A mandibular advancement device associated with lingual control: a new treatment option for obstructive sleep apnea?

Abstract

Oral appliances (OA) have become the main alternative to positive pressure airway devices (PAP) for the control of obstructive sleep apnea (OSA). Despite literature support, controversies about the mode of action and the effectiveness of these devices persist. The aim of this study was to evaluate the efficacy of modified mandibular advancement devices (MAD) in patients with OSA who failed treatment with MAD and toevaluate the role of the tongue as a factor in patients who failed treatment with MAD. Patients unable to control the apnea-hypopnea index (AHI) using a MAD were subsequently treated with a modified version that included a tongue trimming accessory. The objective was to stabilize the tongue by preventing it from sliding with the consequent collapse of the upper airway (UA). New polysomnography (PSG) was performed with the modified MAD in place. A total of 20 patients who failed MAD therapy were studied including15 men (75%) with mean age (±standard deviation) of 58.5±13.1 years and BMI 29.6± 5.0 Kg/m2.After installing the tongue trimmer, the number of patients who achieved complete success with the new MAD (AHI < 5) went from 0 to 30% and those who achieved partial success (5 < AHI < 10) went from 0 to 20%. The number of patient responders (AHI reduced by at least 50%) went from 20 to 75%. The results suggest that the tongue, even in the presence of a MAD, may be one of the contributing factors for the collapse of theUA and consequent device ineffectiveness. By stabilizing the tongue through the insertion of a tongue trimmer, theMAD became more effectivein many cases.