Mandibular Advancement Device in Patients With Obstructive Sleep Apnea: Long-term Effects on Apnea and Sleep

doi:10.1378/chest.120.1.162

Chest

Volume 120, Issue 1, July 2001, Pages 162-169

https://doi.org/10.1378/chest.120.1.162 Get rights and content

Study objectives

To evaluate the long-term effects onapneas and sleep and the tolerability of a mandibular advancementdevice in patients with obstructive sleep apnea.

Design

Prospective study.

Setting

Department of Respiratory Medicine, University Hospital, Umeå, Sweden.

Patients

Thirty-three consecutively treatedpatients.

Interventions

Individually adjustedmandibular advancement devices.

Measurements andresults

Polysomnographic sleep recordings on 1 night without thedevice and 1 night with the device were performed after 0.7 ± 0.5years (mean ± SD) and after 5.2 ± 0.4 years from the start oftreatment. Nineteen of the 33 patients experienced a short-termsatisfactory treatment result with an apnea-hypopnea index of < 10events per hour and a satisfactory reduction in snoring. Fourteenpatients were regarded as being insufficiently treated with the device. Seventeen of the short-term satisfactorily treated patients (90%) and2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 ± 17 to4.9 ± 5.1 events per hour (p < 0.001) in these 19 long-termtreatment patients, which did not differ from what was found at theshort-term follow-up visits in these patients. Patients with theirdevices replaced or adjusted experienced a better long-term effect thanpatients still using their original devices (p < 0.05).

Conclusions

The long-term effect and tolerability of amandibular advancement device are good in patients who are recommendedthe treatment on the basis of a short-term sleep recording, providedthat the device is continuously adjusted or replaced with a new onewhen needed. A short-term follow-up is valuable in the selection ofpatients who will benefit from long-term treatment with a mandibularadvancement device.

Section snippets

Subjects

Thirty-three consecutive patients who received treatment with mandibular advancement devices from September 1989 until March 1994 were included in the study. The patients suffered from mild sleep apnea or more severe disease and were unable to tolerate treatment with nasal continuous positive airway pressure. There were 29 men and 4 women aged 52 ± 11 years (mean ± SD) at the onset of treatment. Approval for the participation of the patients in the study was obtained from the Medical Ethics

Results

Thirty-three patients with obstructive sleep apnea were evaluated for the short-term effects of a mandibular advancement device on apneas and sleep. Nineteen of the 33 patients were still using their mandibular advancement devices at the long-term follow-up visit after 5.2 ± 0.4 years (range, 4.5 to 6.1 years) and reported that they had used their devices for 50 to 90% of the nights since the onset of treatment. There were 17 men and 2 women among these long-term treatment patients. The age of

Discussion

At the long-term follow-up visit, the apnea-hypopnea index was reduced from 22 ± 17 events per hour without the device to 4.9 ± 5.1 events per hour with the device in 19 patients with sleep apnea who received treatment with mandibular advancement devices for 5.2 ± 0.4 years. This result was similar to the findings at the short-term follow-up visit after 0.7 ± 0.5 years. Patients who had replaced or adjusted their devices during the study period experienced a better apnea reduction at the

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Mandibular repositioning device (MRD) therapy is an alternative to continuous positive airway pressure (CPAP). The Orkney Complex Disease Study-ORCADES study is assessing the long-term efficacy and tolerability of MRD therapy in obstructive sleep apnoea syndrome (OSAS); two-year follow-up data are presented.
OSAS patients who refused or were noncompliant with CPAP were fitted with a custom-made computer-aided design/computer-aided manufacturing (CAD/CAM) bi-block MRD (ResMed, Narval CC™); mandibular advancement was individually titrated. Sleep and respiratory parameters were determined at baseline, 3–6 months, and two years. The primary endpoint was treatment success (percentage of patients achieving a ≥50% reduction in the apnoea-hypopnoea index [AHI]).
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The study was conducted at the Sleep Laboratory at the Departmentof Respiratory Medicine, University Hospital, Umeå, Sweden.

Support was provided by grants from the Swedish Association for Heartand Lung Patients and the Swedish Dental Society.

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Chest

Clinical InvestigationsSleep and BreathingMandibular Advancement Device in Patients With Obstructive Sleep Apnea: Long-term Effects on Apnea and Sleep

Study objectives

Design

Setting

Patients

Interventions

Measurements andresults

Conclusions

Section snippets

Subjects

Results

Discussion

Am J Orthod Dentofacial Orthop

Chest

Chest

Chest

Chest

Chest

Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea

Am J Respir Crit Care Med

Oral appliances for the treatment of snoring and obstructive sleep apnea: a review

Sleep

A short term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea

Thorax

Mandibular morphology and the efficacy of a mandibular advancement device in patients with sleep apnoea

Eur J Oral Sci

Mandibular advancement devices for the control of snoring

Eur Respir J

Clinical Investigations
Sleep and Breathing
Mandibular Advancement Device in Patients With Obstructive Sleep Apnea: Long-term Effects on Apnea and Sleep