U.S Army researchers recently cast a spotlight on adjustable oral appliances, with results of their study published in the Journal CHEST, titled “Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome,” where they evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. Results were measured by the apnea-hypopnea index (AHI) score, used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypoapnea) of breathing that last for at least 10 seconds per hour of sleep. The researchers found that a significantly higher percentage of patients using an adjustable OA experienced successful reduction of their AHI score to below five apneic events per hour in this study compared to past reports (62.3 percent versus 54 percent).
What are the implications for soldiers and civilians? Not surprisingly, the quality of sleep among soldiers can be a shambles during combat deployment. Explosions and less-than-ideal sleeping arrangements are unavoidable, but combine it all with sleep apnea and things get even worse. “We know that most injuries are not battle related,” says Lieutenant Colonel Christopher J. Lettieri, MD, FACP, FCCP, FAASM, a lead author of the study. “We have accidents, and if soldiers are sleep deprived, they are going to lack focus and be more prone to accidents.”
It’s also a problem on U.S. roadways, but the stakes are even higher when lethal machinery is mixed in. “If you are driving a 40-ton tank around, you can’t afford to make bad decisions,” adds Lettieri, program director, Sleep Medicine Fellowship, Walter Reed National Military Medical Center, Washington, DC. “Research shows that chronic low-level sleep deprivation impairs reasoning, decision-making, and slows reaction time. You don’t want that in a combat-deployed troop.”
Oral appliances can fit easily in a ruck sack, but do they actually work? Lettieri and his co-researchers decided to try their own study in an effort to add to the growing literature. Beyond the obvious benefits of reduced accidents, they found that even post traumatic stress disorder (PTSD) may be affected by poor sleep. “We have all these guys coming back with PTSD, and we broke it down into guys who were injured, and those who were not,” explains Lettieri. “Among guys who did not sustain a combat injury, almost universally they had some underlying sleep disorder.”
In the full in-depth interview, published in the Feb/Mar issue of Sleep Diagnosis and Therapy, the two lead authors Lt Col. Lettieri and Major Aaron B. Holley, MD, FACP, discuss the study’s impact now that it has been in the public domain since late last year, and review the major findings and implications.