment, 151 (68.6%) of patients had OSA severities of none or mild. Thirty-four (15.5%) of patients had in increase in AHI and 13 (6.0%) of these patients demonstrated an increase in OSA classification. One patient experienced an adverse event in the form of a loose molar tooth requiring repair. Overall findings were limited by missingness of BMI and clinical co-morbidity data, as well as quality of life measures.

Conclusions: In this large, but data limited retrospective series, CARE seems to be an effective and safe approach to OSA management that may be a useful alternative to current mainstays of OSA management. Further investigation is warranted.