Effect of Anterior Mandibular Positioning on Obstructive Sleep Apnea

Abstract

This prospective case report series utilized an anterior mandibular positioning (AMP) device on obstructive sleep apnea (OSA) patients and evaluated the changes in the respiratory disturbance index (RDI) and subjective overall satisfaction with the treatment. The RDI was based on all-night polysomnographic studies performed before and after approximately 4 months of appliance use. Overall satisfaction with the treatment was rated using a Likert scale (0 to 10) after 6, 18, and 36 months of AMP device use. Although only 15 of the 24 subjects agreed to undergo post-appliance polysomnograms, 14 of the 15 subjects showed a clear decrease in the RDI. The effect on the other subjects is unknown, but even if the 9 subjects without polysomnograms had no change in the RDI from the AMP device, a minimum rate of 58% of the subjects (14 of 24) would have substantially improved the RDI at the 3-month time point. Of the 24 subjects, 2 subjects claimed no immediate benefit and stopped using the device, 4 subjects were lost to followup, 1 subject lost weight and stopped using the device, 1 subject had mandibular advancement surgery after using the appliance for a period of time, and 3 stopped using the appliance because of persistent temporomandibular pain problems. The remaining 12 of the 23 (52%) original subjects were still using the appliance successfully at 36 months. One subject died of non-apnea-related causes before the 18-month follow-up time point. The 16 subjects who responded at 36 months reported a mean overall satisfaction with treatment of 6.9 +/- 3.3 on a scale of 10.

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

“…These effects appear to be transient and without any lasting complication. 4,7 • Later complications may result in TMJ discomfort 25 and changes in the occlusion. Bondermark and Lindman 27 have demonstrated that following 2 years of treatment with MAS therapy no adverse effects on the cranio-mandibular status and function were observed.…”

Otorhinolaryngologic Manifestations in Obstructive Sleep Apnea

“…It is also known that the number and frequency of apnea seizures and the blood oxygen desaturation are increased during REM sleep (24)(25)(26). Due to repeated apnea episodes in severe cases, blood oxygen saturation is lowered more than 50%.…”

“…Moreover, reduced blow oxygen causes an increase in carbon dioxide level (21). All these effects are observed more during REM sleep as the hypotonia or atonia of the muscles (especially the genioglossus muscle) is increased during this phase of sleep by repetitive episodes (24,27).…”

Tratamento da síndrome da apnéia e hipopnéia obstrutiva do sono com aparelhos intrabucais

“…In the study done by Ferguson et al (1997) 16 , when compared to the non-adjustable mandibular repositioning device, the adjustable mandibular protruding device, was associated with a higher success of treatment (55% vs. 48%), and fewer failures (5% vs. 24%). For Clark et al (1993) 21 , the follow-up makes clear that when the protrusive position was lower than 75% of maximum protrusion reached by the patient (normally < 5mm) the advancement therapy did not work, and they stated that for those patients who do not tolerate such a degree of advancement, this would not be the indicated therapy.…”