A1 Refereed original research article in a scientific journal
Treatment choice in mild to moderate sleep apnoea in the European Sleep Apnea Database
Authors: Fridriksson, Benedikt; Hedner, Jan; Zou, Ding; Verbraecken, Johan; Schiza, Sophia; Basoglu, Ozen K.; Testelmans, Dries; Joppa, Pavol; Dogas, Zoran; Mihaicuta, Stefan; Saaresranta, Tarja; Ludka, Ondrej; Drummond, Marta; Bailly, Sebastien; Grote, Ludger; the ESADA study group
Publisher: European Respiratory Society (ERS)
Publication year: 2025
Journal: ERJ Open Research
Article number: 00360-2025
Volume: 11
Issue: 6
eISSN: 2312-0541
DOI: https://doi.org/10.1183/23120541.00360-2025
Publication's open availability at the time of reporting: Open Access
Publication channel's open availability : Open Access publication channel
Web address : https://doi.org/10.1183/23120541.00360-2025
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/508190216
Self-archived copy's licence: CC BY NC
Self-archived copy's version: Publisher`s PDF
Introduction: In mild to moderate obstructive sleep apnoea (OSA), positive airway pressure (PAP) and mandibular advancement devices (MADs) are recommended treatments according to guidelines. This cross-sectional study aimed to determine the clinical and organisational predictors for treatment recommendations in mild to moderate OSA.
Methods: In the European Sleep Apnea Database, factors predicting the choice of MAD or PAP treatment were determined in patients with newly diagnosed mild to moderate OSA. Accessibility and reimbursement of MADs study sites was obtained via questionnaire. The regression model included anthropometrics, Epworth Sleepiness Scale score, OSA severity, MAD accessibility and reimbursement, and a comorbidity index variable.
Results: 6618 (65.5%) patients received PAP and 3491 (34.5%) were recommended MADs. MAD recommendations varied between centres (0% to 76%). Significant factors favouring MADs include mild versus moderate OSA (odds ratio 6.0, 95% CI 5.3-6.8), negligible versus moderate intermittent hypoxia (OR 2.0, 95% CI 1.7-2.4), no versus excess daytime sleepiness (OR 2.6, 95% CI 2.1-3.1), a comorbidity index score of 0 compared to 3 or more (OR 3.8, 95% CI 3.1-4.6) and no insomnia diagnosis versus diagnosed insomnia (OR 2.0, 95% CI 1.7-2.4). MAD accessibility and reimbursement predicted MAD treatment recommendations (OR 2.3, 95% CI 1.8-2.9 and OR 1.5, 95% CI 1.4-1.7, respectively).
Conclusion: In mild to moderate OSA, MADs are less frequently recommended than PAP, particularly amongst patients with a higher disease burden. MADs were more frequently used when they were more accessible and reimbursed. Thus, MADs are likely an underused treatment in mild to moderate OSA.
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Funding information in the publication:
B. Fridriksson has received one-time lecturing fees from ResMed and AstraZeneca, and a one-time fee for advisory board participation for GSK. L. Grote has received institutional grants from the Swedish Heart and Lung Foundation, from the Regional Research Support (ALF), and funding from the European Union Horizon 2020 grant “Sleep Revolution” as Work Package Leader; received unrestricted funding for the ESADA study from Resmed and Philips Foundations in 2007 and 2011 as well as from Bayer AG (2018–2021) for a scientific collaboration; owns shares in company with a licensed patent to Desistin GmbH, Germany, for pharmacological treatment in obstructive sleep apnoea; received fees participating in education activities for Astra, Lundbeck, Resmed, Philips and Itamar; has chaired the National guideline committee for OSA in adults, the National Quality Registry for OSA in Adults (SESAR), and the Clinical Research Collaboration ESADA of the ERS; has received support as ERS Representative for Assembly 4 2020–2023 and as an European Sleep Research Society examination committee member; and outside the current manuscript, is a medical advisor for Onera BV, Netherlands. J. Hedner has received a Desitin GmbH research grant related to carbonic anhydrase inhibition in sleep apnoea (CAISA study, 2021–2023) as payment to his institution; has received payment from Desitin GmbH via a institutional clinical trial agreement with independent monitor (and University of Gothenburg) proof of concept trial (STM026) for sulthiame in obstructive sleep apnoea (2018–2020); received unrestricted funding for the ESADA study from Resmed and Philips Foundations in 2007 and 2011 as well as from Bayer AG (2018–2021) for a scientific collaboration; has received university grants from Swedish Heart and Lung Foundation and the Västra Götaland Regionen (ALF Agreement); owns shares in a company with a licensed patent relating to drug treatment in sleep apnea (Apnimed); and has received consulting fees as member of a medical advisory board for SomnoMed (discontinued 2024). D. Zou has received an institutional grant from the Swedish Heart Lung Foundation. J. Verbraecken reports grants and fees from AirLiquide AstraZen, Atos Medical, Azelis, Bioprojet, Desitin, Epilog, Idorsia, Inspire Medical Systems, Löwenstein Medical, Mediq, Micromed OSG, Philips, ProSomnus, ResMed, Sefam, SD Worx, SomnoMed, SOS Oxygène, Tilman, Total Care, Vivisol, Vlaamse Gemeenschap, Vlerick, Westfalen Medical and Zoll Itamar outside the submitted work; and consultancy for Bioprojet and Epilog; and is an associate editor of this journal. S. Bailly is supported by funding through the French National Research Agency in the framework of the “Investissements d'avenir” programme (ANR-15-IDEX-02) and the “e-health and integrated care and trajectories medicine and MIAI artificial intelligence” Chairs of excellence from the Grenoble Alpes University Foundation (ANR-19-P3IA-0003). D. Testelmans has received fees for lecturing from ResMed and for advisory board membership from Bioproject. T. Saaresranta has received institutional support from Finnish Governmental VTR Grant #13542, Finnish Anti-Tuberculosis Association Foundation, Tampere Tuberculosis Foundation, Foundation for Respiratory Diseases, Jalmari and Rauha Ahokas Foundation; and reports the task force roles as Chair of the Finnish Task Force of Current Care Guidelines for Adult Sleep Apnea, and Member of the ESRS Task Force BPAP in Obstructive Sleep Apnea. S. Schiza, P. Joppa, S. Mihaicuta, O.K. Basoglu, O. Ludka, Z. Dogas and M. Drummond report no conflict of interest.
Support statement: The ESADA network was supported by the European Union COST action B26 (2005–2009). In addition, the ERS has funded ESADA as a Clinical Research Collaboration (2015–ongoing). The ResMed Foundation and the Philips Respironics Foundation have provided unrestricted seeding grants for establishment of the database in 2007 and 2011. The ESADA has a scientific collaboration with Bayer AG (2018–2022). The ESADA is part of the European Union Horizon 2020-funded “Sleep Revolution project” (grant agreement number 965417). In this context, the current study explored contemporary patient management in obstructive sleep apnoea and the current level of patient participation on the European level. L. Grote and J. Hedner received institutional grants from the Swedish Heart and Lung Foundation, which included the analysis of data from the ESADA.
