Therapeutic Efficacy of Mandibular Advancement Devices in Patients with Severe Sleep Apnea: A Preliminary Report

Overview

Journal Adv Exp Med Biol

Specialties Biology
General Medicine

Date 2017 Oct 7

PMID 28983863

Authors

M Wojda

J Kostrzewa-Janicka

P Bielen

P Jurkowski

E Mierzwinska-Nastalska

Affiliations

Soon will be listed here.

Abstract

Obstructive sleep apnea (OSA) is defined as episodes of upper airway obstructions during sleep. The method of choice in conservative treatment of OSA is the use of devices that produce positive airway pressure (CPAP). In patients with mild-moderate form of OSA, intraoral mandibular advancement devices (MAD) are applied. The aim of the study was to evaluate the therapeutic efficacy of MAD in patients with severe OSA who were unable to use CPAP. In this preliminary study three patients from a group of 25 severe OSA sufferers who failed to use CPAP, were included. The three patients underwent a triple polysomnographic (PSG) investigation: on CPAP, before MAD treatment, and during MAD. The patients completed the Epworth Sleepiness Scale questionnaire twice. We found significant improvements of subjective symptoms and PSG-evaluated variables after application of MAD in all three patients in comparison with both baseline and CPAP-recorded data. We conclude that MAD can be an alternative treatment option for severe OSA patients who are non-compliant with CPAP therapy.

References

Aarab G, Lobbezoo F, Hamburger H, Naeije M . Variability in the apnea-hypopnea index and its consequences for diagnosis and therapy evaluation. Respiration. 2008; 77(1):32-7. DOI: 10.1159/000167790. View

Aarab G, Lobbezoo F, Hamburger H, Naeije M . Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration. 2010; 81(5):411-9. DOI: 10.1159/000319595. View

Barnes M, McEvoy R, Banks S, Tarquinio N, Murray C, Vowles N . Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004; 170(6):656-64. DOI: 10.1164/rccm.200311-1571OC. View

Bixler E, Vgontzas A, ten HAVE T, Tyson K, Kales A . Effects of age on sleep apnea in men: I. Prevalence and severity. Am J Respir Crit Care Med. 1998; 157(1):144-8. DOI: 10.1164/ajrccm.157.1.9706079. View

Blanco J, Zamarron C, Abeleira Pazos M, Lamela C, Suarez Quintanilla D . Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath. 2005; 9(1):20-5. DOI: 10.1007/s11325-005-0003-4. View

Carra M, Bruni O, Huynh N . Topical review: sleep bruxism, headaches, and sleep-disordered breathing in children and adolescents. J Orofac Pain. 2012; 26(4):267-76. View

Doff M, Hoekema A, Wijkstra P, van der Hoeven J, Huddleston Slater J, de Bont L . Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep. 2013; 36(9):1289-96. PMC: 3738037. DOI: 10.5665/sleep.2948. View

Fritsch K, Iseli A, Russi E, Bloch K . Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med. 2001; 164(5):813-8. DOI: 10.1164/ajrccm.164.5.2003078. View

Gagnadoux F, Fleury B, Vielle B, Petelle B, Meslier N, NGuyen X . Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009; 34(4):914-20. DOI: 10.1183/09031936.00148208. View

10.

Gotsopoulos H, Chen C, Qian J, Cistulli P . Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. Am J Respir Crit Care Med. 2002; 166(5):743-8. DOI: 10.1164/rccm.200203-208OC. View

11.

Hoffstein V . Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2006; 11(1):1-22. PMC: 1794626. DOI: 10.1007/s11325-006-0084-8. View

12.

Johal A, Battagel J . Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances. Br Dent J. 2001; 190(10):532-6. DOI: 10.1038/sj.bdj.4801025. View

13.

Kostrzewa-Janicka J, Sliwinski P, Wojda M, Rolski D, Mierzwinska-Nastalska E . Mandibular Advancement Appliance for Obstructive Sleep Apnea Treatment. Adv Exp Med Biol. 2016; 944:63-71. DOI: 10.1007/5584_2016_61. View

14.

McGown A, Makker H, Battagel J, LEstrange P, Grant H, Spiro S . Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey. Eur Respir J. 2001; 17(3):462-6. DOI: 10.1183/09031936.01.17304620. View

15.

Mehta A, Qian J, Petocz P, Darendeliler M, Cistulli P . A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med. 2001; 163(6):1457-61. DOI: 10.1164/ajrccm.163.6.2004213. View

16.

Okuno K, Sato K, Arisaka T, Hosohama K, Gotoh M, Taga H . 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. 2014; 41(7):542-54. DOI: 10.1111/joor.12162. View

17.

Petelle B, Vincent G, Gagnadoux F, Rakotonanahary D, Meyer B, Fleury B . One-night mandibular advancement titration for obstructive sleep apnea syndrome: a pilot study. Am J Respir Crit Care Med. 2002; 165(8):1150-3. DOI: 10.1164/ajrccm.165.8.2108056. View

18.

Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P . Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design. J Sleep Res. 2008; 17(2):221-9. DOI: 10.1111/j.1365-2869.2008.00645.x. View

19.

Phillips C, Grunstein R, Darendeliler M, Mihailidou A, Srinivasan V, Yee B . Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2013; 187(8):879-87. DOI: 10.1164/rccm.201212-2223OC. View

20.

Sharples L, Clutterbuck-James A, Glover M, Bennett M, Chadwick R, Pittman M . Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Sleep Med Rev. 2015; 27:108-24. PMC: 5378304. DOI: 10.1016/j.smrv.2015.05.003. View