Mandibular Advancement Devices in Obstructive Sleep Apnea Patients Intolerant to Continuous Positive Airway Pressure Treatment
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.
KeywordsAirways 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.
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 written consent was obtained from all individual participants included in the study.
- Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 31:1551–1558Google Scholar
- 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
- 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