A Multicenter Prospective Study on the Use of a Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea

Abstract

The main objective of this prospective study was the evaluation of 1 mm step titration of mandible advancement in the success of treating obstructive sleep apnea (OSA). For that, a multicenter prospective study was designed to recruit patients with OSA who were eligible to receive a mandibular advancement device. Gradual titration of mandibular advancement (steps of 1 mm) from maximum intercuspidation was performed to determine the optimal mandibular advancement (highest reduction in the apnea-hypopnea index (AHI)). The principal variable was the percentage of patients where a reduction ≥50% of the AHI was achieved at the end of the titration phase. A total of 102 patients participated in this study. Fifty-six percent of the participants were males and 67% had a BMI ≥ 25 kg/m2. Most of the patients (79%) had an age ≥ 50 years and the majority (74%) were either non-smokers or ex-smokers. Excessive daytime sleepiness was reported by 40% of the patients. The mean AHI at baseline was 20.6 ± 12.7 events/h. The mean advancement of the mandible was 3.1 ± 1.6 mm. The device achieved a reduction in the AHI in 93% of the patients and success (≥50% reduction in the AHI) in 69% of the patients. Success was achieved in 50%, 81.6%, and 73.3% of the patients with mild, moderate, and severe OSA, respectively. Decreasing the magnitude of mandibular advancement could be possible by controlling the vertical mouth opening and step-by-step titration.

"Comparison of Two Mandibular Advancement Devices in the Treatment of Obstructive Sleep Apnea: The Effect of the Vertical Mouth Opening"

“…Although the amount of mandibular forward displacement was different (8 mm for the Orthoapnea device Vs 3 mm for the BTI DIA), it could be observed that the area of the symphysis and the lower incisors was in the same anteroposterior position. Several factors may influence the occurrence of adverse effects such as the vertical mouth opening, the distance of mandibular advancement, and the device design [12,13]. Titration of the mandibular advancement is a key element to place the mandible in the least anterior position that is effective in the treatment of OSA.…”

“…Titration of the mandibular advancement is a key element to place the mandible in the least anterior position that is effective in the treatment of OSA. In this regard, using a device that needs lower mandibular advancement would be advantageous [12,13]. The number of patients with symptomatic TMJ and muscles have been reduced in both devices but more in the BTI DIA.…”

“…For example, the degree of mouth opening should be optimized not to increase the risk of mandible falling backwards and thus altering the device efficacy [10]. The risk of having side effects is increased by the increase in the magnitude of mandibular advancement [12,13]. For that, there is a need to personalize the optimal mandibular protrusion that results in the highest reduction in the Apnea-hypopnea index (AHI) and in producing the least side effects.…”

Revolutionizing Sleep Health: The Emergence and Impact of Personalized Sleep Medicine

“…Certain craniofacial structures and alignments, like retrognathia (receded jaw), high-arched palate, and overbite, can predispose individuals to OSA [ 81 ]. By taking into account these features, personalized treatment may involve dental or orthodontic interventions such as mandibular advancement devices (MADs) or surgeries to modify the craniofacial structure, thereby improving airway patency [ 82 , 83 ]. Skeletal features, including the size and positioning of the jaw and other facial bones, can significantly affect airway size and shape [ 81 ].…”

“…Skeletal features, including the size and positioning of the jaw and other facial bones, can significantly affect airway size and shape [ 81 ]. As such, personalized interventions might include orthognathic surgery to reposition skeletal components for patients with severe skeletal discrepancies [ 81 , 82 , 83 ].…”