By: Dr. Jagdeep Bijwadia
Recent evidence increasingly supports health outcomes with oral devices being equivalent to CPAP in a wide range of conditions. In patients with mild to moderate OSA, improvements in sleepiness, quality of life and blood pressure are similar. Recent studies by Dr. Cistulli have confirmed equivalent outcomes in both groups in patients with moderate and severe OSA with cardiovascular outcomes like aortic augmentation index as well as driving simulation. A recent article by Charitte looked at cardiac autonomic function, and again outcomes with oral devices were comparable to CPAP.
The conclusion that oral devices and CPAP could have similar health outcomes has been difficult to explain given the many studies that show CPAP decreases AHI more effectively. A recent article published in the Journal of Dental Sleep Medicine helps put these findings into perspective. The article points out the difference between efficacy that is a measured outcome – in this case AHI in “ideal” circumstances (the assumption being that the patients 100% compliant) – versus effectiveness which takes into account “real life” use.
While CPAP is indeed more effective in reducing AHI, this is offset by the many studies confirming higher compliance rates with oral devices both when measured subjectively and objectively. The ideal metric for treatment should take into account both the AHI and the compliance. Drs. Cistulli and Sutherland introduce the idea of SARAHI sleep adjusted residual AHI. This metric can be easily calculated and is reflective of the effectiveness of each therapy.
The finding of equivalent health outcomes with CPAP and Oral Devices in recent publications could therefore likely be explained by similar sleep adjusted AHIs with CPAP and COAT.
To figure the sleep adjusted AHI, simply use the equation below:
Sleep adjusted AHI= (AHI X number of hours on treatment) + AHI X number of hours untreated) / total hours of sleep
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As Chief Medical Officer of SomnoMed North America, Dr. Bijwadia is charged with helping to define strategy for the medical initiative, build clinical research educational programs and create collaborative bridges between physicians and dentists. In addition to his leadership of SomnoMed, Dr. Bijwadia has an active private clinical practice in Saint Paul MN. He previously served as Attending Physician at HealthPartners Medical Group (HPMG), where he was the Department Head and Director of the Sleep Medicine Center before stepping down to take the CMO role at SomnoMed. He holds a faculty position as Assistant Professor in the Department of Pulmonary Critical Care and Sleep Medicine at the University of Minnesota where he served as Director of the Sleep Program until 2012.
Dr. Bijwadia earned his medical degree and did his internship and residency at Mumbai University. He then moved to the United States, where he completed his internship and residency at Nassau University Medical Centre at the State University of New York, where he was named Chief Resident of Internal Medicine in 1991. Dr. Bijwadia completed a Fellowship in Pulmonary and Critical Medicine at the University of Southern California. He is board certified in Internal Medicine, Pulmonary Diseases, and Sleep Medicine. He completed the Executive Course at the Physician Leadership College at St. Thomas University, Opus College of Business in Minneapolis, Minnesota in 2011 and Health Insurance Executive Certification at the American Health Insurance Plans and Kellogg School of Business. He is currently enrolled in the Executive MBA Program at St. Thomas University Opus College of Business.