Effects of a Mandibular Repositioning Appliance on Sleep Structure, Morning Behavior and Clinical Symptomatology in Patients with Snoring and Sleep-Disordered Breathing

Abstract

Background: Mandibular repositioning appliances (MRAs) have become an established treatment for snoring and sleep-disordered breathing – though most studies only focused on the evaluation of respiratory variables. Methods: This single-blind, placebo-controlled case-series study investigated the effects of an individually adjustable MRA on psychopathology, macro-/microstructure of sleep, periodic leg movements, morning performance, mood/affect and psychophysiology. Fifty patients (37 males) aged 59.7 ± 10.3 years, suffering from primary snoring (7), mild (22), moderate (15) and severe apnea (6), spent 4 nights in the sleep laboratory (adaptation, placebo, drug and MRA night). The drug night is not subject of the present paper. Results: Confirmatory statistics showed an improvement of the snoring index by 72%. Descriptively, the apnea index and the apnea-hypopnea index normalized. A clinical improvement was seen in the Pittsburgh Sleep Quality Index, the Zung Anxiety/Depression Scales and the Epworth Sleepiness Scale. The restless legs syndrome also improved. Polysomnographically, sleep stages REM and 4 as well as REM latency increased, stage 3, movement time, stage shifts and periodic leg movements decreased, as did all arousal measures. Subjectively, morning well-being, drive, affectivity and wakefulness improved. Objectively, attention, motor and reaction time performance, critical flicker frequency as well as muscular strength increased, diastolic blood pressure and the pulse rate decreased. Conclusion: Apart from its good therapeutic effects on snoring and respiratory variables (snoring showed complete or partial response in 68%, the apnea-hypopnea index in 67% of the apnea patients), the MRA also improved psychopathology, objective and subjective sleep and awakening quality.

Oral appliance titration in patients with obstructive sleep apnea induces the appearance of periodic limb movements

“…Treatment of obstructive sleep apnea with CPAP has been speculated to uncover the concurrent sleep disturbance of PLMD [6,7]. The significant trend toward an increase of PLM with arousals in our patients is in contrast with a study on patients with concomitant mild/ moderate OSA and PLMD who showed decreases in the number of PLM during treatment of the respiratory disturbance with continuous positive airway pressure [6,20].…”

Obstructive Sleep Apnea Management: An Overview of the Literature

“…The effectiveness of MRAs has been observed to fundamentally improve objective sleep measurements . MRAs have been shown to notably enhance subjective and objective sleep measurements of sleepiness, excellence of life, and daily monitored blood pressure . Aarab et al stated that MRAs and CPAP devices have shown improvement in objective sleep measurements such as AHI, arousal index, and minimum arterial oxygen saturation.…”

Long-term effects of the mandibular advancement device IST®

“…Während die akute Wirksamkeit und Verträglichkeit von UPS durch zahlreiche Publikationen und Metaanalysen gut dokumentiert ist [13,17,23,24,25], gibt es hinsichtlich ihrer Langzeitwirkungen weniger Daten.…”

“…Während in unseren früheren Studien über UPS bei Schnarchen und schlafbezogenen Atmungsstörungen die akute Wirkung des jeweiligen Protrusionsbehelfs zwecks Therapieeffizienzkontrolle im Zentrum der Aufmerksamkeit stand [23,24,25], wurden in dieser Studie die Compliance, Langzeit-und Nebenwirkungen mittels Fragebögen untersucht.…”