Original ArticleMandibular advancement appliances remain effective in lowering respiratory disturbance index for 2.5–4.5 years
Introduction
Although continuous positive airway pressure (CPAP) is the gold standard treatment for obstructive sleep apnea syndrome (OSAS), many studies have demonstrated the efficacy of the mandibular advancement appliance (MAA) in the management of mild to moderate OSAS [1], [2], [3], [4]. The MAA is now recognized as a first-line therapy option in the presence of snoring and mild to moderate OSAS with moderate symptoms [5].
The majority of long-term follow-up studies involving an MAA focus on tooth displacement and/or skeletal changes [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17]. Few studies on subjects with mild to moderate OSAS have reported long-term follow-up (from 1 to 5 years) on MAA efficiency in terms of reduced respiratory disturbance index (RDI), blood pressure, and cardiac rhythm, or improved subjective symptoms such as sleepiness, quality of life, sleep quality, and subject’s and bed partner’s satisfaction [18], [19], [20], [21], [22], [23], [24].
The aim of this follow-up study was to assess whether the previously reported [25] efficacy (RDI, physiological variables such as blood pressure and cardiac rhythm) and patient’s subjective appreciation (sleep quality, quality of life and symptoms) of the two MAA had remained stable, improved, or deteriorated over time.
Section snippets
Subjects
Of the 16 subjects who participated in a previous controlled study comparing two MAA in a randomized cross-over design [25], 15 were still using the MAA they preferred at the end of the previous comparative study and were available for a clinical follow-up. Subjects signed an informed consent form approved by our hospital’s Institutional Ethics Review Board. One refused and 14 agreed to participate in a single night of polygraphic recording. The 14 subjects (4 women, 10 men) had a mean age of
RDI, oxymetry and blood pressure
RDI remained low at the follow-up night recording compared to baseline (p < 0.001) with no significant difference from the night at the end of the previous comparative study (p = 0.2) (Fig. 1, Table 1).
We also observed that 10 of the 14 subjects suffered from positional sleep apnea at the baseline night. This ratio was reduced to 8/14 at the end of the previous comparative study and 6/14 at the follow-up. We then decided to assess positional RDI. RDI in supine position was reduced from the baseline
Discussion
This follow-up study confirms that both the Klearway and the Silencer remained effective in reducing RDI at the end of the previous comparative study. In the long term, and on average, subjects with mild OSAS showed stable RDI and improvements in both total and supine indexes.
Among the positive outcomes were the reduction in percentage of REM sleep and increased stage 3–4 sleep. The negative outcomes were reduced TST with consequent reduced sleep efficiency. The reduced total sleep time and
Conclusion
The results of this study show that both types of MAA are indicated in the long-term management of mild to moderate OSAS. Improvements in RDI, subjective symptoms, quality of life and sleep, systolic and diastolic blood pressure, and cardiac rhythm were observed in relation to a BMI increase, and further assessment is needed.
Conflict of interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: doi:10.1016/j.sleep.2011.05.004.
Acknowledgments
The authors would like to thank Christiane Manzini, Carmen Remo and the entire staff at the Laboratoire de sommeil du Centre de Santé et des Services Sociaux de Chicoutimi (particularly Anny Blackburn, Nadya Michaud, Hélène Bouchard, Marie-Claude Godin, Marie-Christine Duchesne and Julie Gaudreault) for technical support. We would also like to thank CIHR (Grant to Dr. Gilles Lavigne), the Fond de l’Ordre des dentists du Québec-FRSQ, the Ministère des Transports du Québec and Sogedent for
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