Effects of Mandibular Advancement Devices on the Evolution of Obstructive Sleep Apnea

Overview

Journal Sleep Breath

Publisher Springer

Date 2024 Jan 5

PMID 38180684

Authors

Nessie Zhu

Guillaume Buiret

Affiliations

Soon will be listed here.

Abstract

Purpose: Mandibular advancement devices (MADs) are a treatment for obstructive sleep apnea (OSA). Titration is a necessary component of proper fitting of MADs, yet little is known about what happens at each step of the titration. The objectives of this study were to determine the clinical and paraclinical evolution of OSA at every mm of MAD advancement.

Methods: Volunteers were fitted with MADs set to 50% of maximum advancement. MAD clinical and paraclinical results were recorded at every additional mm-titration, including apnea-hypopnea index (AHI), as well as symptoms of sleepiness and fatigue.

Results: In 20 volunteers with OSA, the MAD had a significant effect on every polygraphic parameter at the onset of use. The mean AHI with MAD fell by 15.2/h (p < 0.001). The mean Epworth Sleepiness Score and Pichot Fatigue questionnaire with MAD fell by 2.0 (p = 0.0687) and 2.4 (p = 0.1073) respectively. There was no proportionality between clinical gains (drowsiness and fatigue) and AHI improvements.

Conclusions: MADs led to a significant improvement in AHI and other polygraphic parameters from the onset of use. The decrease of clinical symptoms (drowsiness and fatigue) was more complex to interpret because of the small decreases observed. The absence of concordance between AHI improvement and clinical symptoms was nevertheless objectively quantified and symptoms were alleviated with advancements. The findings suggest that it may be appropriate to use clinical symptoms as a main aim of titration, since the improvement in AHI is reached at the onset of MAD use.

References

Li W, Xiao L, Hu J . The comparison of CPAP and oral appliances in treatment of patients with OSA: a systematic review and meta-analysis. Respir Care. 2013; 58(7):1184-95. DOI: 10.4187/respcare.02245. View

Lim J, Lasserson T, Fleetham J, Wright J . Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev. 2006; (1):CD004435. PMC: 8080100. DOI: 10.1002/14651858.CD004435.pub3. View

Randerath W, Verbraecken J, Andreas S, Bettega G, Boudewyns A, Hamans E . Non-CPAP therapies in obstructive sleep apnoea. Eur Respir J. 2011; 37(5):1000-28. DOI: 10.1183/09031936.00099710. View

Vecchierini M, Leger D, Laaban J, Putterman G, Figueredo M, Levy J . Efficacy and compliance of mandibular repositioning device in obstructive sleep apnea syndrome under a patient-driven protocol of care. Sleep Med. 2007; 9(7):762-9. DOI: 10.1016/j.sleep.2007.09.007. View

Vecchierini M, Attali V, Collet J, dOrtho M, El Chater P, Kerbrat J . A custom-made mandibular repositioning device for obstructive sleep apnoea-hypopnoea syndrome: the ORCADES study. Sleep Med. 2015; 19:131-40. DOI: 10.1016/j.sleep.2015.05.020. View

Buiret G, Bechara M, Plouin-Gaudon I, Bavozet F, Dancea O, Pujo K . Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients. Laryngoscope. 2021; 131(6):E2089-E2096. DOI: 10.1002/lary.29439. View

Ferguson K, Cartwright R, Rogers R, Schmidt-Nowara W . Oral appliances for snoring and obstructive sleep apnea: a review. Sleep. 2006; 29(2):244-62. DOI: 10.1093/sleep/29.2.244. View

Clark G, Sohn J, Hong C . Treating obstructive sleep apnea and snoring: assessment of an anterior mandibular positioning device. J Am Dent Assoc. 2000; 131(6):765-71. DOI: 10.14219/jada.archive.2000.0275. View

Ng A, Gotsopoulos H, Qian J, Cistulli P . Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med. 2003; 168(2):238-41. DOI: 10.1164/rccm.200211-1275OC. View

10.

Serra-Torres S, Bellot-Arcis C, Montiel-Company J, Marco-Algarra J, Almerich-Silla J . Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review. Laryngoscope. 2015; 126(2):507-14. DOI: 10.1002/lary.25505. View

11.

Almeida F, Tsuiki S, Hattori Y, Takei Y, Inoue Y, Lowe A . Dose-dependent effects of mandibular protrusion on genioglossus activity in sleep apnoea. Eur Respir J. 2011; 37(1):209-12. DOI: 10.1183/09031936.00194809. View

12.

Dieltjens M, Vanderveken O, Van de Heyning P, Braem M . Current opinions and clinical practice in the titration of oral appliances in the treatment of sleep-disordered breathing. Sleep Med Rev. 2011; 16(2):177-85. DOI: 10.1016/j.smrv.2011.06.002. View

13.

Johns M . A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep. 1991; 14(6):540-5. DOI: 10.1093/sleep/14.6.540. View

14.

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

15.

Sawyer A, Gooneratne N, Marcus C, Ofer D, Richards K, Weaver T . A systematic review of CPAP adherence across age groups: clinical and empiric insights for developing CPAP adherence interventions. Sleep Med Rev. 2011; 15(6):343-56. PMC: 3202028. DOI: 10.1016/j.smrv.2011.01.003. View

16.

Engleman H, Wild M . Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS). Sleep Med Rev. 2003; 7(1):81-99. DOI: 10.1053/smrv.2001.0197. View

17.

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

18.

Lam B, Sam K, Mok W, Cheung M, Fong D, Lam J . Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax. 2006; 62(4):354-9. PMC: 2092459. DOI: 10.1136/thx.2006.063644. View

19.

Randerath W, Heise M, Hinz R, Ruehle K . An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest. 2002; 122(2):569-75. DOI: 10.1378/chest.122.2.569. View

20.

Marklund M, Verbraecken J, Randerath W . Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J. 2011; 39(5):1241-7. DOI: 10.1183/09031936.00144711. View