Skip to main content
SpringerLink
Log in

Mandibular Advancement Devices in Obstructive Sleep Apnea Patients Intolerant to Continuous Positive Airway Pressure Treatment

  • Chapter
  • First Online:
Pulmonary Health and Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((NR,volume 1150))

Abstract

Obstructive sleep apnea (OSA) is defined as episodes of upper airway obstruction occurring during sleep. Conservative treatment of OSA consists of continuous positive airway pressure (CPAP). An alternative treatment in mild-to-moderate OSA could be the use of intraoral mandibular advancement devices (MAD). The aim of this study was to evaluate therapeutic efficacy of MAD in OSA patients intolerant to CPAP. The study group included 8 patients, who fulfilled specific inclusion criteria during a dental examination, out of the 30 CPAP intolerant patients who were referred for the possible use of MAD. The selected patients used MAD for 30 days and then switched to CPAP for 10 days to compare the effectiveness of both treatment methods. They had 3 polysomnographic (PSG) examination: baseline before treatment, and at the end of MAD and CPAP. We found that either treatment method resulted in comparable symptomatic improvements in OSA patients. In detail, the apnea-hypopnea index decreased, along with the overall number of obstructive, central, and mixed apneic episodes during sleep time. The mean arterial oxygen saturation (SaO2) improved and the minimum SaO2 level noted during night time got enhanced. Differences in the sleep apnea indices after MAD and CPAP treatments were insignificant, but there was a consistent impression that CPAP was superior to MAD as it tended to improve symptoms to a somehow greater extent. We conclude that MAD is a sufficiently effective treatment alternative for OSA patients who are intolerant to CPAP or in whom CPAP therapy fails.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Aarab G, Lobbezzo F, Hamburger HL, Naeije M (2009) Variability in the apnea- hypopnea index and its consequences for diagnosis and therapy evaluation. Respiration 77:32–37

    Article  Google Scholar 

  • Aarab G, Lobbezzo F, Hamburger HL, Naeije M (2011) Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea; a randomized, placebo-controlled trial. Respiration 81:411–419

    Article  Google Scholar 

  • AASM (1999) American Academy of Sleep Medicine Task Force Report. Sleep–related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689

    Article  Google Scholar 

  • Barnes MR, McEvoy D, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664

    Article  Google Scholar 

  • Bernhold M, Bondemark L (1998) A magnetic appliance for treatment of snoring patients with and without obstructive sleep apnea. Am J Orthod Dentofac Orthop 113(2):144–155

    Article  CAS  Google Scholar 

  • Blanco J, Zamarron C, Abeleira Pazos MT, Lamela C, Suarez Quintanilla D (2005) Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome. Sleep Breath 9:20–25

    Article  CAS  Google Scholar 

  • Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJR, de Bont LGM, Stegenda B (2013) Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow- up. Sleep 36(9):1289–1296

    Article  Google Scholar 

  • Fergusson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA (1996) A randomized crossover study of an oral appliance versus nasal continuous positive airway pressure in the treatment of mild-moderate sleep apnea. Chest 109:1269–1275

    Article  Google Scholar 

  • Fritsch KM, Iseli A, Russi EW, Bloch KE (2001) Side effects of mandibular advancement devices for sleep apnea treatment. Am J Respir Crit Care Med 164(5):813–818

    Article  CAS  Google Scholar 

  • Gagnadoux F, Fleury B, Vielle B, Petelle B, Meslier N, N’Guyen XL, Trzepizur W, Racineux JL (2009) Titrated mandibular advancement versus positive airway pressure for sleep apnea. Eur Respir J 34:914–920

    Article  CAS  Google Scholar 

  • Gotsopoulos H, Chen C, Quian J, Cistulli PA (2002) Oral appliance therapy improves symptoms in obstructive sleep apnea. Am J Respir Crit Care Med 166:743–748

    Article  Google Scholar 

  • Hoffstein V (2007) Review of oral appliance for treatment of sleep-disordered breathing. Sleep Breath 11:1–22

    Article  Google Scholar 

  • Hudgel DW (1992) Mechanism of obstructive sleep apnea. Chest 101(2):541–549

    Article  CAS  Google Scholar 

  • Johal A, Bottegal JM (2001) Current principles in the management of obstructive sleep apnea with mandibular advancement appliances. Br Dent J 190(100):532–536

    Article  CAS  Google Scholar 

  • Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 31:1551–1558

    Google Scholar 

  • Kostrzewa–Janicka J, Śliwiński P, Wojda M, Rolski D, Mierzwińska- Nastalska E (2016) Mandibular advancement appliance for obstructive sleep apnea treatment. Adv Exp Med Biol 944:63–71

    Article  Google Scholar 

  • McGown AD, Makker HK, Battagel JM, Grant HR, Spiro SG (2001) Long term use of mandibular advancement splints for snoring and obstructive sleep apnea: a questionnaire survey. Eur Respir J 17(3):462–466

    Article  CAS  Google Scholar 

  • Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163:1457–1461

    Article  CAS  Google Scholar 

  • Okuno K, Sato K, Arisaka T, Hosohama K, Gotoh M, Taga H (2014) The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: a systematic review and meta – analysis of randomised controlled trials. J Oral Rehabil 41:542–554

    Article  CAS  Google Scholar 

  • Petelle B, Vincent G, Gagnadoux F, Rakotonanahary B, Meyer B, Fleury B (2002) One-night mandibular advancement titration for obstructive sleep apnea syndrome. Am J Respir Crit Care Med 165(8):1150–1153

    Article  Google Scholar 

  • Petri N, Svanholt P, Solow B, Wildschiodtz G, Winkel P (2008) Mandibular advancement appliance for obstructive sleep apnea: results of a randomized placebo controlled trial using parallel group design. J Sleep Res 17:221–229

    Article  Google Scholar 

  • Pitsit AJ, Darendeliler M, Gotsopoulos H, Petocz P, Cistulli PA (2002) Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 166(6):860–864

    Article  Google Scholar 

  • Sharples LD, Clutterbuck-James AL, Glover MJ, Bennett MS, Chadwick R, Pittman MA, Quinnell TG (2016) Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnea-hypopnea. Sleep Med Rev 27:108–124

    Article  Google Scholar 

  • Smith DM, Stradling JR (2002) Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure? Thorax 579(4):305–308

    Article  Google Scholar 

  • Standards of Practice Committee of American Sleep Disorders Association (1995) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliance. Sleep 18:511–513

    Article  Google Scholar 

  • Tan YK, L’Estrange PR, Luo YM, Smith C, Grant HR, Simonds AK, Spiro SG, Battagel JM (2002) Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnea: a randomized cross-over trial. Eur J Orthod 24:239–249

    Article  CAS  Google Scholar 

  • Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S (1993) The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 328:1230–1235

    Article  CAS  Google Scholar 

  • Young K, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med 165(9):1217–1239

    Article  Google Scholar 

Download references

Conflicts of Interest

The authors declare no conflicts of interest in relation to this article.

Ethical Approval

The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw, Poland (permit no. KB/65/2015). All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Informed Consent

Informed written consent was obtained from all individual participants included in the study.

Author information

Authors and Affiliations

  1. Department of Prosthodontics, Medical University of Warsaw, Warsaw, Poland

    M. Wojda, J. Kostrzewa-Janicka, P. Jurkowski & E. Mierzwińska-Nastalska

  2. Second Department of Respiratory Medicine, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland

    P. Śliwiński & P. Bieleń

  3. Department of Dental Propedeutics and Prophylaxis, Medical University of Warsaw, Warsaw, Poland

    R. Wojda

Authors
  1. M. Wojda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Kostrzewa-Janicka
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. P. Śliwiński
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Bieleń
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Jurkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. Wojda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. E. Mierzwińska-Nastalska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Wojda .

Editor information

Editors and Affiliations

  1. Opole Medical School, Opole, Poland

    Mieczyslaw Pokorski

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Wojda, M. et al. (2018). Mandibular Advancement Devices in Obstructive Sleep Apnea Patients Intolerant to Continuous Positive Airway Pressure Treatment. In: Pokorski, M. (eds) Pulmonary Health and Disorders. Advances in Experimental Medicine and Biology(), vol 1150. Springer, Cham. https://doi.org/10.1007/5584_2018_275

Download citation

Publish with us

Policies and ethics

Search

Navigation