Sleep and Breathing

, Volume 18, Issue 2, pp 305–311 | Cite as

Influencing factors on the effect of mandibular advancement device in obstructive sleep apnea patients: analysis on cephalometric and polysomnographic parameters

  • Young-Kyun Kim
  • Jeong-Whun Kim
  • In-Young Yoon
  • Chae Seo Rhee
  • Chul Hee Lee
  • Pil-Young Yun
Original Article



The purposes of this study were to evaluate clinical outcome of mandibular advancement device (MAD) for obstructive sleep apnea (OSA) patients and to estimate influencing factors on MAD effect.


From the patients who were diagnosed as OSA by polysomnography at Seoul National University Bundang Hospital from January 2007 to February 2009, the patients who chose MAD as initial treatment option were included. All the patients' data were collected by reviewing and analyzing medical record and radiograph retrospectively.


Eighty-six patients (76 males and 10 females; mean age of 51.5 ± 9.8 years) with OSA were included in this study. Total success rate of MAD treatment was 47.7 % (41/86 patients). Among cephalometric parameters, lower facial height (35.61 ± 4.26 vs. 38.19 ± 4.89) showed significant difference between success group and non-success group. From the polysomnographic parameters, apnea index (19.79 ± 17.32 vs. 30.08 ± 23.28), average oxygen saturation (95.03 ± 1.42 vs. 94.32 ± 1.56), lowest oxygen saturation (81.44 ± 6.64 vs. 76.87 ± 7.98), oxygen saturation under 90 % (4.47 ± 5.90 vs. 9.01 ± 9.29), and oxygen desaturation index (23.58 ± 17.46 vs. 37.16 ± 22.35) showed significant difference between groups.


From the results, it was proved that MAD was an effective treatment option for the OSA patients. Some cephalometric and polysomnographic parameters including posterior lower facial height, apnea index, average oxygen saturation, lowest oxygen saturation, oxygen saturation under 90 %, and oxygen desaturation index could be influencing factors on MAD effect.


Obstructive sleep apnea Mandibular advancement device Cephalometry Polysomnography 


  1. 1.
    The Report of an American Academy of Sleep Medicine Task Force (1999) Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Sleep 22(5):667–689Google Scholar
  2. 2.
    Redline S, Strohl KP (1998) Recognition and consequences of obstructive sleep apnea hypopnea syndrome. Clin Chest Med 19(1):1–19PubMedCrossRefGoogle Scholar
  3. 3.
    Strollo PJ Jr, Rogers RM (1996) Obstructive sleep apnea. N Engl J Med 334(2):99–104PubMedCrossRefGoogle Scholar
  4. 4.
    George CF (2001) Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP. Thorax 56(7):508–512PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Schafer H, Ewig S, Hasper E, Luderitz B (1997) Predictive diagnostic value of clinical assessment and nonlaboratory monitoring system recordings in patients with symptoms suggestive of obstructive sleep apnea syndrome. Respiration 64(3):194–199PubMedCrossRefGoogle Scholar
  6. 6.
    Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev (1):CD001106Google Scholar
  7. 7.
    McNamara JA, Howe RP (1988) Clinical management of the acrylic splint Herbst appliance. Am J Orthod Dentofacial Orthop 94(2):142–149PubMedCrossRefGoogle Scholar
  8. 8.
    Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29(2):240–243PubMedGoogle Scholar
  9. 9.
    Ng AT, Gotsopoulos H, Qian J, Cistulli PA (2003) Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 168(2):238–241PubMedCrossRefGoogle Scholar
  10. 10.
    Lee YH, Johan A, Wong KK, Edwards N, Sullivan C (2009) Prevalence and risk factors for obstructive sleep apnea in a multiethnic population of patients presenting for bariatric surgery in Singapore. Sleep Med 10(2):226–232PubMedCrossRefGoogle Scholar
  11. 11.
    Coleman RM, Roffwarg HP, Kennedy SJ, Guilleminault C, Cinque J, Cohn MA, Karacan I, Kupfer DJ, Lemmi H, Miles LE, Orr WC, Phillips ER, Roth T, Sassin JF, Schmidt HS, Weitzman ED, Dement WC (1982) Sleep-wake disorders based on a polysomnographic diagnosis. A national cooperative study. JAMA 247(7):997–1003PubMedCrossRefGoogle Scholar
  12. 12.
    Collop NA, Anderson WM, Boehlecke B, Claman D, Goldberg R, Gottlieb DJ, Hudgel D, Sateia M, Schwab R (2007) Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine. J Clin Sleep Med 3(7):737–747PubMedGoogle Scholar
  13. 13.
    Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ (1989) The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res 28(2):193–213PubMedCrossRefGoogle Scholar
  14. 14.
    Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14(6):540–545PubMedGoogle Scholar
  15. 15.
    Schwartz AR, Gold AR, Schubert N, Stryzak A, Wise RA, Permutt S, Smith PL (1991) Effect of weight loss on upper airway collapsibility in obstructive sleep apnea. Am Rev Respir Dis 144(3 Pt 1):494–498PubMedCrossRefGoogle Scholar
  16. 16.
    Ogawa T, Enciso R, Shintaku WH, Clark GT (2007) Evaluation of cross-section airway configuration of obstructive sleep apnea. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 103(1):102–108PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Johal A, Gill G, Ferman A, McLaughlin K (2007) The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea. Clin Physiol Funct Imaging 27(1):47–53PubMedCrossRefGoogle Scholar
  18. 18.
    Ash SP, Smith AM (2004) Chrome cobalt mandibular advancement appliances for managing snoring and obstructive sleep apnea. J Orthod 31(4):295–299PubMedCrossRefGoogle Scholar
  19. 19.
    Hoekema A, Hovinga B, Stegenga B, De Bont LG (2003) Craniofacial morphology and obstructive sleep apnoea: a cephalometric analysis. J Oral Rehabil 30(7):690–696PubMedCrossRefGoogle Scholar
  20. 20.
    Lowe AA, Gionhaku N, Takeuchi K, Fleetham JA (1986) Three-dimensional CT reconstructions of tongue and airway in adult subjects with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 90(5):364–374PubMedCrossRefGoogle Scholar
  21. 21.
    Lowe AA, Fleetham JA, Adachi S, Ryan CF (1995) Cephalometric and computed tomographic predictors of obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop 107(6):589–595PubMedCrossRefGoogle Scholar
  22. 22.
    Chan AS, Cistulli PA (2009) Oral appliance treatment of obstructive sleep apnea: an update. Curr Opin Pulm Med 15(6):591–596PubMedCrossRefGoogle Scholar
  23. 23.
    Ahrens A, McGrath C, Hagg U (2011) A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod 33(3):318–324PubMedCrossRefGoogle Scholar
  24. 24.
    Cozza P, Polimeni A, Ballanti F (2004) A modified monobloc for the treatment of obstructive sleep apnoea in paediatric patients. Eur J Orthod 26(5):523–530PubMedCrossRefGoogle Scholar
  25. 25.
    Lawton HM, Battagel JM, Kotecha B (2005) A comparison of the Twin Block and Herbst mandibular advancement splints in the treatment of patients with obstructive sleep apnoea: a prospective study. Eur J Orthod 27(1):82–90PubMedCrossRefGoogle Scholar
  26. 26.
    Bloch KE, Iseli A, Zhang JN, Xie X, Kaplan V, Stoeckli PW, Russi EW (2000) A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med 162(1):246–251PubMedCrossRefGoogle Scholar
  27. 27.
    Rose E, Staats R, Virchow C, Jonas IE (2002) A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod 24(2):191–198PubMedCrossRefGoogle Scholar
  28. 28.
    Kushida CA, Littner MR, Hirshkowitz M, Morgenthaler TI, Alessi CA, Bailey D, Boehlecke B, Brown TM, Coleman J Jr, Friedman L, Kapen S, Kapur VK, Kramer M, Lee-Chiong T, Owens J, Pancer JP, Swick TJ, Wise MS (2006) Practice parameters for the use of continuous and bilevel positive airway pressure devices to treat adult patients with sleep-related breathing disorders. Sleep 29(3):375–380PubMedGoogle Scholar
  29. 29.
    Henke KG, Frantz DE, Kuna ST (2000) An oral elastic mandibular advancement device for obstructive sleep apnea. Am J Respir Crit Care Med 161(2 Pt 1):420–425PubMedCrossRefGoogle Scholar
  30. 30.
    Eveloff SE (2002) Treatment of obstructive sleep apnea: no longer just a lot of hot air. Chest 121(3):674–677PubMedCrossRefGoogle Scholar
  31. 31.
    Liu Y, Lowe AA, Fleetham JA, Park YC (2001) Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 120(6):639–647PubMedCrossRefGoogle Scholar
  32. 32.
    Otsuka R, Almeida FR, Lowe AA, Ryan F (2006) A comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea. Am J Orthod Dentofacial Orthop 129(2):222–229PubMedCrossRefGoogle Scholar
  33. 33.
    Marklund M, Stenlund H, Franklin KA (2004) Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 125(4):1270–1278PubMedCrossRefGoogle Scholar
  34. 34.
    Ng AT, Darendeliler MA, Petocz P, Cistulli PA (2012) Cephalometry and prediction of oral appliance treatment outcome. Sleep Breath 16(1):47–58PubMedCrossRefGoogle Scholar
  35. 35.
    Lowe AA (2002) Principles of oral appliance therapy for the management of sleep disordered breathing. Oral Maxillofac Surg Clin North Am 14(3):305–317PubMedCrossRefGoogle Scholar
  36. 36.
    Ingman T, Nieminen T, Hurmerinta K (2004) Cephalometric comparison of pharyngeal changes in subjects with upper airway resistance syndrome or obstructive sleep apnoea in upright and supine positions. Eur J Orthod 26(3):321–326PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Young-Kyun Kim
    • 1
  • Jeong-Whun Kim
    • 2
  • In-Young Yoon
    • 3
  • Chae Seo Rhee
    • 2
  • Chul Hee Lee
    • 2
  • Pil-Young Yun
    • 1
  1. 1.Department of Oral and Maxillofacial Surgery, Section of DentistrySeoul National University Bundang HospitalSeongnam-siSouth Korea
  2. 2.Department of OtorhinolaryngologySeoul National University Bundang HospitalSeongnamSouth Korea
  3. 3.Department of NeuropsychiatrySeoul National University Bundang HospitalSeongnamSouth Korea

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