Mandibular advancement device in patients with obstructive sleep apnea : long-term effects on apnea and sleep

• Published in: Chest Vol. 120; no. 1; p. 162
• Main Authors: Marklund, M, Sahlin, C, Stenlund, H, Persson, M, Franklin, K A
• Format: Journal Article
• Language: English
• Published: United States 01-07-2001
• Subjects: Activator Appliances; Adult; Aged; Female; Follow-Up Studies; Humans; Male; Mandibular Advancement - instrumentation; Middle Aged; Polysomnography; Sleep Apnea, Obstructive - physiopathology; Sleep Apnea, Obstructive - therapy; Treatment Outcome
• ISSN: 0012-3692
• DOI: 10.1378/chest.120.1.162

To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement device in patients with obstructive sleep apnea.
Prospective study.
Department of Respiratory Medicine, University Hospital, Umeå, Sweden.
Thirty-three consecutively treated patients.
Individually adjusted mandibular advancement devices.
Polysomnographic sleep recordings on 1 night without the device and 1 night with the device were performed after 0.7 +/- 0.5 years (mean +/- SD) and after 5.2 +/- 0.4 years from the start of treatment. Nineteen of the 33 patients experienced a short-term satisfactory treatment result with an apnea-hypopnea index of < 10 events per hour and a satisfactory reduction in snoring. Fourteen patients were regarded as being insufficiently treated with the device. Seventeen of the short-term satisfactorily treated patients (90%) and 2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 +/- 17 to 4.9 +/- 5.1 events per hour (p < 0.001) in these 19 long-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients. Patients with their devices replaced or adjusted experienced a better long-term effect than patients still using their original devices (p < 0.05).
The long-term effect and tolerability of a mandibular advancement device are good in patients who are recommended the treatment on the basis of a short-term sleep recording, provided that the device is continuously adjusted or replaced with a new one when needed. A short-term follow-up is valuable in the selection of patients who will benefit from long-term treatment with a mandibular advancement device.