Advertisement

pp 1-7 | Cite as

Mandibular Advancement Devices in Patients with Symptoms of Obstructive Sleep Apnea: A Review

  • M. WojdaEmail author
  • P. Jurkowski
  • A. Lewandowska
  • E. Mierzwińska-Nastalska
  • J. Kostrzewa–Janicka
Chapter
Part of the Advances in Experimental Medicine and Biology book series

Abstract

Obstructive sleep apnea (OSA) is a sleep disorder resulting from the repetitive narrowing and collapse of the upper respiratory tract. The results of previous epidemiological studies confirm a significant impact of OSA on the health situation around the world. Untreated OSA is associated with many adverse health effects, such as hypertension, coronary artery disease, stroke, atrial fibrillation, congestive heart failure, and daytime sleepiness. Excessive mortality of OSA patients, especially in men under 50 years of age, associated with advanced disease, obesity, cardiovascular complications, and a greater risk of road accidents, requires an urgent extension of the diagnostic–therapeutic database dealing with this problem. It is estimated that in the adult population, OSA occurs in 4% of men and in 2% of women. In recent years, intraoral devices have become an increasingly common method of OSA and snoring treatment. Nevertheless, the use of devices producing continuous positive airway pressure (CPAP) remains the most effective treatment method. However, intraoral devices have the advantage of not requiring a source of electricity and are less troublesome in everyday use. Intraoral devices are well tolerated by the majority of patients, and their therapeutic efficacy is confirmed. Since such devices become commoner, the purpose of this work was to present the procedures, indications, and recommendations involved with intraoral devices while taking into consideration a variety of dental conditions. The side effects of the use of intraoral devices and their influence on the entire stomatognathic system were also described.

Keywords

Continuous positive airway pressure Intraoral device Mandibular advancement appliance Obstructive sleep apnea Snoring Stomatognathic system 

Notes

Conflict of Interest

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

Ethical Consideration

This review article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 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 81:411–419Google Scholar
  2. Angle EH (1907) Treatment of malocclusion of the teeth Angle’s system. S.S. White Manufacturing Co, PhiladelphiaGoogle Scholar
  3. 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 170:656–664Google Scholar
  4. Battagel JM, Kotecha B (2005) Dental side effects of mandibular advancement splint wear in patients who snore. Clin Otolaryngol 30:46–156Google Scholar
  5. 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):144–155Google Scholar
  6. 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):246–251Google Scholar
  7. Bondemark L, Lindman R (2000) Craniomandibular status and function in patients with habitual snoring and obstructive sleep apnea after nocturnal treatment with a mandibular advancement splint: a 2-year follow-up. Eur J Orthod 22(1):53–60Google Scholar
  8. Carra MC, Bruni O, Huynh N (2012) Topical review: sleep bruxism, headaches, and sleep-disordered breathing in children and adolescents. J Orofac Pain 26(4):267–276Google Scholar
  9. Chung JW, Enciso R, Levendowski DJ, Morgan TD, Westbrook PR, Clark GT (2010) Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 109(5):724–731Google Scholar
  10. Doff MH, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJR, de LGM B, Stegenga B (2013) Oral appliance versus continuous positive air- way pressure in obstructive sleep apnea syndrome: a 2–year follow-up. Sleep 36(9):1289–1296Google Scholar
  11. Engelman HM, McDonald JP, Graham D, Lello GE, Kingshott RN, Coleman EL, Mackay TW, Douglas NJ (2002) 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 166:855–859Google Scholar
  12. Fergusson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA (1996) A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest 109(5):1269–1275Google Scholar
  13. Fransson AM, Tegelberg Å, Svenson BAH, Lennartsson B, Isacsson G (2002) Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring. Am J Orthod Dentofac Orthop 122(4):371–379Google Scholar
  14. Fransson AM, Tegelberg A, Leissner L, Wenneberg B, Isacsson G (2003) 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(3):131–141Google Scholar
  15. 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 apnoea. Eur Respir J 34:914–920Google Scholar
  16. Ghazal A, Sorichter S, Jonas I, Rose EC (2009) A randomized prospective long-term study of two oral appliances for sleep apnoea treatment. J Sleep Res 18(3):321–328Google Scholar
  17. Gotsopoulos H, Chen C, Quian J, Cistulli PA (2002) Oral appliance therapy improves symptoms in obstructive sleep apnea. Am J Respir Crit Care Med 166:743–748Google Scholar
  18. Hans MG, Nelson S, Luks VG, Lorkovich P, Baek SJ (1997) Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS). Am J Orthod Dentofac Orthop 111:562–570Google Scholar
  19. Hoekema A, Stegenda B, Wijkstra PJ, van der Hoeven JH, de Bont LG (2008) Obstructive sleep apnea therapy. J Dent Res 87(9):882–887Google Scholar
  20. Hoffstein V (2007) Review of oral appliance for treatment of sleep-disordered breathing. Sleep Breath 11:1–22Google Scholar
  21. Hudgel DW (1992) Mechanism of obstructive sleep apnea. Chest 101(2):541–549Google Scholar
  22. Johal A, Bottegal JM (2001) Current principles in the management of obstructive sleep apnea with mandibular advancement appliances. Br Dent J 190(100):532–536Google Scholar
  23. Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 31:1551–1558Google Scholar
  24. 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):1065–1072Google Scholar
  25. 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 944:63–71Google Scholar
  26. 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, American Academy of Sleep (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29(2):240–243Google Scholar
  27. 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):82–90Google Scholar
  28. 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):677–681Google Scholar
  29. Liu Y, Lowe AA (2000) Factors related to the efficacy of an adjustable oral appliance for the treatment of obstructive sleep apnea. Chin J Dent Res 3(3):15–23Google Scholar
  30. 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):1270–1272Google Scholar
  31. Martinez-Gomis J, Willaert E, Nogues L, Pascual M, Somoza M, Monasterio C (2010) Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications. Angle Orthod 80:30–36Google Scholar
  32. 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 163:1457–1461Google Scholar
  33. Ng AT, Qian J, Cistulli PA (2006) Oropharyngeal collapse predicts treatment response with oral appliance therapy in obstructive sleep apnea. Sleep 29(5):666–671Google Scholar
  34. Ng AT, Darendeliler MA, Petocz P, Cistulli PA (2012) Cephalometry and prediction of oral appliance treatment outcome. Sleep Breath 16(1):47–58Google Scholar
  35. Padma A, Ramakrishnan N, Narayanan V (2007) Management of obstructive sleep apnea: a dental perspective. Indian J Dent Res 18(4):201–209Google Scholar
  36. Petit FX, Pepin JL, Bettega G, Sadek H, Raphael B, Levy P (2002) Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J Respir Crit Care Med 166(3):274–278Google Scholar
  37. Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, Marks GB, Cistulli PA (2013) Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J Respir Crit Care Med 187(8):879–887Google Scholar
  38. 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):860–864Google Scholar
  39. Quinnell TG, Bennett M, Jordan J, Clutterbuck-James AL, Davies MG, Smith IE, Oscroft N, Pittman MA, Cameron M, Chadwick R, Morrell MJ, Glover MJ, Fox-Rushby JA, Sharples LD (2014) A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea–hypopnoea (TOMADO). Thorax 69:938–945Google Scholar
  40. 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):773–827Google Scholar
  41. Rinqqvist M, Walker-Engström ML, Tegelberg A, Rinqqvist I (2003) Dental and skeletal changes after 4 years of obstructive sleep apnea treatment with a mandibular advancement device: a prospective, randomized study. Am J Orthod Dentofac Orthop 124:53–60Google Scholar
  42. Robin P (1934) Glossoptosis due to atresia and hypotrophy of the mandible. JAMA Pediatr 48(3):541–547Google Scholar
  43. 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 27:108–124Google Scholar
  44. 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 18:511–513Google Scholar
  45. 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 24:239–249Google Scholar
  46. Young K, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea. Am J Respir Crit Care Med 165(9):1217–1239Google Scholar
  47. Zeng B, Ng AT, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2008) Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea. Sleep 31(4):543–547Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • M. Wojda
    • 1
    Email author
  • P. Jurkowski
    • 1
  • A. Lewandowska
    • 1
  • E. Mierzwińska-Nastalska
    • 1
  • J. Kostrzewa–Janicka
    • 1
  1. 1.Department of ProsthodonticsWarsaw Medical UniversityWarsawPoland

Personalised recommendations