An Oral Elastic Mandibular Advancement Device for Obstructive Sleep Apnea

Abstract

Oral mandibular advancement devices are becoming an increasingly important treatment alternative for obstructive sleep apnea (OSA). The first aim of the study was to determine whether a new oral elastic mandibular advancement device (EMA) prevents pharyngeal airway closure during sleep in patients with OSA. The second aim of the study was to determine if the polysomnographic response to the oral mandibular advancement device was dependent on the site of airway closure. Overnight polysomnograms were performed in 28 untreated OSA subjects with and without EMA. A third polysomnogram was performed in 12 of the subjects to determine the site of airway closure without the device. Site of airway closure above or below the oropharynx was determined by measuring the respective presence or absence of respiratory fluctuations in oropharyngeal pressure during induced occlusions in non-rapid eye movement (NREM) sleep. Mean apnea-hypopnea index (AHI) was 52.6 +/- 28.2 (SD) events/h without the device and 21.2 +/- 19.3 events/h with the device. Nineteen subjects (68%) had at least a 50% reduction in AHI with the device. The change in AHI with the device (AHI without device - AHI with device) was directly related to the AHI without the device. All three subjects with airway closure in the lower pharyngeal airway had a greater than 80% reduction in AHI with the device. Two of the nine subjects with airway closure in the velopharynx had a similar therapeutic response. The results show the effectiveness of EMA in the treatment of OSA. The results also indicate that polysomnographic severity of OSA and the site of airway closure should not be used to exclude patients from this oral device treatment.

Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity

“…Although the functional properties of the UA including the relationship between mandibular advancement and UA muscle activity [13] in OSA patients are still to be tested, it is no longer in question that mandibular advancement improves the AHI and the minimum Sa,O 2 and increases the calibre, cross-sectional area, and possibly, the volume of the UA [4,6,[14][15][16][17]. The results of this study are consistent with previous reports obtained from titration protocols of OAs [4,6,17].…”

Effects of mandibular advancement on brain activation during inspiratory loading in healthy subjects: a functional magnetic resonance imaging study

“…However, until now, the assessment of the efficacy of mandibular advancement by an OA for the treatment of OSA has depended solely on changes in clinical symptoms (17,23,40,42). Moreover, the amount of mandibular advancement by an OA has been determined in the light of the best balance between clinical indications and contraindications (42,48).…”

“…Continuous positive airway pressure (CPAP) has been regarded to be the gold standard in the treatment of OSA. On the other hand, mandibular advancement using an oral appliance (OA) has been used as an alternative to CPAP, as its effectiveness has been demonstrated in many previous studies in adults (17,23,33,40,42) and children (55) with OSA. The most popular explanation regarding how mandibular advancement by an OA relieves the symptoms of OSA is that it mechanically widens the constricted velopharyngeal passage and reduces the possibility of collapse of the airway during sleep.…”

“…Although the cause-and-effect relationship between anatomical and functional deficiencies has not been determined, the examination of neural sites that characterize OSA may reveal the neurogenic nature and/or consequences of the disorder (19). It should be noted that the pathological background of OSA is not straightforward, rather there is the variability in signs and symptoms and effectiveness of treatment alternatives (e.g., CPAP, OA), according to factors that included the severity of the disease, obesity, and gender (1,17,18,23,40,42). Thus, for better understanding of the possible interaction between neural deficits and responses to the OA for a wide spectrum of OSA, it would be necessary to collect the baseline knowledge regarding mandibular advancement in healthy subjects.…”

MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome

“…It can be speculated that some specific anatomical configuration can be used to predict success or failure of the device [16]. One recently published study measured respiratory fluctuations in oropharyngeal pressure during induced occlusions in nonrapid eye movement sleep [17]. In this study the site of airway closure above or below the oropharynx was determined by the respective presence or absence of respiratory fluctuations.…”