Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome

Abstract

The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States -POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.

The impact of oral appliance therapy with moderate mandibular advancement on obstructive sleep apnea and upper airway volume

“…Our findings indicate that in subjects with a deep bite the intermaxillary space for the tongue in the oral cavity is reduced, which is then normalized by mandibular advancement with MAD. Thus our finding strengthens the previous suggestion [22] that the ratio between the tongue and bony enclosure size may be a predictive factor for the response of MAD therapy. Besides changing the position of the jaw and tongue MAD therapy is likely to increase the m. genioglossus tone and thus reduce the collapsibility of the upper airways.…”

“…Concerning the effect of age on MAD treatment success, previous studies are contradictory [21,22,24]. In the present sample, complete responders were significantly younger than partial/non-complete responders.…”

“…This kind of craniofacial anatomy predisposes the mandible to rotate clockwise with the MAD in situ, thus reducing the retrolingual pharyngeal space. Clear improvement in AHI by MAD therapy has been found to correlate to a retrognathic mandible [20], large upper intermolar width [21], and wide lower inter-canine width [22]. In the present report complete responders had significantly deeper (over)bite and they tended to have more often mandibular retrusion than partial /non-complete responders.…”

Severe obstructive sleep apnea treatment with mandibular advancement device: A case report

“…On the contrary, the measurements of the lower airspace of the pharynx were diminished, which according to a study carried out by Cunha et al. 18 is a good predictor of success for MAD therapy.…”

Correlation between Craniofacial Structures and Severity of Obstructive Sleep Apnea

“…The secondary form is related to an obstruction of upper airway. These structures may be influenced by the maxillo-mandibular-hyoid position [23].…”