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Impact of type D personality on adherence to oral appliance therapy for sleep-disordered breathing

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Abstract

Purpose

Type D personality, defined as a combination of social inhibition and negative affectivity, has been associated with poor medication adherence and lower adherence to continuous positive airway pressure in patients with sleep-disordered breathing. Up to this date, the association of patient’s personality with adherence with a mandibular advancement device (MAD) has not been studied. The purposes of this study were to examine the association between type D personality and poor adherence to MAD treatment and to examine the impact of type D personality on perceived side effects during this treatment.

Methods

Eighty-two patients out of 113 patients with a known baseline type D scale who have started MAD treatment between June 2006 and December 2009 were included. Information about side effects and adherence were collected via a postal questionnaire. Thirty-three patients were using a monobloc MAD and 49 patients were using a duobloc MAD.

Results

Forty-five percent of type D patients discontinued MAD treatment, whereas only 15 % of non-type D patients reported treatment discontinuation. The odds ratio for treatment discontinuation was 6.03 (95 % confidence interval 1.22–29.81; p = 0.027) for type D personality, adjusted for age, gender, MAD type (monobloc or duobloc), and decrease in apnea severity. In continuing MAD users, no significant difference in perceived side effects was reported between the personality types.

Conclusion

This is the first study to examine the relationship between type D personality and adherence to MAD treatment. Type D patients reported a significantly higher discontinuation rate when compared to patients without type D personality.

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References

  1. Young T, Badr S, Dempsey J, Palta M, Skatrud J, Weber S (1993) The occurrence of sleep disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  PubMed  CAS  Google Scholar 

  2. Young T, Gottlieb D, Peppard P (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239

    Article  PubMed  Google Scholar 

  3. Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J (2002) Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 166:159–165

    Article  PubMed  Google Scholar 

  4. Gottlieb DJ, Yenokyan G, Newman AB, O’Connor GT, Punjabi NM, Quan SF, Redline S, Resnick HE, Tong EK, Diener-West M, Shahar E (2010) Prospective study of obstructive sleep apnea and incident coronary heart disease and heart failure: the Sleep Heart Health Study. Circulation 122:352–360

    Article  PubMed  Google Scholar 

  5. American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendation for syndrome definition and measurement techniques in clinical research. Sleep 22:667–689

    Google Scholar 

  6. Sullivan CE, Berthon-Jones M, Eves L, Issa FG (1981) Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet 1:862–865

    Article  PubMed  CAS  Google Scholar 

  7. Chan AS, Cistulli PA (2009) Oral appliance treatment of obstructive sleep apnea: an update. Curr Opin Pulm Med 16:591–596

    Article  Google Scholar 

  8. Kushida CA, Alessi CA, Bailey D, Coleman J, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Littner MR, Morgenthaler TI (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29:240–243

    PubMed  Google Scholar 

  9. Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P (2008) Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res 17:221–229

    Article  PubMed  Google Scholar 

  10. Marklund M, Franklin KA (2007) Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 16:414–420

    Article  PubMed  Google Scholar 

  11. Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Franklin KA, De Backer WA, Van de Heyning PH (2008) Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med 178:197–202

    Article  PubMed  Google Scholar 

  12. Schwarting S, Huebers U, Heise M, Schlieper J, Hauschild A (2007) Position paper on the use of mandibular advancement devices in adults with sleep-related breathing disorders. A position paper of the German Society of Dental Sleep Medicine (Deutsche Gesellschaft Zahnaerztliche Schlafmedizin, DGZS). Sleep Breath 11:125–126

    Article  PubMed  Google Scholar 

  13. Engleman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL, Mackay TW, Douglas NJ (2002) Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med 166:855–859

    Article  PubMed  Google Scholar 

  14. Machado MA, Juliano L, Taga M, de Carvalho LB, do Prado LB, do Prado GF (2007) Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option? Sleep Breath 11:225–231

    Article  PubMed  Google Scholar 

  15. Holley AB, Lettieri CJ, Shah AA (2011) Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest 140:1511–1516

    Article  PubMed  Google Scholar 

  16. Almeida FR, Parker JA, Hodges JS, Lowe AA, Ferguson KA (2009) Effect of a titration polysomnogram on treatment success with a mandibular repositioning appliance. J Clin Sleep Med 5:198–204

    PubMed  Google Scholar 

  17. Fleury B, Rakotonanahary D, Petelle B, Vincent G, Pelletier FN, Meyer B, Lebeau B (2004) Mandibular advancement titration for obstructive sleep apnea: optimization of the procedure by combining clinical and oximetric parameters. Chest 125:1761–1767

    Article  PubMed  Google Scholar 

  18. Denollet J, Brutsaert DL, Sys SU (1995) Personality and mortality after myocardial infarction. J Psychosom Res 57:582–591

    CAS  Google Scholar 

  19. Denollet J (2000) Type-D personality: a potential risk factor refined. J Psychosom Res 49:255–266

    Article  PubMed  CAS  Google Scholar 

  20. Denollet J, Sys SU, Stroobant N, Rombouts H, Gillebert TC, Brutsaert DL (1996) Personality as independent predictor of long-term mortality in patients with coronary heart disease. Lancet 347:417–421

    Article  PubMed  CAS  Google Scholar 

  21. Denollet J (2005) DS14: standard assessment of negative affectivity, social inhibition, and type D personality. J Psychosom Res 67:89–97

    Google Scholar 

  22. Schiffer AA, Pedersen SS, Widdershoven JW, Denollet J (2008) Type D personality and depressive symptoms are independent predictors of impaired health status in chronic heart failure. Eur J Hear Fail 10:802–810

    Article  Google Scholar 

  23. Mols F, Denollet J (2010) Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry 32:66–72

    Article  PubMed  Google Scholar 

  24. Williams L, O’Conner CR, Grubb N, O’Carroll R (2011) Type D personality predicts poor medication adherence in myocardial infarction patients. Psychol Health 26(6):703–712

    Article  PubMed  Google Scholar 

  25. Bröstrom A, Strömberg A, Martensson J, Ulander M, Harder L, Svanborg E (2007) Association of type-D personality to perceived side effects and adherence in CPAP-treated patients with OSAS. J Sleep Res 16:439–447

    Article  PubMed  Google Scholar 

  26. Ekici A, Ekici M, Oguzturk O, Karaboga I, Cimen D, Senturk E (2012) Personality profiles in patients with obstructive sleep apnea. Sleep Breath. doi:10.1007/s11325-012-0691-5

  27. Dieltjens M, Vanderveken OM, Van de Heyning PH, Braem MJ (2012) Current opinions and clinical practice in the titration of oral appliances in the treatment of sleep-disordered breathing. Sleep Med Rev 16:177–185

    Article  PubMed  Google Scholar 

  28. Dieltjens M, Vanderveken OM, Hamans E, Verbraecken JA, Wouters K, Willemen M, De Backer WA, Van de Heyning PH, Braem MJ (2012) Treatment of obstructive sleep apnea using a custom-made titratable duobloc oral appliance: a prospective clinical study. Sleep Breath. doi:10.1007/s11325-012-0721-3

  29. Vanderveken OM, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Willemen M, Wuyts FL, De Backer WA, Van de Heyning PH (2004) Pilot study of a novel mandibular advancement device for the control of snoring. Acta Otolaryngol 124:628–633

    Article  PubMed  Google Scholar 

  30. Weaver TE, Grunstein RR (2008) Adherence to continuous positive airway pressure therapy. Proc Am Thorac Soc 5:173–178

    Article  PubMed  Google Scholar 

  31. Ravesloot MJ, de Vries N (2011) Reliable calculation of the efficacy of non-surgical and surgical treatment of obstructive sleep apnea revisited. Sleep 34:105–110

    PubMed  CAS  Google Scholar 

  32. Sin DD, Mayers I, Man GC, Pawluk L (2002) Long-term compliance rates to continuous positive airway pressure in obstructive sleep apnea: a population-based study. Chest 121:430–435

    Article  PubMed  Google Scholar 

  33. Basoglu OK, Midilli M, Midilli R, Bilgen C (2011) Adherence to continuous positive airway pressure therapy in obstructive sleep apnea syndrome: effect of visual education. Sleep Breath doi:10.1007/s11325-011-0631-9

  34. de Almeida FR, Bittencourt LR, de Almeida CI, Tsuiki S, Lowe AA, Tufik S (2002) Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance. Sleep 25:507–513

    PubMed  Google Scholar 

  35. Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, Ryan F (2005) Long-term compliance and side effects of oral appliances used for the treatment. J Clin Sleep Med 1:143–152

    PubMed  Google Scholar 

  36. Lettieri CJ, Paolino N, Eliasson AH, Shah AA, Holley AB (2011) Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med 7:439–445

    PubMed  Google Scholar 

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Conflict of interest

All authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Special Care Dentistry, Antwerp University Hospital, Edegem, Belgium

    M. Dieltjens, D. Van den Bosch & M. J. Braem

  2. Department of ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium

    M. Dieltjens, O. M. Vanderveken, D. Van den Bosch & P. H. Van de Heyning

  3. Department of Scientific Coordination and Biostatistics, Antwerp University Hospital, Edegem, Belgium

    K. Wouters

  4. Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Antwerp, Belgium

    O. M. Vanderveken, J. A. Verbraecken & P. H. Van de Heyning

  5. Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    M. Dieltjens, O. M. Vanderveken, J. A. Verbraecken, P. H. Van de Heyning & M. J. Braem

  6. Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, Tilburg, The Netherlands

    J. Denollet

Authors
  1. M. Dieltjens
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  2. O. M. Vanderveken
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  3. D. Van den Bosch
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  4. K. Wouters
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  6. J. A. Verbraecken
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  7. P. H. Van de Heyning
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  8. M. J. Braem
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Correspondence to M. Dieltjens.

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Dieltjens, M., Vanderveken, O.M., Van den Bosch, D. et al. Impact of type D personality on adherence to oral appliance therapy for sleep-disordered breathing. Sleep Breath 17, 985–991 (2013). https://doi.org/10.1007/s11325-012-0788-x

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