Skip to main content

Advertisement

Log in

The use of a mandibular repositioning device for obstructive sleep apnea

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

Abstract

The objective of this study was to verify the effect of a mandibular repositioning device (MRD) on polysomnographic parameters and on the mean electromyographic activity of the masseter and temporal muscles in individuals with obstructive sleep apnea syndrome (OSAS). This is a prospective cohort study conducted at multidisciplinary OSAS center in a tertiary referral center. Nineteen individuals with mild or moderate OSAS associated with Mallampati 3–4 were treated with an MRD during sleep. The subjects underwent diurnal electromyography (EM) and nocturnal polysomnography (PSG) examinations both prior and after initial treatment (3 months with MRD for PSG and 6 and 12 months of treatment for EM). The examinations performed at different times were compared. Comparison of the initial and final polysomnography examination revealed a significant mean reduction of apnea–hypopnea index (AHI) from 13.8 to 7.8. The successful treatment rate with the MRD was 52.6 %, and the improved treatment rate was 68.4 %. Patients with lower pre-treatment AHI presented higher rates of cure. There was no statistically significant change in electromyography examination among different times. The MRD reduced the apnea–hypopnea index in individuals with enlarged base of tongue and mild and moderate OSAS without damaging the function of the masseter and temporal muscles as determined by electromyography.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

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

    Google Scholar 

  2. Iber C, Ancoli-Israel S, Chesso A, Qua S (2007) For the American Academy Of Sleep Medicine. The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications. 1st Ed. Westchester, New York

  3. Tufik S, Santos-Silva R, Taddei JA, Bittencourt LRA (2010) Obstructive sleep apnea syndrome in the Sao Paulo epidemiologic sleep study. Sleep Med 11:441–446

    Article  PubMed  Google Scholar 

  4. Marin JM, Agusti A, Villar I, Forner M, Nieto D, Carrizo SJ, Barbé F, Vicente E, Wei Y, Nieto FJ, Jelic S (2012) Association between treated and untreated obstructive sleep apnea and risk of hypertension. JAMA 307:2169–2176

    Article  CAS  PubMed  Google Scholar 

  5. Marin JM, Carrizo SJ, Vicente E, Agusti AG (2005) Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 365:1046–1053

    Article  PubMed  Google Scholar 

  6. Hoffstein V, Mateika S (1992) Differences in abdominal and neck circumferences in patients with and without obstructive sleep apnoea. Eur Respir J 5:377–381

    CAS  PubMed  Google Scholar 

  7. Shah N, Roux F (2009) The relationship of obesity and obstructive sleep apnea. Clin Chest Med 30:455–465

    Article  PubMed  Google Scholar 

  8. Strobel RJ, Rosen RC (1996) Obesity and weight loss in obstructive sleep apnea: a critical review. Sleep 19:104–115

    CAS  PubMed  Google Scholar 

  9. Young T, Peppard PE, Taheri S (2005) Excess weight and sleep-disordered breathing. J Appl Physiol 99:1592–1599

    Article  PubMed  Google Scholar 

  10. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Loube DL, Owens J, Pancer JP, Wise M (2005) Practice parameters for the indications for polysomnography and related procedures: an update. Sleep 28:499–521

    PubMed  Google Scholar 

  11. Doherty LS, Kiely JL, Swan V, McNicholas WT (2005) Long-term effects of nasal continuous positive airway pressure therapy on cardiovascular outcomes in sleep apnea syndrome. Chest 127:2076–2084

    Article  PubMed  Google Scholar 

  12. Somers VK, White DP, Amin R et al (2008) Sleep apnea and cardiovascular disease: an american heart association scientific statement. Circulation 118:1080–1111

    Article  PubMed  Google Scholar 

  13. Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA (2009) Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep 32:648–653

    PubMed Central  PubMed  Google Scholar 

  14. 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 Dentofacial Orthop 111:562–570

    Article  CAS  PubMed  Google Scholar 

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

    CAS  PubMed  Google Scholar 

  16. Schmidt-Nowara WW, Meade TE, Hays MB (1991) Treatment of snoring and obstructive sleep apnea with a dental orthosis. Chest 99:1378–1385

    Article  CAS  PubMed  Google Scholar 

  17. 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. Sleep 29:240–243

    PubMed  Google Scholar 

  18. Castroflorio T, Bracco P, Farina D (2008) Surface electromyography in the assessment of jaw elevator muscles. J Oral Rehabil 35:638–645

    Article  CAS  PubMed  Google Scholar 

  19. Cooper BC (1997) The role of bioelectronic instrumentation in the documentation and management of temporomandibular disorders. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:91–100

    Article  CAS  PubMed  Google Scholar 

  20. de Felício CM, Freitas RL, Vitti M, Regalo SC (2007) Comparison of upper and lower lip muscle activity between stutterers and fluent speakers. Int J Pediatr Otorhinolaryngol 71:1187–1192

    Article  PubMed  Google Scholar 

  21. Cecílio FA, Regalo SC, Palinkas M, Issa JP, Siéssere S, Hallak JE, Machado-de-Sousa JP, Semprini M (2010) Ageing and surface EMG activity patterns of masticatory muscles. J Oral Rehabil 37:248–255

    Article  PubMed  Google Scholar 

  22. Cohen-Levy J, Pételle B, Pinguet J, Limerat E, Fleury B (2012) Forces created by mandibular advancement devices in OSAS patients: a pilot study during sleep. Sleep Breath. doi:10.1007/s11325-012-0765-4

    PubMed  Google Scholar 

  23. 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 31:1071–1078

    PubMed Central  PubMed  Google Scholar 

  24. Blanco J, Zamarrón C, Abeleirapazos 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  PubMed  Google Scholar 

  25. Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA (2009) Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep 32:648–653

    PubMed Central  PubMed  Google Scholar 

  26. Sam K, Lam B, Ooi CG, Cooke M, Ip MS (2006) Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea. Respir Med 100:897–902

    Article  CAS  PubMed  Google Scholar 

  27. Vecchierini MF, Léger D, Laaban JP, Putterman G, Figueredo M, Levy J, Vacher C, Monteyrol PJ, Philip P (2008) Efficacy and compliance of mandibular repositioning device in obstructive sleep apnea syndrome under a patient-driven protocol of care. Sleep Med 9:762–769

    Article  CAS  PubMed  Google Scholar 

  28. Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, Verbraecken JA, Franklin KA, De Backer WA, Van de Heyning PH (2008) Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med 178:197–202

    Article  PubMed  Google Scholar 

  29. Levendowski DJ, Morgan TD, Patrickus JE, Westbrook PR, Berka C, Zavora T, Popovic D (2007) In-home evaluation of efficacy and titration of a mandibular advancement device for obstructive sleep apnea. Sleep Breath 11:139–147

    Article  PubMed Central  PubMed  Google Scholar 

  30. Marklund M, Franklin KA (2007) Long-term effects of mandibular repositioning appliances on symptoms of sleep apnoea. J Sleep Res 16:414–420

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by Capes—Coordenação de Aperfeiçoamento de Pessoal de Nível Superior.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Fabiana C. P. Valera.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Leite, F.G.J., Rodrigues, R.C.S., Ribeiro, R.F. et al. The use of a mandibular repositioning device for obstructive sleep apnea. Eur Arch Otorhinolaryngol 271, 1023–1029 (2014). https://doi.org/10.1007/s00405-013-2639-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-013-2639-1

Keywords

Navigation