Use of the Complete Airway Repositioning and Expansion (CARE) approach in 220 patients with Obstructive Sleep Apnea (OSA): A retrospective cohort study.
Level 4 - case-series / case-control
Retrospective single-arm before-and-after study without a control group
PubMed 35921719 · doi:10.1016/j.sleep.2022.07.005
What was done
A retrospective cohort study evaluated 220 adult patients with obstructive sleep apnea (OSA) treated with the Complete Airway Repositioning and Expansion (CARE) approach. Patients underwent gradual airway expansion (with or without mandibular advancement) using one of two dental devices for at least 6 months. Sleep study metrics, primarily the apnea-hypopnea index (AHI), and demographic/radiographic data were compared pre- and post-treatment.
What was found
The median cohort age was 50 years (50% female). Median AHI decreased by 49.0%, dropping from 17.3 pre-treatment to 9.6 post-treatment (p < 0.001). Overall, 63.6% improved their OSA severity class, and 25.9% (n = 57) achieved complete resolution. After treatment, 68.6% (n = 151) had none or mild OSA. However, 15.5% (n = 34) had an increased AHI, and 6.0% (n = 13) worsened in OSA severity class. One adverse event was reported (a loose molar requiring repair).
Why it matters
This study provides preliminary real-world evidence that gradual airway expansion via the CARE approach can reduce AHI in adults with OSA, potentially offering an alternative to standard oral appliances or CPAP.
Limits
The study lacked a control or comparator group and was retrospective in design. BMI, clinical comorbidity records, and subjective quality-of-life measures were missing from the dataset. In addition, 15.5% of patients experienced disease worsening, and long-term durability was not evaluated.
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