Chest
Volume 113, Issue 3, March 1998, Pages 707-713
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Clinical Investigations: Sleep and Breathing
The Effect of a Mandibular Advancement Device on Apneas and Sleep in Patients With Obstructive Sleep Apnea

https://doi.org/10.1378/chest.113.3.707Get rights and content

Objective

To evaluate the effects of a mandibular advancement device on apneas and sleep in mild, moderate, and severe obstructive sleep apnea.

Design

Prospective study.

Subjects

Forty-four of 47 patients included.

Intervention

Individually adjusted mandibular advancement devices.

Measurements

Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings.

Results

The device reduced the median obstructive apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range, 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range, 44 to 66) to 14 (range, 2 to 32) (p<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=—0.41; p<0.01).

Conclusions

A mandibular advancement device reduces apneas and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.

Section snippets

Subjects

Forty-three men and four women who did not accept treatment with nasal continuous positive airway pressure or were not offered that treatment because of mild obstructive sleep apnea were invited to participate in the present study. Twenty-six patients were consecutive and thereafter only patients with an obstructive apnea-hypopnea index of >20 according to preceding sleep apnea recordings were included. Three men of the invited 47 patients refused to take part in the study and were thus

General Findings

Mild sleep apnea (obstructive apnea-hypopnea index <20) was defined in 21 of the 44 patients, moderate sleep apnea (obstructive apnea-hypopnea index 20-40) was found in 15 patients, and severe sleep apnea (obstructive apnea-hypopnea index≧40) was found in 8 patients. The three severity groups did not differ in terms of age, body mass index, total sleep time, and the percentage of sleep spent in the supine position. Medication, body mass index, and total sleep time did not differ between the two

Discussion

In the present study, the mandibular advancement device reduced the obstructive apnea-hypopnea index and the arousal index and improved the sleep stage patterns in patients with mild, moderate, and severe sleep apnea. Satisfactory results were found more frequently in those with mild apnea than in subjects with severe apnea. More than 50% of patients who had unsatisfactory results with the device still reported a satisfactory effect on snoring. These patients were regarded as suffering from

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  • Cited by (118)

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    Supported by grants from The Swedish Association for Heart and Lung Patients and The Swedish Dental Society.

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