Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: A cross-over randomized study

Gauthier, Luc; Laberge, Luc; Beaudry, Michel; Laforte, Mario; Rompré, Pierre; Lavigne, Gilles

doi:10.1016/j.sleep.2008.03.011

Cited by 86 publications

(83 citation statements)

References 23 publications

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“…A significant reduction in blood pressure has been reported from MAD treatment [13,20,26,39]. A 2-mmHg decrease in 24-h diastolic blood pressure was found, together with a halving of the mean AHI, as a result of a MAD compared with a control splint after 4 weeks' treatment [39].…”

Section: Effects On Cardiovascular Healthmentioning

confidence: 90%

“…The RCTs evaluated the effects of MADs compared with placebo treatment [11,13,14,22,23,25,[28][29][30], CPAP [11, 13, 16-19, 24, 26, 32, 34] or between appliance designs [15,20,27,31,33,35,36,38]. Three studies reported longer-term results from MAD treatment after 1-4 yrs, compared with CPAP [12], surgery [37] or between two types of MAD [21].…”

Section: Description Of the Included Studiesmentioning

confidence: 99%

“…Patients included in the RCTs had mild to severe OSA [13,14,17,18,20,[24][25][26][27][29][30][31][32][33][34][35][36][37][38], with mean AHI or RDI of 10-50. With MADs, AHI or RDI decreased to mean values of 4.5-34, which corresponded to reductions in the frequency of respiratory disturbances of means of 28-80% (mean reduction from all studies of 55%).…”

Section: Effects On Osamentioning

confidence: 99%

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Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Marklund¹,

Verbraecken²,

Randerath³

2011

Eur Respir J

166

136

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Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

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Section: Effects On Cardiovascular Healthmentioning

confidence: 90%

Section: Description Of the Included Studiesmentioning

confidence: 99%

Section: Effects On Osamentioning

confidence: 99%

See 1 more Smart Citation

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Marklund¹,

Verbraecken²,

Randerath³

2011

Eur Respir J

166

136

View full text Add to dashboard Cite

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“…MAS protrudes the mandible with the aim of increasing upper airway caliber, thereby preventing collapse of the upper airway during sleep. 12,13 It has been demonstrated that MAS treatment ameliorates the polysomnographic (PSG) variables in OSA patients, decreases symptoms during both the day and night, 14,15 and reduces arterial blood pressure. 16 Unlike the data on CPAP treatment, 4,9 studies on the effect of MAS treatment on inflammatory and hemostatic parameters are scarce.…”

Section: Modulation Of Infl Ammatory and Hemostatic Markers In Obstrumentioning

confidence: 99%

Modulation of Inflammatory and Hemostatic Markers in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Splints: A Parallel, Controlled Trial

Niżankowska-Jędrzejczyk

Almeida

Lowe

et al. 2014

Journal of Clinical Sleep Medicine

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BRIEF SUMMARYCurrent Knowledge/Study Rationale: The aim of our study was to assess the effi ciency of fi brinolysis and its determinants, in particular thrombin activatable fi brinolysis inhibitor (TAFI), in OSA patients, since until now plasminogen activator inhibitor-1 and D-dimer have been the only fi brinolytic parameters studied in this disease. This is the fi rst study to investigate the effects of mandibular advancement splints on hemostasis in OSA patients. Study Impact: The study demonstrates antifi brinolytic mechanisms in OSA patients, largely mediated by increased TAFI. MAS treatment in OSA patients is associated with favorable alterations in hemostasis, including improved fi brinolysis.

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“…However, CPAP may produce a better clinical outcome than MADs, as well as better control of snoring [65,[70][71][72]. MADs can have some beneficial cardiovascular effects with improvement in blood pressure control, in cardiac function, endothelial function, and oxidative markers [62,[72][73][74][75][76][77][78][79]. Several studies have demonstrated that MADs are more successful in milder sleep apnea, position dependent OSA (lateral AHI<10/h), females, and in patients with a lower BMI [64,68,[80][81][82][83][84].…”

Section: Mandibular Advancement Devices (Mad)mentioning

confidence: 99%

Non-positive airway pressure therapy for obstructive sleep apnea

Jafari

Roux

2012

Curr Respir Care Rep

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Obstructive sleep apnea (OSA) is a common disorder associated with cardiovascular morbidity. Various methods are offered to improve symptoms of OSA and its outcome. Although positive airway pressure is the most effective treatment for OSA, its clinical effectiveness is limited by patients' compliance. Other suggested treatments for OSA focus on expanding upper airway and reducing its collapsibility. For example, mandibular advancement device (MAD) achieves this goal by mechanically protruding the mandible. Other available treatments including weight reduction, positional therapy, drugs, nasal dilators, and nasal expiratory pressure device are clearly inferior to CPAP.

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Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: A cross-over randomized study

Cited by 86 publications

References 23 publications

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Modulation of Inflammatory and Hemostatic Markers in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Splints: A Parallel, Controlled Trial

Non-positive airway pressure therapy for obstructive sleep apnea

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