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Volume 15 No. 04
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Accepted Papers

Scientific Investigations

Scoring of Hypersomnolence and Fatigue in Patients With Obstructive Sleep Apnea Treated With a Titratable Custom-Made Mandibular Advancement Device

Elahe Kazemeini, MD1,2; Marc J. Braem, DDS, PhD1,3; Greta Moorkens, MD, PhD4; Sowjanya Balina, DDS3; Chloé Kastoer, MD, PhD1,2; Sara Op de Beeck, MSc1,2; Olivier M. Vanderveken, MD, PhD1,2,5; Marijke Dieltjens, MSc, PhD1,2,3
1Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Antwerp, Belgium; 2Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Antwerp, Belgium; 3Department of Special Dentistry Care, Antwerp University Hospital, Edegem, Antwerp, Belgium; 4Department of Internal Medicine, Antwerp University Hospital, Edegem, Antwerp, Belgium; 5Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Antwerp, Belgium

Study Objectives:

The objective of this study was to measure fatigue and hypersomnolence in patients with obstructive sleep apnea (OSA) treated with a mandibular advancement device (MAD), using Epworth Sleepiness Scale (ESS) for hypersomnolence and Checklist Individual Strength questionnaire (CIS20R) for fatigue.


This was a single-center, prospective cohort study. A total of 58 patients with OSA filled out ESS and CIS20R questionnaires at baseline and after 3 months of MAD treatment. A total of 39 full datasets were collected. Statistical analysis for reliability of the questionnaires, comparison between baseline and 3-month follow-up, correlation between the changes in the values of the two questionnaires, and changes in apnea-hypopnea index (AHI) were performed.


CIS20R showed excellent reliability in this patient group at baseline and 3-month follow-up (Cronbach α = .97), ESS showed a marginally good reliability (Cronbach α = .82). The CIS20R (82/140) expressed high levels of fatigue at baseline, and ESS showed a normal level of daytime sleepiness. AHI, ESS, and CIS20R were significantly reduced under MAD treatment. A significant correlation between ESS and CIS20R was observed. No significant correlation between any of the questionnaires and the change in AHI was found.


The CIS20R questionnaire results showed a high level of fatigue in the patients with OSA, and the questionnaire can be used to evaluate changes in fatigue due to MAD treatment after 3 months. The ESS failed to show similar characteristics. Therefore, a combination of ESS for hypersomnolence with CIS20R for fatigue is proposed for the follow-up of patients with OSA treated with MAD.


Kazemeini E, Braem MJ, Moorkens G, Balina S, Kastoer C, Op de Beeck S, Vanderveken OM, Dieltjens M. Scoring of hypersomnolence and fatigue in patients with obstructive sleep apnea treated with a titratable custom-made mandibular advancement device. J Clin Sleep Med. 2019;15(4):623–628.

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