These data show that MAD treatment remained effective over 5-year follow-up in patients with mild to severe OSA who were intolerant of, non-compliant with, or refused CPAP. Efficacy interms of AHI reduction did decline over time, but most of this attenuation of effect was evident by 2 years of follow-up, consistent with existing data. Despite the slight worsening of respiratory parameters over time, sleepiness and symptoms (eg, fatigue, morning headache) remained well controlled,and sleep quality and state on wakening showed marked and sustained improvements during long term MAD therapy. These findings suggest that measurement of AHI alone might not provide an accurate picture of the long-term benefits associated with MAD therapy, particularly in patients with mild OSA for whom improvement in symptoms, especially diurnal sleepiness, might be more clinically relevant than substantial reductions in the AHI. Therefore, both objective and self-reported assessments should be included in the evaluation of MAD therapy, especially over the longer term.
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