Effects of a Mandibular Protruding Device on the Sleep of Patients with Obstructive Sleep Apnea and Snoring Problems: A 2-Year Follow-Up

Abstract

Objectives: To evaluate subjective discomfort and somnographic measures of patients with obstructive sleep apnea and snoring problems who had been treated for 2 years with a mandibular protruding device (MPD). Methods: The study population comprised 65 patients with a pretreatment diagnosis of obstructive sleep apnea (OSA) (n = 44) or habitual snoring without apnea (n = 21). After a baseline medical and somnographic examination, a functional examination of the stomatognathic system, and a questionnaire focused on sleep-related qualities, each patient received an MPD. Two follow-ups were made 6 months and 2 years after MPD treatment had been initiated, and all initial examinations were repeated. Results: At the 2-year follow-up, significant subjective improvements were registered in 90% of the patients regarding a reduction of snoring and apneas, in 76% regarding a reduction in daytime tiredness, and in 84% regarding an improvement in the quality of the night sleep (change of ≥ 50% from baseline data). At the 2-year follow-up of the OSA group, the oxygen desaturation index (ODI) had dropped significantly from a mean value of 14.7 (SD, 12.7) to 3.1 (SD, 4.2) (P < 0.001), and the mean SaO2 nadir rose from 78.2% (SD, 8.1) to 89.0% (SD, 4.7) (P < 0.001). Only one of the snorers increased his ODI value; the others retained their initial healthy values. The OSA patients significantly reduced the amount of time they snored during their sleep. Conclusion: MPD treatment is associated with a significant reduction in subjective complaints such as disturbing snoring, apneas, daytime tiredness, and poor quality of night sleep, and with a significant reduction in ODI values in the OSA group. In addition, favorable 6-month results were unchanged after 2 years.

This is a preview of subscription content, access via your institution.

References

  1. 1.

    Svanborg E. Upper airway nerve lesions in obstructive sleep apnea. Am J Respir Crit Care Med 2001;164:187–189

    Google Scholar 

  2. 2.

    Schmidt-Nowara W. A review of sleep disorders. The history and diagnosis of sleep disorders related to the dentist. Dent Clin North Am 2001;45:631–642

    Google Scholar 

  3. 3.

    Lindberg E. Snoring and sleep apnea. A study of evolution and consequences in a male population. Minireview based on a doctoral thesis. Ups J Med Sci 1998;103:155–202

    Google Scholar 

  4. 4.

    Partinen M, Jamieson A, Guilleminault C. Long-term outcome for obstructive sleep apnea patients. Mortality. Chest 1988;94:1200–1204

    Google Scholar 

  5. 5.

    Marklund M, Franklin KA, SahlinC, Lundgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 1998;113:707–713

    Google Scholar 

  6. 6.

    Clark GT, Arand D, Chung E, Tong D. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Rev Respir Dis 1993;147:624–629

    Google Scholar 

  7. 7.

    O’Sullivan R, Hillman D, Mateljan R, Pantin C, Finucane K. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1995;151:194–198

    Google Scholar 

  8. 8.

    Menn SJ, Loube DI, Morgan TD, Mitler MM, Berger JS, Erman MK. The mandibular repositioning device: role in the treatment of obstructive sleep apnea. Sleep 1996;19:794–800

    Google Scholar 

  9. 9.

    Marklund M, Persson M, FranklinKA. Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest 1998;114:1630–1635

    Google Scholar 

  10. 10.

    Cohen R. Obstructive sleep apnea: oral appliance therapy and severity of condition. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998;85:388–392

    Google Scholar 

  11. 11.

    Fransson AMC, Isacsson G, LeissnerLC, Näsman AB, Alton MK. Treatment of snoring and obstructive sleep apnea with a mandibular protruding device: an open-label study. Sleep Breath 2001;5:23–34

    Google Scholar 

  12. 12.

    Fransson AMC, Svenson BAH, Isacsson G. The effect of posture and a mandibular protruding device on pharyngeal dimensions. A cephalometric study. Sleep Breath 2002;6:55–68

    Google Scholar 

  13. 13.

    George PT. Treatment of snoring and obstructive sleep apnea with a dental device. Dent Update 1996;23:12–19

    Google Scholar 

  14. 14.

    Fransson AMC, Tegelberg Å, Svenson BAH, Lennartsson B, Isacsson G. Influence of mandibular protruding device on airway passage and dentofacial characteristics in obstructive sleep apnea and snoring. Am J Orthod Dentofacial Orthop 2002;122:371–379

    Google Scholar 

  15. 15.

    McGown AD, Makker HK, Battagel JM, L’Estrange PR, Grant HR, Spiro SG. Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey. Eur Respir J 2001;17:462–466

    Google Scholar 

  16. 16.

    Guilleminault C, Dement W. Sleep Apnea Syndromes. New York, NY: Alan R Liss; 1978.

    Google Scholar 

  17. 17.

    Guilleminault C, Dement W. Sleeping and waking disorders: indications and techniques. Menlo Park, NJ: Addison-Wesley; 1982:155–212

    Google Scholar 

  18. 18.

    Svanborg E, Carlsson-Nordlander B, Larsson H, Pirskanen R, Sterner J. Screening for sleep apnea syndrome: static charge sensitive bed and ear oxymetry. Electroencephalogr Clin Neurophysiol 1986;64:86P–86P

    Google Scholar 

  19. 19.

    Leissner LC, Leissner P. SAS-screening enl Örebro, en effektiv undersökningsmetod. Annual general meeting of the Swedish Society of Medicine November 25–27; 1992:268–268.

  20. 20.

    Hasan J, Alihanka J. Construction of REM-nREM sleep hypnograms from body movement recordings. Sleep 1980; 5th Eur Congr Sleep Res, Amsterdam; 1980:S344–S347

  21. 21.

    Svanborg E, Larsson H, Carlsson-Nordlander B, Pirskanen R. A limited diagnostic investigation for obstructive sleep apnea syndrome. Oximetry and static charge sensitive bed. Chest. 1990;98:1341–1345.

    Google Scholar 

  22. 22.

    Block A, Boysen P, Wynne J, Hunt L. Sleep apnea, hypopnea and oxygen desaturation in normal subjects. A strong male predominance. N Engl J Med 1979;300:513–517

    Google Scholar 

  23. 23.

    Wynne J, Block A, Hemenway J, Hunt L, Flick M. Disordered breathing and oxygen desaturation during sleep in patients with chronic obstructive lung disease (COLD). Am J Med 1979;66:573–579

    Google Scholar 

  24. 24.

    Wilhelmsson B, Tegelberg Å, Walker-Engström M-L, et al. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol 1999;119:503–509

    Google Scholar 

  25. 25.

    Walker-Engström M-L, Tegelberg Å, Wilhelmsson B, Ringqvist I. 4-year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Chest 2002;121:739–746

    Google Scholar 

  26. 26.

    Svanborg E, Larsson H. Development of nocturnal respiratory disturbance in untreated patients with obstructive sleep apnea syndrome. Chest 1993;104:340–343

    Google Scholar 

  27. 27.

    Marklund M, Sahlin C, Stenlund H, Persson M, Franklin K. Mandibular advancement device in patients with obstructive sleep apnea: long-term effects on apnea and sleep. Chest 2001;120:162–169

    Google Scholar 

  28. 28.

    Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. Sleep 2001;24:538–544

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Anette M. C. Fransson D.D.S..

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fransson, A.M.C., Tegelberg, Å., Leissner, L. et al. Effects of a Mandibular Protruding Device on the Sleep of Patients with Obstructive Sleep Apnea and Snoring Problems: A 2-Year Follow-Up. Sleep Breath 7, 131–141 (2003). https://doi.org/10.1007/s11325-003-0131-7

Download citation

Keywords

  • Sleep apnea
  • snoring
  • mandibular protruding device
  • sleep quality questionnaire