Skip to main content

Advertisement

SpringerLink
Log in

Effectiveness of a mandibular advancement device in obstructive sleep apnea patients: a prospective clinical trial

  • Miscellaneous
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to determine the effectiveness of a mandibular advancement device in a sample of obstructive sleep apnea syndrome patients by the evaluation of respiratory and neurophysiologic parameters and clinical symptoms. Second, the influence of certain predictor factors related with the patient and the intraoral device, were considered in the final response with this treatment option.

Methods

Forty-one patients constituted the final sample. Outcomes were measured using polysomnography, Epworth sleepiness scale and an analogue visual snoring scale, before treatment and once the device was properly titrated.

Results

Mean apnea–hypopnea index decreased from 22.5 ± 16.8 to 9.1 ± 11.6 (p ≤ 0.05), influencing only gender and Fujita index as predictor factors. The oxygen saturation, arousal index, percentages of sleep stages and sleep efficiency significantly improved with the mandibular advancement device (MAD) placement. The snoring index improved in absolute terms in 6.1 units and the excessive daytime sleepiness was reduced from 12.2 ± 4.7 to 8.5 ± 3.8 (p ≤ 0.00).

Conclusions

The successful treatment rate with the MAD was 65.8%. The placement and posterior regulation of the intraoral appliance efficiently reduced the apnea–hypopnea index, improved the sleep quality and the clinical symptomatology associated. Obstructive sleep apnea syndrome is a highly prevalent disease. and dentists should be aware of the benefits enhanced by this prosthetic device, considered the first treatment option by certain physicians.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165(9):1217–1239

    Article  PubMed  Google Scholar 

  2. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P (1993) A cause off excessive daytime sleepiness. The upper airway resistance syndrome. Chest 104(3):781–787

    Article  PubMed  CAS  Google Scholar 

  3. Punjabi NM (2008) The epidemiology of adult obstructive sleep apnea. Proc Am Thorac Soc 5(2):136–143

    Article  PubMed  PubMed Central  Google Scholar 

  4. 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(17):1230–1235

    Article  PubMed  CAS  Google Scholar 

  5. Young T, Finn L, Peppard PE, Szklo-Coxe M, Austin D, Nieto FJ, Stubbs R, Hla KM (2008) Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. Sleep 31(8):1071–1078

    PubMed  PubMed Central  Google Scholar 

  6. Wang X, Ouyang Y, Wang Z, Zhao G, Liu L, Bi Y (2013) Obstructive sleep apnea and risk of cardiovascular disease and all-cause mortality: a meta-analysis of prospective cohort studies. Int J Cardiol 169(3):207–214

    Article  PubMed  Google Scholar 

  7. Gordon P, Sanders MH (2005) Sleep.7: positive airway pressure therapy for obstructive sleep apnoea/hypopnoea syndrome. Thorax 60(1):68–75

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  8. Grote L, Hedner J, Grunstein R, Kraiczi H (2000) Therapy with nCPAP: incomplete elimination of sleep related breathing disorder. Eur Respir J 16(5):921–927

    Article  PubMed  CAS  Google Scholar 

  9. Vanderveken OM, Hoekema A (2010) How to treat patients that do not tolerate continuous positive airway pressure. Breathe 7:157–167

    Article  Google Scholar 

  10. Lloberes P, Durán-Cantolla J, Martínez-García M, Marín JM, Ferrer A, Corral J, Masa JF, Parra O, Alonso-Álvarez ML, Terán Santos J (2011) Diagnosis and treatment of sleep apnea-hypopnea síndrome. Spanish Society of Pulmonology and Thoracic Surgery. Arch Bronconeumol 47(3):143–156

    Article  PubMed  Google Scholar 

  11. Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 11(7):773–827

    PubMed  PubMed Central  Google Scholar 

  12. Sampol Rubio G, Macías Escalada E, Montserrat Canal JM, Terán Santos J (2017) Mandibular advancement devices in the treatment of obstructive sleep apnea. A necessary and effective option. Med Clin (Barc). https://doi.org/10.1016/j.medcli.2017.11.026. (Epub ahead of print)

    Article  Google Scholar 

  13. Cistulli PA, Gotsopoulos H, Marklund M, Lowe AA (2004) Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances. Sleep Med Rev 8(6):443–457

    Article  PubMed  Google Scholar 

  14. Milano F, Mondini S, Billi MC, Gobbi R, Gracco A, Sorrenti G (2013) The impact of a multidisciplinary approach on response rate of mandibular advancing device therapy in patients with obstructive sleep apnoea syndrome. Acta Othorhinolaryngol Ital 33(5):337–342

    CAS  Google Scholar 

  15. Esteller-Moré E, Moyano-Montero A, Segarra-Isern F, Amorós-Baixauli F, Matiño-Soler E, Prades-Morera E, Ademà-Alcover JM (2010) Mandibular advancement devices for the treatment of adult sleep respiratory disorders. Acta Otorrinolaringol Esp 61(4):293–300

    Article  PubMed  Google Scholar 

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

    Article  Google Scholar 

  17. Vroegop AV, Vanderveken OM, Dieltjens M, Wouters K, Saldien V, Braem MJ, Van de Heyning PH (2013) Sleep endoscopy with simulation bite for prediction of oral appliance treatment outcome. J Sleep Res 22(3):348–355

    Article  PubMed  Google Scholar 

  18. Lee CH, Kim JW, Lee HJ, Seo BS, Yun PY, Kim DY, Yoon IY, Rhee CS, Park JW, Mo JH (2010) Determinants of treatment outcome after use of the mandibular advancement device in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 136(7):677–681

    Article  PubMed  Google Scholar 

  19. Berry RB, Brooks R, Gamaldo CE et al (2015) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, version 2.2. http://www.aasment.org. Darien: American Academy of Sleep Medicine

  20. Johns MW (1991) A new method for measuring daytime sleepiness. Sleep 14(6):540–545

    Article  PubMed  CAS  Google Scholar 

  21. Berry RB, Budhiraja R, Gottlieb DJ, Gozal D, Iber C, Kapur VK, Marcus CL, Mehra R, Parthasarathy S, Quan SF, Redline S, Strohl KP, Davidson Ward SL, Tangredi MM; American Academy of Sleep Medicine (2012) Rules for scoring respiratory events in sleep: update of the 2007 AASM Manual for the scoring of sleep and associated events. Deliberations of the sleep apnea definitions task force of the American academy of sleep medicine. J Clin Sleep Med 8(5):597–619

    PubMed  PubMed Central  Google Scholar 

  22. American Academy of Sleep Medicine Atlas Task Force Report (1999) EEG arousals: scoring rules and examples. A preliminary report from the sleep disorders Atlas Task Force of the American Sleep Disorders Association. Sleep 15(2): 174–184

    Google Scholar 

  23. Kotecha BT, Hall AC (2014) Role of surgery in adult obstructive sleep apnoea. Sleep Med Rev 18(5):405–413

    Article  PubMed  Google Scholar 

  24. Fukuda T, Tsuiki S, Kobayashi M, Nakayama H, Inoue Y (2014) Selection of response criteria affects the success rate of oral appliance treatment for obstructive sleep apnea. Sleep Med 15(3):367–370

    Article  PubMed  Google Scholar 

  25. Sutherland K, Vanderveken OM, Tsuda H, Marklund M, Gagnadoux F, Kushida CA, Cistulli P (2014) Oral appliance treatment for obstructive sleep apnea: an update. J Clin Sleep Med 10(2):215–227

    PubMed  PubMed Central  Google Scholar 

  26. González Martinez M, Martinez Martinez MA, Puertas Cuesta FJ, Montserrat Canal JM (2015) Métodos para la evaluación clínica de los trastornos del sueño. In: Montserrat Canal JM. y Puertas Cuesta FJ (eds) Patología Básica del Sueño. Elsevier, Barcelona, pp 47–82

  27. Leite FG, Rodrigues RC, Ribeiro FR, Eckeli AL, Regalo SC, Sousa LG, Fernandes RM, Valera FC (2014) The use of a mandibular repositioning device for obstructive sleep apnea. Eur Arch Otorhinolaryngol 271(5):1023–1029

    Article  PubMed  Google Scholar 

  28. Raunio A, Mattila P, Huuskonen U, Oikarinen K, Sándor GK (2015) The influence of a mandibular advancement plate on polysomnography in different grades of obstructive sleep apnea. J Oral Maxillofac Res 6(1):e4

    Article  PubMed  PubMed Central  Google Scholar 

  29. Seehra J, Sherriff M, Winchester L (2014) Craniofacial characteristics of successful responders to mandibular advancement splint therapy: a pilot study. Br J Oral Maxillofac Surg 52(4):314–316

    Article  PubMed  Google Scholar 

  30. Kato J, Isono S, Tanaka A, Watanabe T, Araki D, Tanzawa H, Nishino T (2000) Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest 117(4):1065–1072

    Article  PubMed  CAS  Google Scholar 

  31. Aarab G, Lobbezoo F, Hamburger HL, Naeije M (2010) Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig 14(3):339–345

    Article  PubMed  Google Scholar 

  32. Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RW, Darendeliler MA, Cistulli PA (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65(8):726–732

    Article  PubMed  Google Scholar 

  33. Anitua E, Durán-Cantolla J, Almeida GZ, Alkhraisat MH (2017) Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea. Sleep Med 34:226–231

    Article  PubMed  Google Scholar 

  34. Banhiran W, Kittiphumwong P, Assanasen P, Chongkolwatana C, Metheetrairut C (2014) Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: outcomes and practicability. Laryngoscope 124(10):2427–2432

    Article  PubMed  Google Scholar 

  35. Randerath WJ, Heise M, Hinz R, Ruehle KH (2002) An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest 122(2):569–575

    Article  PubMed  Google Scholar 

  36. Campbell AJ, Reynolds G, Trengrove H, Neill AM (2009) Mandibular advancement splint titration in obstructive sleep apnoea. Sleep Breath 13(2):157–162

    Article  PubMed  CAS  Google Scholar 

  37. Lam B, Sam K, Mok WY, Cheung MT, Fong DY, Lam JC, Lam DC, Yam LY, Ip MS (2007) Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 62(4):354–359

    Article  PubMed  Google Scholar 

  38. Gauthier L, Laberge L, Beaudry M, Laforte M, Rompré PH, Lavigne GJ (2011) Mandibular advancement appliances remain effective in lowering respiratory disturbance index for 2.5–4.5 years. Sleep Med 12(9):844–849

    Article  PubMed  Google Scholar 

  39. Gauthier L, Laberge L, Beaudry M, Laforte M, Rompré PH, Lavigne GJ (2009) Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study. Sleep Med 10(3):329–336

    Article  PubMed  Google Scholar 

  40. Zhou J, Liu YH (2012) A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea/hypopnoea syndrome. J Oral Rehabil 39(12):914–922

    Article  PubMed  CAS  Google Scholar 

  41. Schönhofer B, Stoohs RA, Rager H, Wenzel M, Wenzel G, Köhler D (1997) A new tongue advancement technique for sleep-disordered breathing: side effects and efficacy. Am J Respir Crit Care Med 155(2):732–738

    Article  PubMed  Google Scholar 

  42. Marcussen L, Henriksen JE, Thygesen T (2015) Do mandibular advancement devices influence patients’ snoring and obstructive sleep apnea? A cone-beam computed tomography analysis of the upper airway volume. J Oral Maxillofac Surg 73(9):1816–1826

    Article  PubMed  Google Scholar 

  43. Verbruggen AE, Dieltjens M, Wouters K, De Volder I, Van de Heyning PH, Braem MJ, Vanderveken OM (2014) Prevalence of residual excessive sleepiness during effective oral appliance therapy for sleep-disordered breathing. Sleep Med 15(2):269–272

    Article  PubMed  CAS  Google Scholar 

  44. Huang JF, Chen LD, Lin QC, Chen GP, Yu YH, Huang JC, Zhao JM (2016) The relationship between excessive daytime sleepiness and metabolic syndrome in severe obstructive sleep apnea syndrome. Clin Respir J 10(6):714–721

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors of this study would like to thank Dr. Carmen Díez Fernández and Cristina Prada Marcos for the help with editing and formatting of the manuscript.

Author information

Authors and Affiliations

  1. Unit of Prosthodontics and Occlusion, Stomatology Department, Faculty of Medicine and Dentistry, Universidad de Valencia, Calle Gasco Oliag 1, CP 46010, Valencia, Spain

    Rocío Marco Pitarch & Marina Selva García

  2. Sleep Unit, Neurophysiology Department, Hospital Universitario de La Ribera, Ctra. Corbera Km 1, Alzira, CP 46600, Valencia, Spain

    Javier Puertas Cuesta

  3. Otorhinolaryngology Department, Hospital Clínico Universitario, Avenida Blasco Ibañez 17, CP 46010, Valencia, Spain

    Jaime Marco Algarra & Enrique Fernández Julian

  4. Section of Prosthodontics and Occlusion, Stomatology Department, Faculty of Medicine and Dentistry, Universidad de Valencia, Calle Gasco Oliag 1, CP 46010, Valencia, Spain

    Antonio Fons Font

Authors
  1. Rocío Marco Pitarch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marina Selva García
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Javier Puertas Cuesta
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jaime Marco Algarra
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Enrique Fernández Julian
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Fons Font
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rocío Marco Pitarch.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Marco Pitarch, R., Selva García, M., Puertas Cuesta, J. et al. Effectiveness of a mandibular advancement device in obstructive sleep apnea patients: a prospective clinical trial. Eur Arch Otorhinolaryngol 275, 1903–1911 (2018). https://doi.org/10.1007/s00405-018-4978-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-018-4978-4

Keywords

Search

Navigation