Chest
Clinical InvestigationsSLEEP AND BREATHINGMandibular Advancement Titration for Obstructive Sleep Apnea: Optimization of the Procedure by Combining Clinical and Oximetric Parameters
Section snippets
Patients
The study population consisted of 44 snorers (36 men) with OSAS that had been confirmed during an all-night diagnostic sleep study. Patients with inadequate dental structures for the anchoring of the OA, temporomandibular joint dysfunction, and/or previous uvulopalatopharyngoplasty were excluded.
All patients were initially treated by nasal continuous positive airway pressure (nCPAP) for a mean (± SD) duration of 1,185 ± 876 days. Despite attentive management and correction of the usual side
Study Population
Of the 44 eligible subjects enrolled in the project, 40 completed all aspects of the study. Three patients dropped out of the study as they were unable to adapt to OA because of temporomandibular joint pain, and one patient was lost to follow-up because he failed to attend the scheduled appointments.
The mean age of the 40 patients was 57 ± 9 years, and their mean body mass index was 28 ± 4 kg/m2. Their mean ESS score was 12 ± 4. Polysomnography recordings confirmed an elevated mean AHI of 46 ±
Discussion
This study confirms that a titratable OA can be a satisfactory treatment in a large proportion of patients with moderate-to-severe OSAS refusing long-term nCPAP therapy, as this modality achieved a complete response in 64% of these patients. This response consisted of a reduction in AHI of < 10 events per hour combined, with clinical improvement together with improvement in the quality of sleep. This result was obtained by progressively advancing the mandible according to a titration protocol
ACKNOWLEDGMENT
We thank Y. Dumet, E. Christiany, and J.F. Faucher for their technical assistance.
References (30)
- et al.
The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea
Chest
(1998) - et al.
A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea
Chest
(1996) - et al.
The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty
Chest
(1998) - et al.
An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome
Chest
(2002) - et al.
Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing
Chest
(2000) - et al.
Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea
Chest
(1999) - et al.
Mandibular advancement device in patients with obstructive sleep apnea: long-term effects on apnea and sleep
Chest
(2001) - et al.
Predictive factors for the need for additional humidification during nasal continuous positive airway pressure therapy
Chest
(2001) - et al.
The age and other factors in the evaluation of compliance with nasal continuous positive airway pressure for obstructive sleep apnea syndrome: a Cox's proportional hazard analysis
(2001) - et al.
Improving CPAP use by patients with the sleep apnoea/hypopnoea syndrome (SAHS)
Sleep Med Rev
(2003)
Diastolic blood pressure is the first to rise in association with early subclinical obstructive sleep apnea: lessons from periodic examination screening
Am J Hypertens
Clinical value of polysomnography
Lancet
Does 2 years' nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible?
Am J Orthod Dentofacial Orthop
Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring
Am J Orthod Dentofacial Orthop
Advancement of the mandible improves velopharyngeal airway patency
J Appl Physiol
Cited by (74)
Oral appliances for obstructive sleep apnoea: What can we expect?
2020, Revue des Maladies RespiratoiresNovel Approaches to the Management of Sleep-Disordered Breathing
2016, Sleep Medicine Clinics