Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

For patients with obstructive sleep apnea (OSA) there are two front line treatments, continuous positive airway pressure (CPAP) and dental appliances. Currently, nearly everyone diagnosed with OSA is started on CPAP because it is highly effective. Despite this, adherence to CPAP is poor due to the fact that it is inconvenient to use. Studies have shown that approximately half of OSA patients prefer less effective but more convenient dental appliances; however these patients are often not given the option to use a dental appliance. This trial is evaluating a patient decision aid (PtDA) in patients with OSA. A PtDA is a tool, either on paper, computer, or video, that provides OSA patients with information about both CPAP and dental appliances, and helps them determine which treatment is best for their specific situation. Specifically, an economic evaluation of the PtDA will be performed - it will measure how much it costs to provide the PtDA to patients and the benefit that it provides. This trial will also explore how providing patients with the treatment they prefer may change adherence; it is proposed that patients may be more adherent to a treatment they prefer. Increased adherence may translate into fewer adverse events, such as stroke, heart attack, or motor vehicle crashes - outcomes that are more common in individuals with OSA than the general population. Lastly, current measurement techniques underestimate the value provided by PtDAs. Increased knowledge, reduced anxiety or decisional conflict, and choosing a treatment that you prefer is not captured in the current measurement framework. In a subset of OSA patients, we will explore how much patients value these outcomes and incorporate this into the economic evaluation. Measuring this benefit will allow it to be considered by policy-makers who make funding decisions.