Indian Journal of Sleep Medicine

Register      Login

VOLUME 11 , ISSUE 4 ( October-December, 2016 ) > List of Articles

ORIGINAL ARTICLE

Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea

Sunil Kumar, Mohit Sharma, B Jayan, Amit Kumar Bansal, Prasanna Kumar MP, Amrit Thapa

Keywords : MDSA, OSA, AHI, ESS

Citation Information : Kumar S, Sharma M, Jayan B, Bansal AK, MP PK, Thapa A. Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea. Indian Sleep Med 2016; 11 (4):151-160.

DOI: 10.5958/0974-0155.2016.00022.X

License: CC BY-SA 4.0

Published Online: 01-10-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: Medical Dental Sleep Appliance (MDSA) is an adjustable MAD recommended for treatment of snoring and OSA. There are very few studies on Indian population which evaluate the therapeutic efficacy of mandibular advancement devices in the management of OSA. Material and methods: A prospective clinical study was carried out. 20 Polysomnography diagnosed Obstructive Sleep Apnea patients fulfilling the inclusion and exclusion criteria were treated with MDSA and changes in pre and post treatment sleep parameters (AHI, ESS) were recorded. Results: Mean differences in Pre-treatment (T1 = 30.7 ± 5.0) and post-treatment (T2 = 17.2 ± 3.9) AHI values and ESS pre-treatment (T1 = 17.2 ± 0.6) and post-treatment (T2 = 10.9 ± 0.9) were highly statistically significant (p < 0.001). Clinically the maximum improvement was observed in mild and moderate OSA cases. Although significant clinical improvement was also observed in severe OSA cases, the post treatment AHI and ESS were still high. Conclusion: MDSA is a non invasive, low risk and cost-effective treatment option for patients suffering from mild and moderate obstructive sleep apnea and also in cases of severe OSA who are not comfortable with CPAP or not willing for surgery.


PDF Share
  1. American Sleep Disorders Association Standard of Practice committee: Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep. 1995; 18(6): 511-3.
  2. Lowe AA. Dental appliances for snoring and Obstructive sleep apnea. In: Kryger M, Roth T, Dement W, editors. Principles and practice of sleep medicine. 3rd edition. Philadelphia: WB Saunders 2000; 929-39.
  3. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasalcontinuous positive airway pressure in the treatment of mildmoderate obstructive sleep apnea. Chest. 1996; 109:1269-75.
  4. Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest. 1996; 109:1477–88.
  5. Ferguson KA, Ono T, Lowe AA, Majed SA, Keenan SP, Love LL, et al. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax. 1997; 52:362-8.
  6. Jayan B, Prasad BNBM, Kamat UR, Kharbanda OP, Bhattacharrya D. Therapeutic efficacy of Thornton adjustable positioned in the management of patients with severe Obstructive sleep apnea: A Pilot study. Indian J Sleep Med. 2008; 3.3:97-101.
  7. Jayan B, Prasad BNBM, Rajput AK, Bhattacharya R, Dhiman RK. Management of Obstructive Sleep Apnea with Oral Appliances: Our Experience. Indian J Sleep Med. 2006; 1.4:204-7.
  8. Jayan B, Prasad BNBM, Dhiman RK. Role of Oral Appliances in the Management of Sleep Disorders. Med J Armed Forces India. 2009; 65:123-7.
  9. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999; 22(5):667-89.
  10. Lim J, Lasserson TJ, Fleetham J, Wright JJ. Oral appliances for obstructive sleep apnoea. Cochrane Database of Systematic Reviews. 2006, Issue 1. Art. No.: CD004435. DOI: 10.1002/14651858.
  11. 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.
  12. American Academy of Sleep Medicine Practice Parameters for the Treatment of Snoring and Obstructive Sleep Apnea with Oral Appliances: An Update, 2005.
  13. Johal A. A review on the use of mandibular advancement appliances in sleep disordered breathing. Dent Update. 2008; 35:230-5.
  14. Ichioka M, Tojo N, Yoshizawa M, Chida M, Miyazato I, Taniai S, et al. A dental device for the treatment of obstructive sleep apnea: a preliminary study. Otolaryngol Head Neck Surg. 1991; 104:555–8.
  15. Pepin JL, Leger P, Veale D. Side effects of nasal continuous positive airway pressure in sleep apnea syndrome. Study of 193 patients in two French sleep centers. Chest. 1995; 107:375- 81.
  16. Wilhelmsson B, Tegelberg Å, Walker- Engström ML, Ringqvist M, Andersson L, Krekmanov L, et al. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol. 1999; 119:503-9.
  17. Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest. 1999; 116:1511-8.
  18. Barthlen GM, Brown LK, Wiland MR, Sadeh JS, Patwari J, Zimmerman M. Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome. Sleep Med. 2000; 1(4):299-305.
  19. Gotsopoulos H, Chen C, Qian J, Cistulli PA. Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med. 2002; 166:743-8.
  20. Johnston CD, Gleadhill IC, Cinnamond MJ, Gabbey J, Burden DJ. Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial. Eur J Orthod. 2002; 24:251-62.
  21. Tan YK, L'Estrange PR, Luo YM, Smith C, Grant HR, Simonds AK. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod. 2002; 24:239-49.
  22. Engleman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL. Randomized crossover trial of two treatments for sleep apnea/ hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med. 2002; 166:855-9.
  23. Randerath WJ, Heise M, Hinz R, Ruehle KH. An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest. 2002; 122:569-75.
  24. Rose EC, Germann M, Sorchter S, Jonas IE. Case Control study in the treatment of Obstructive sleep disordered breathing with a mandibular protrusive appliance. J Orofac Orthop. 2004; 65:489-500.
  25. Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004; 170:656-64.
  26. Gotsopoulos H, Kelly JJ, Cistulli PA. Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep. 2004; 27(5):934-41.
  27. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest. 2004; 125:1270- 8.
  28. Izci B, McDonald JP, Coleman EL, Mackay TW, Douglas NJ, Engleman HM. Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint. Respir Med. 2005; 99:337-46.
  29. Vecchierini MF, Léger D, Laaban JP, Putterman G, Figueredo M, Levy J, et al. Efficacy and compliance of mandibular repositioning device in obstructive sleep apnea syndrome under a patient-driven protocol of care. Sleep Med. 2008; 9(7):762-9
  30. Aarab G, Lobbezoo F, Hamburger HL, NaeijeM.Oral Appliance Therapy versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: A Randomized, Placebo-Controlled Trial. Respiration. 2011; 81:411–9.
  31. Holley AB, Lettieri CJ, Shah AA. Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome. Chest. 2011; 140:1511-6.
  32. Vuorjoki-Ranta TR, Lobbezoo F, Tuomilehto H, Könönen M, Pihakari A, Ahlberg J. Mandibular Advancement Device Therapy in Obstructive Sleep Apnea and Snoring in Community Dental Care: Two-year Follow-up Study on Selfreported Sleep Quality, Side Effects, and Compliance. Sleep Disord Ther. 2014; 3:5, http://dx.doi.org/10.4172/2167- 0277.1000180.
  33. Ballanti F, Ranieri S, Baldini A, Cozza P. Long Term Therapeutic Efficacy of a Soft Monobloc Mandibular Advancement Device in Adults with Obstructive Sleep. Scientific World Journal. 2015, Article ID 408469, http:// dx.doi.org/10.1155/2015/408469.
  34. Banno K, Kryger MH. Sleep apnea: clinical investigations in humans. Sleep Med. 2007; 8:400-26.
  35. Tsuchiya M, Lowe AA, Pae EK, Fleetham JA. Obstructive sleep apnoea subtypes by cluster analysis. Am J Orthod DentofacOrthop. 1992; 101:533-42.
  36. Mayer P, Pépin JL, Bettega G, Veale D, Ferretti G, Deschaux C, et al. Relationship between body mass index, age and upper airway measurements in snorersand sleep apnoea patients. Eur Respir J. 1996; 9:1801–9.
  37. Kumar PVG, M Bhatia, M Tripathi, AK Srivastava, S Jain. Obstructive sleep apnoea: a case controlled study. Neurology India. 2003; 51(4):497-9.
  38. Lee RW, Chan AS, Grunstein RR, Cistulli PA. Craniofacial phenotyping in obstructive sleep apnoea – A novel quantitative photographic approach. Sleep. 2009; 32(1):37-45.
  39. Johnston CD, Gleadhill IC, Cinnamond MJ, Peden MW. Oral appliances for management of snoring: a randomized controlled trial. Eur J Orthod. 2001; 23:127-34.
  40. Sharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, et al. Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Sleep Medicine Reviews. 2015; http://dx.doi.org/10.1016/ j.smrv.2015.05.003.
  41. Pantin CC, Hillman DR, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea. Sleep. 1999; 22(2):237-40.
  42. Fritsch KM, Iseli A, Russi EW, Bloch KE. Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med. 2001; 164:813-8.
  43. Bondemark L, Lindman R. Craniomandibular status and function in patients with habitual snoring and obstructive sleep apnoea after nocturnal treatment with a mandibular advancement splint: a 2-year follow-up. Eur J Orthod. 2000; 22:53-60.
  44. Almeida FR, Lowe AA, Sung JO, Tsuiki S, Otsuka R. Longterm sequelae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis. Am J Orthod DentofacialOrthop. 2006; 129:195-204.
  45. Marklund M, Franklin KA, Persson M. Orthodontic sideeffects of mandibular advancement devices during treatment of snoring and sleep apnoea. Eur J Orthod. 2001; 23:135- 44.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.