A Crossover Study Comparing the Efficacy of Continuous Positive Airway Pressure With Anterior Mandibular Positioning Devices on Patients With Obstructive Sleep Apnea

Clark, Glenn T.; Blumenfeld, Israel; Yoffe, N; Peled, Einat; Lavie, Peretz

doi:10.1378/chest.109.6.1477

Cited by 214 publications

(132 citation statements)

References 17 publications

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“…[16][17][18][19] Two of these compared the use of a mandibular advancement splint with nasal CPAP 16,17 and concluded that the MAS achieved substantial success (45% reduction in AHI score), but were less effective …”

Section: Rationale For the Use Of Mandibular Advancement Splintsmentioning

confidence: 99%

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

Johal¹,

Battagel²

2001

Br Dent J

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Section: Rationale For the Use Of Mandibular Advancement Splintsmentioning

confidence: 99%

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

Johal¹,

Battagel²

2001

Br Dent J

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“…[8][9][10][11][12][13] Existing research demonstrates that OA therapy is superior to commonly offered surgical procedures, 8,9 and may be comparable to CPAP when adherence is included in the defi nition of successful treatment. [12][13][14][15][16][17][18][19][20][21] In 2006, the American Academy of Sleep Medicine (AASM) published updated OSA treatment guidelines which state that OAs are a reasonable alternative to CPAP in patients with mild to moderate OSA who prefer these devices or do not tolerate CPAP. 5 Mandibular advancement devices provide a therapeutic effect by protruding the mandible relative to the maxilla, simultaneously advancing the tongue and reducing the propensity for airway collapse during sleep.…”

mentioning

confidence: 99%

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

Lettieri

Paolino

Eliasson

et al. 2011

Journal of Clinical Sleep Medicine

115

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Study Objectives: To compare the effi cacy of adjustable and fi xed oral appliances for the treatment of OSA. Methods: Retrospective review of consecutive patients with OSA treated with either adjustable or fi xed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defi ned as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared effi cacy rates between fi xed and adjustable appliances and sought to identify factors associated with greater success. Results: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fi xed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was signifi cantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fi xed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fi xed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. Conclusions: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these fi ndings, the baseline AHI should be considered when selecting the type of oral appliance. Keywords: Oral appliance, mandibular advancement device, obstructive sleep apnea, effi cacy Citation: Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fi xed oral appliances for the treatment of obstructive sleep apnea.

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“…Although randomized cross-over studies indicate that CPAP is more efficacious than OA's, generally patients prefer OA's to CPAP therapy. 19 The use of OA's are indicated for patients who have mild to moderate OSA. 17 Our severe OSA patient however was intolerant to both CPAP and OA therapy.…”

Section: Discussionmentioning

confidence: 99%

Microimplant mandibular advancement (MiMA) therapy for the treatment of snoring and obstructive sleep apnea (OSA)

Ngiam

Kyung

2010

Korean J Orthod

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This case report describes the treatment of a 66 year old adult patient with a diagnosis of severe obstructive sleep apnea who was intolerant of nasal continuous positive airway pressure (nCPAP) treatment and oral appliance therapy. An alternative treatment of snoring and obstructive sleep apnea (OSA) with 2 orthodontic microimplants anchored to the mandible providing skeletal anchorage for mandibular advancement was implemented. After a 2 week healing period, a custom designed facemask provided extraoral anchorage to which the microimplants were connected to for titratable mandibular advancement. Microimplant Mandibular Advancement (MiMA) therapy resulted in resolution of the symptoms of severe OSA with a reduction of the apnea-hypopnea index (AHI), snoring and OSA symptoms.

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A Crossover Study Comparing the Efficacy of Continuous Positive Airway Pressure With Anterior Mandibular Positioning Devices on Patients With Obstructive Sleep Apnea

Cited by 214 publications

References 17 publications

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

Microimplant mandibular advancement (MiMA) therapy for the treatment of snoring and obstructive sleep apnea (OSA)

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