Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

Abstract

MAS are now widely used for the treatment of OSA both as a primary therapy and as an alternative for patients with severe OSA who are unwilling or unable to tolerate CPAP. 5 MAS are a simple, reversible, quiet, and cost effective therapy for selected patients with OSA. study objectives: CPAP is used as the fi rst-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP. Methods: Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months. Results: Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m 2 completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased signifi cantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no signifi cant differences in SAQLI between MAS and CPAP treatment, while ESS decreased signifi cantly on MAS. MAS self-reported usage was correlated with treatment effi cacy (r = 0.52; p < 0.05). Seventy-fi ve percent of the patients reported being suffi ciently satisfi ed with MAS to continue to use it as an alternative short-term therapy. s C I e N t I F I C I N V e s t I g A t I o N sO bstructive sleep apnea (OSA) is a common syndrome that is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. OSA is associated with reduced quality of life, decreased cardiovascular health and increased healthcare utilization, car crashes, and mortality.1,2 There are a variety of treatment options currently available for OSA including lifestyle modifi cations, continuous positive airway pressure (CPAP), mandibular advancement splints (MAS), and corrective upper airway surgery. CPAP is the most effi cient treatment for OSA and has been demonstrated to improve daytime symptoms and reduce cardiovascular disease and car crashes. 3,4 Despite improvements in the portability of CPAP machines, many patients fi nd this treatment not feasible when away from home. CPAP machines require access to a reliable electrical source while asleep. This can sometimes be provided by a battery, but is quite cumbersome and needs periodic recharging. Many patients faced with short-term diffi culties complying with CPAP during periods of travel or vacation stop treatment in these circumstances. Current knowle...

Perceived Effectiveness, Self-efficacy, and Social Support for Oral Appliance Therapy Among Older Veterans With Obstructive Sleep Apnea

“…7 Moreover, studies suggest that patients who use oral appliances are often satisfied with their therapy. 8 These data support the use of oral appliances for those unable to tolerate positive airway pressure.…”

Biomimetic Oral Appliance Therapy in Adults with Severe Obstructive Sleep Apnea

“…They reported that the residual AHI for MAD-treated patients was higher than a CPAP-treated group, but concluded that both CPAP and MAD may be effective therapies to reduce the risk of cardiovascular fatalities in patients with severe OSA. Although CPAP is regarded as the first option for patients with severe OSA, one study [23] investigated whether patients with severe OSA could use a MAD as an alternative treatment to CPAP. In that study, the AHI decreased with MAD use from 30.7 hr -1 to 13.2 hr -1 , and they concluded that MADs completely reduce sleep disordered breathing in selected patients with severe OSA.…”

Treating OSA: Current and emerging therapies beyond CPAP

“…OA should be considered not only an alternative to CPAP but rather a potentially complementary treatment modality to further improve treatment outcomes. The combination of OA and CPAP to be used on alternative days has been reported as a successful approach . Almeida et al found that patients who were compliant with CPAP (>4 h/night) had their sleepiness further improved once they had the option to use an OA when CPAP was not being worn.…”

“…The combination of OA and CPAP to be used on alternative days has been reported as a successful approach. 46 Almeida et al found that patients who were compliant with CPAP (>4 h/night) had their sleepiness further improved once they had the option to use an OA when CPAP was not being worn. Patients did describe a smaller burden of this therapy, having an option for a day off CPAP, and also described less pressure on teeth, having a day off OA.…”