Mandibular Advancement Devices in 630 Men and Women With Obstructive Sleep Apnea and Snoring * (original) (raw)
Related papers
European Archives of Oto-Rhino-Laryngology, 2018
Purpose This study aimed to determine the effectiveness of a mandibular advancement device in a sample of obstructive sleep apnea syndrome patients by the evaluation of respiratory and neurophysiologic parameters and clinical symptoms. Second, the influence of certain predictor factors related with the patient and the intraoral device, were considered in the final response with this treatment option. Methods Forty-one patients constituted the final sample. Outcomes were measured using polysomnography, Epworth sleepiness scale and an analogue visual snoring scale, before treatment and once the device was properly titrated. Results Mean apnea-hypopnea index decreased from 22.5 ± 16.8 to 9.1 ± 11.6 (p ≤ 0.05), influencing only gender and Fujita index as predictor factors. The oxygen saturation, arousal index, percentages of sleep stages and sleep efficiency significantly improved with the mandibular advancement device (MAD) placement. The snoring index improved in absolute terms in 6.1 units and the excessive daytime sleepiness was reduced from 12.2 ± 4.7 to 8.5 ± 3.8 (p ≤ 0.00). Conclusions The successful treatment rate with the MAD was 65.8%. The placement and posterior regulation of the intraoral appliance efficiently reduced the apnea-hypopnea index, improved the sleep quality and the clinical symptomatology associated. Obstructive sleep apnea syndrome is a highly prevalent disease. and dentists should be aware of the benefits enhanced by this prosthetic device, considered the first treatment option by certain physicians.
Indian Journal of Sleep Medicine, 2016
Introduction: Medical dental sleep appliance (MDSA) is an adjustable mandibular advancement device (MAD) recommended for treatment of snoring and obstructive sleep apnea (OSA). There are very few studies on Indian population which evaluate the therapeutic efficacy of mandibular advancement devices in the management of OSA. Materials and Methods: A prospective clinical study was carried out. Twenty polysomnography diagnosed OSA patients fulfilling the inclusion and exclusion criteria were treated with MDSA and changes in pre and post-treatment sleep parameters (apneahypopnea index (AHI) and epworth sleepliness scale (ESS)) were recorded. Results: Mean differences in pre-(T 1 = 30.7 ± 5.0) and posttreatment (T 2 = 17.2 ± 3.9) AHI values and ESS pre-treatment (T 1 = 17.2 ± 0.6) and post-treatment (T 2 = 10.9 ± 0.9) were highly statistically significant (p < 0.001). Clinically the maximum improvement was observed in mild and moderate OSA cases. Although significant clinical improvement was also observed in severe OSA cases, the post-treatment AHI and ESS were still high. Conclusion: MDSA is a non-invasive, low risk and cost-effective treatment option for patients suffering from mild and moderate obstructive sleep apnea and also in cases of severe OSA who are not comfortable with CPAP or not willing for surgery.
Mandibular Advancement Device in Patients With Obstructive Sleep Apnea *
CHEST Journal, 2001
To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement device in patients with obstructive sleep apnea. Design: Prospective study. Setting: Patients: Thirty-three consecutively treated patients. Interventions: Individually adjusted mandibular advancement devices. Measurements and results: Polysomnographic sleep recordings on 1 night without the device and 1 night with the device were performed after 0.7 ؎ 0.5 years (mean ؎ SD) and after 5.2 ؎ 0.4 years from the start of treatment. Nineteen of the 33 patients experienced a short-term satisfactory treatment result with an apnea-hypopnea index of < 10 events per hour and a satisfactory reduction in snoring. Fourteen patients were regarded as being insufficiently treated with the device. Seventeen of the short-term satisfactorily treated patients (90%) and 2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 ؎ 17 to 4.9 ؎ 5.1 events per hour (p < 0.001) in these 19 long-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients. Patients with their devices replaced or adjusted experienced a better long-term effect than patients still using their original devices (p < 0.05). Conclusions: The long-term effect and tolerability of a mandibular advancement device are good in patients who are recommended the treatment on the basis of a short-term sleep recording, provided that the device is continuously adjusted or replaced with a new one when needed. A short-term follow-up is valuable in the selection of patients who will benefit from long-term treatment with a mandibular advancement device. (CHEST 2001; 120:162-169)
Cumhuriyet Dental Journal, 2015
Oral appliances are an alternative to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Mandibular advancement device (MAD) is a popular treatment alternative particularly for mild to moderate OSA. Polysomnographic (PSG) evaluation were performed on two patients before and about one year after continuous use of the MADs. The results were compared. In the first case, the apnea-hypopnea index (AHI) before treatment was 22.0 and decreased, to 4.3, after one year of treatment. After one year, the AHI differ significantly from the pretreatment value. In the second case, before treatment, the AHI was 21.4 and decreased to 10.1 after one year of treatment. The one year follow-up showed that occlusion was preserved, masticatory muscles and temporomandibular joint (TMJ) were protected. The MADs reduced apneas and improved sleep quality in patients with OSA.
Sleep Medicine Reviews, 2021
The aim of this review was to systematically evaluate the available scientific evidence on the benefit of mandibular advancement devices (MADs) in the treatment of primary snoring (PS). From 905 initially identified articles, 18 were selected. Papers that provided indirect information regarding obstructive sleep apnea syndrome (OSAS) and/or sleep breathing disorders (SBD) were included. Information was obtained on monoblock and duoblock appliances from the selected studies. The devices were most commonly able to achieve 50%-70% of the maximum mandibular protrusion. The frequently used outcome measurements were the apnea-hypopnea index, Epworth sleepiness scale, and oxygen desaturation index, which all yielded positive post-treatment results. The most common side effects were temporomandibular joint pain and excessive salivation, which improved with time. Our findings indicated that the use of MADs, even with varying designs, improved outcomes in all the reported patient populations (PS, OSAS, and SBD). Despite the lack of studies on PS, the available evidence supports the use of MADs for treatment of PS. Snoring should be treated from a preventive and psychosocial perspective to avoid progression to more severe diseases that could have a significant medical and economic impact.
Journal of Sleep Disorders & Therapy, 2015
Background: Oral appliances have emerged as an important alternative in treating patients with mild-moderate obstructive sleep apnea (OSA). They are effective, simple to use and well tolerated by the patient compared to other therapeutic solutions, such as continuous positive airway pressure (CPAP) or surgery of the upper airways. Aim: The aim of this preliminary study was to assess the effectiveness of a new mandibular advancement device, the BestMAD, in the treatment of OSA patients. Materials and methods: We selected 10 patients, 9 males and 1 female, with an average age of 51.5 years, affected by OSA, with a BMI (Body Mass Index) value ≤25 kg/m2. All patients used the BestMAD for at least 6 months. A control polysomnography was repeated after 6 months and a questionnaire was administered to assess the side effects eventually felt by the patient. Results: After treatment with BestMAD, a statistically significant improvement was found in AHI (p=0.0051), RDI (p=0.0051) and ESS (p=0.0049). With regard to adherence to the treatment, 8 patients claimed to have used the BestMAD for the entire duration of nocturnal rest, while the remaining 2 only for a few hours at night. Conclusions: BestMAD is a comfortable device which has proved effective in improving the polysomnographic parameters.
MANDIBULAR ADVANCEMENT DEVICE USE IN A PATIENT WITH OBSTRUCTIVE SLEEP APNEA: A CASE REPORT (Atena Editora), 2022
Obstructive sleep apnea (OSA) is a sleep-related respiratory condition that causes episodes of reduced breathing or complete stops, in addition to triggering other major health complications such as cardiovascular problems, stroke, fatigue and drowsiness. Usual treatments are performed with continuous positive airway pressure (CPAP) devices and mandibular advancement devices (MADs). The study presents a case report of a male patient, 57 years old, 84kg diagnosed with OSA, in which treatment with MADs made and adjusted in the patient is presented, so that beneficial results could be collected and confirmed. Observing that after 1 month of treatment with MADs there was an improvement in the percentage of sleep, as well as a reduction in AHI, in addition to greater oxygenation, absence of nucturia and reduction of snoring for some sporadic moments.
Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults
International Archives of Medicine
Introduction: This article is based on Clinical Guidelines for obstructive sleep apnoea (OSA) established by a taskforce coordinated by the Brazilian Sleep Association. Objective: The aim of this article is to evaluate the available scientific evidence regarding the efficacy, adherence and safety of using mandibular advancement devices (MAD) as a therapeutic course for treating obstructive sleep apnoea in adult patients. Method: Active searches were performed in the PubMed/MEDLINE, EMBASE, Scielo/LILACS and Cochrane Library databases. Methodological aspects were used to rank the levels of evidence according to the criteria of the Centre for Evidence-Based Medicine at Oxford. Results: Mandibular advancement devices offer the best results for patients with primary snoring, upper airway resistance syndrome and mild or moderate OSA (Levels of Evidence I and II). Patients seem to exhibit greater adherence to oral appliances (MAD) than to continuous positive airway pressure (CPAP) devic...
Sleep Medicine, 2018
Objective: To survey potential predictors of success of mandibular advancement device (MAD) therapy in patients with obstructive sleep apnea (OSA), and in particular, to examine anatomical narrowings and sleep-related collapse levels in the upper airway. Methods: This was a prospective study of 62 OSA patients (median apnea-hypopnea index [AHI] of 34), who were treated with a custom-made, monobloc MAD. The upper airway was examined by inspection, nasopharyngoscopy, overnight acoustic reflectometry recording collapses, and cephalometry of soft tissue dimensions (in addition to skeletal parameters). MAD treatment was controlled by polysomnograpy before and after at least 5 weeks from the beginning of treatment. Independent predictors of actual reduction in AHI and treatment success (reduction in AHI ≥ 50% with residual AHI < 10) were determined, using multivariable linear and logistic regression. Results: Positional OSA (POSA) and nonsupine AHI (adjusted for upper airway narrowness and collapses, together with gender, age, body mass index, neck circumference, and baseline AHI) were the only independent predictors: POSA indicative for success, and nonsupine AHI inversely related to success. Cephalometry was not predictive. Two predictive models were proposed, one based on POSA having a specificity of 70% and sensitivity of 69%, and the other based on nonsupine AHI, generating a receiver operating characteristic (ROC) curve (area under ROC = 0.78). Using the ROC model, specificity could be increased to 80% without lowering sensitivity. Conclusions: Only variables related to sleep position proved to be independent predictors of success with MAD therapy. The results could be explained by the MAD counteracting the mandible from moving backwards when sleeping supine.