Mandibular Advancement Devices in Obstructive Sleep Apnea Patients Intolerant to Continuous Positive Airway Pressure Treatment

  • M. WojdaEmail author
  • J. Kostrzewa-Janicka
  • P. Śliwiński
  • P. Bieleń
  • P. Jurkowski
  • R. Wojda
  • E. Mierzwińska-Nastalska
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 1150)


Obstructive sleep apnea (OSA) is defined as episodes of upper airway obstruction occurring during sleep. Conservative treatment of OSA consists of continuous positive airway pressure (CPAP). An alternative treatment in mild-to-moderate OSA could be the use of intraoral mandibular advancement devices (MAD). The aim of this study was to evaluate therapeutic efficacy of MAD in OSA patients intolerant to CPAP. The study group included 8 patients, who fulfilled specific inclusion criteria during a dental examination, out of the 30 CPAP intolerant patients who were referred for the possible use of MAD. The selected patients used MAD for 30 days and then switched to CPAP for 10 days to compare the effectiveness of both treatment methods. They had 3 polysomnographic (PSG) examination: baseline before treatment, and at the end of MAD and CPAP. We found that either treatment method resulted in comparable symptomatic improvements in OSA patients. In detail, the apnea-hypopnea index decreased, along with the overall number of obstructive, central, and mixed apneic episodes during sleep time. The mean arterial oxygen saturation (SaO2) improved and the minimum SaO2 level noted during night time got enhanced. Differences in the sleep apnea indices after MAD and CPAP treatments were insignificant, but there was a consistent impression that CPAP was superior to MAD as it tended to improve symptoms to a somehow greater extent. We conclude that MAD is a sufficiently effective treatment alternative for OSA patients who are intolerant to CPAP or in whom CPAP therapy fails.


Airways CPAP Mandibular advancement appliance Sleep apnea Treatment effectiveness Upper airways 


Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw, Poland (permit no. KB/65/2015). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Informed written consent was obtained from all individual participants included in the study.


  1. Aarab G, Lobbezzo F, Hamburger HL, Naeije M (2009) Variability in the apnea- hypopnea index and its consequences for diagnosis and therapy evaluation. Respiration 77:32–37CrossRefGoogle Scholar
  2. Aarab G, Lobbezzo F, Hamburger HL, Naeije M (2011) Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea; a randomized, placebo-controlled trial. Respiration 81:411–419CrossRefGoogle Scholar
  3. AASM (1999) American Academy of Sleep Medicine Task Force Report. Sleep–related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689CrossRefGoogle Scholar
  4. Barnes MR, McEvoy D, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664CrossRefGoogle Scholar
  5. Bernhold M, Bondemark L (1998) A magnetic appliance for treatment of snoring patients with and without obstructive sleep apnea. Am J Orthod Dentofac Orthop 113(2):144–155CrossRefGoogle Scholar
  6. Blanco J, Zamarron C, Abeleira Pazos MT, Lamela C, Suarez Quintanilla D (2005) Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath 9:20–25CrossRefGoogle Scholar
  7. Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJR, de Bont LGM, Stegenda B (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow- up. Sleep 36(9):1289–1296CrossRefGoogle Scholar
  8. Fergusson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA (1996) A randomized crossover study of an oral appliance versus nasal continuous positive airway pressure in the treatment of mild-moderate sleep apnea. Chest 109:1269–1275CrossRefGoogle Scholar
  9. Fritsch KM, Iseli A, Russi EW, Bloch KE (2001) Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med 164(5):813–818CrossRefGoogle Scholar
  10. Gagnadoux F, Fleury B, Vielle B, Petelle B, Meslier N, N’Guyen XL, Trzepizur W, Racineux JL (2009) Titrated mandibular advancement versus positive airway pressure for sleep apnea. Eur Respir J 34:914–920CrossRefGoogle Scholar
  11. Gotsopoulos H, Chen C, Quian J, Cistulli PA (2002) Oral appliance therapy improves symptoms in obstructive sleep apnea. Am J Respir Crit Care Med 166:743–748CrossRefGoogle Scholar
  12. Hoffstein V (2007) Review of oral appliance for treatment of sleep-disordered breathing. Sleep Breath 11:1–22CrossRefGoogle Scholar
  13. Hudgel DW (1992) Mechanism of obstructive sleep apnea. Chest 101(2):541–549CrossRefGoogle Scholar
  14. Johal A, Bottegal JM (2001) Current principles in the management of obstructive sleep apnea with mandibular advancement appliances. Br Dent J 190(100):532–536CrossRefGoogle Scholar
  15. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 31:1551–1558Google Scholar
  16. Kostrzewa–Janicka J, Śliwiński P, Wojda M, Rolski D, Mierzwińska- Nastalska E (2016) Mandibular advancement appliance for obstructive sleep apnea treatment. Adv Exp Med Biol 944:63–71CrossRefGoogle Scholar
  17. McGown AD, Makker HK, Battagel JM, Grant HR, Spiro SG (2001) Long term use of mandibular advancement splints for snoring and obstructive sleep apnea: a questionnaire survey. Eur Respir J 17(3):462–466CrossRefGoogle Scholar
  18. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163:1457–1461CrossRefGoogle Scholar
  19. Okuno K, Sato K, Arisaka T, Hosohama K, Gotoh M, Taga H (2014) The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: a systematic review and meta – analysis of randomised controlled trials. J Oral Rehabil 41:542–554CrossRefGoogle Scholar
  20. Petelle B, Vincent G, Gagnadoux F, Rakotonanahary B, Meyer B, Fleury B (2002) One-night mandibular advancement titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med 165(8):1150–1153CrossRefGoogle Scholar
  21. Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P (2008) Mandibular advancement appliance for obstructive sleep apnea: results of a randomized placebo controlled trial using parallel group design. J Sleep Res 17:221–229CrossRefGoogle Scholar
  22. Pitsit AJ, Darendeliler M, Gotsopoulos H, Petocz P, Cistulli PA (2002) Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 166(6):860–864CrossRefGoogle Scholar
  23. Sharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, Quinnell TG (2016) Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnea-hypopnea. Sleep Med Rev 27:108–124CrossRefGoogle Scholar
  24. Smith DM, Stradling JR (2002) Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure? Thorax 579(4):305–308CrossRefGoogle Scholar
  25. Standards of Practice Committee of American Sleep Disorders Association (1995) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliance. Sleep 18:511–513CrossRefGoogle Scholar
  26. Tan YK, L’Estrange PR, Luo YM, Smith C, Grant HR, Simonds AK, Spiro SG, Battagel JM (2002) Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnea: a randomized cross-over trial. Eur J Orthod 24:239–249CrossRefGoogle Scholar
  27. Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235CrossRefGoogle Scholar
  28. Young K, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med 165(9):1217–1239CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • M. Wojda
    • 1
    Email author
  • J. Kostrzewa-Janicka
    • 1
  • P. Śliwiński
    • 2
  • P. Bieleń
    • 2
  • P. Jurkowski
    • 1
  • R. Wojda
    • 3
  • E. Mierzwińska-Nastalska
    • 1
  1. 1.Department of ProsthodonticsMedical University of WarsawWarsawPoland
  2. 2.Second Department of Respiratory MedicineInstitute of Tuberculosis and Lung DiseasesWarsawPoland
  3. 3.Department of Dental Propedeutics and ProphylaxisMedical University of WarsawWarsawPoland

Personalised recommendations