Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome

Abstract

The purpose of this study was to investigate the effects of an oral appliance (OA), with and without mandible advance, in the treatment of obstructive sleep apnea syndrome (OSA). Twenty-four patients diagnosed with OSA agreed to participate in this study. The patients were treated for 3 months (with a removable soft elastic silicone positioner customized with thermoplastic silicone and with a 5-mm opening). Patients were selected, using a randomized design, to receive an OA model either with (12 patients) or without advance (12 patients). Before treatment, a snoring questionnaire, the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Epworth Sleepiness Scale (ESS), and polysomnography were completed. Fifteen subjects completed the protocol (13 men, two women). With respect to basal values, the mandible-advanced OA group presented a decrease in the mean apnea-hypopnea index (AHI) (33.8+/-4.7 versus 9.6+/-2.1; p<0.01), number of arousals per hour (33.8+/-13.9 versus 16.0+/-1.5; p<0.05), ESS score (14.7+/-5.1 versus 5.1+/-1.9; p<0.05), snoring score (15.4+/-1.9 versus 10.1+/-3.2; p<0.05), and total FOSQ score (78.1+/-22.6 versus 99.3+/-14.4; p<0.05). After treatment, the non-advanced group presented a decrease in the mean AHI (24.0+/-12.2 versus. 11.7+/-7.9; p<0.05). However, no significant differences were found in the number of arousals per hour, ESS score, snoring, and total FOSQ score in the non-advanced group. Neither study group showed significant difference in mean SF36 scores. Oral appliances, especially those that advance the mandible, offer an effective treatment for OSA.

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

“…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].…”

Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

“…In addition, adjustable OAs can also be expensive, with fees for fabricating and adjusting these devices potentially exceeding $3000, 22 causing adjustable OAs in some settings to be more expensive than CPAP. 24 In addition to the time required to fabricate adjustable OAs, a period of incremental titration is needed to facilitate patients› tolerance of the mandibular advancement, which further adds to the inherent delay to effective treatment.…”

“…Fixed OAs have been shown to reduce events, but their ability to provide adequate therapy or normalize the AHI has not been established. [24][25][26] No large studies directly comparing the performance between fixed and adjustable OAs have been conducted. While fixed OAs offer advantages, they may not provide adequate reduction of obstructive respiratory events and may result in residual disease or inadequate therapy for some patients.…”

Disminución de la permeabilidad de la vía aérea con el uso de dispositivos intraorales estabilizadores en pacientes con trastornos respiratorios del sueño. Una revisión de la literatura.

“…(19) publicaron resultados favorables con ambos dispositivos (protrusión 0% y protrusión 75%) respecto de la permeabilidad de la vía aérea Rev. Clin.…”