Efficacy of the mandibular advancement device in patients with sleep apnea syndrome and no tolerance CPAP

Abstract

Introduction The high efficacy of continuous positive airway pressure (CPAP) in treating obstructive sleep apnea (OSA) is limited by poor compliance often related to pressure intolerance. Mandibular advancement devices (MAD) as a medical non-continuous positive airway pressure (CPAP) treatment have proven to reduce respiratory disturbances to a level which may be sufficient in mild to moderate sleep apnea. Purpose: The present study investigated the effectiveness of an intra-oral mandibular advancement device in the treatment of patients with OSA who could not tolerate or who had failed to comply with CPAP. Materials and methods A total of 27 sleep apnea patients treated during 2011–2012, who do not tolerate CPAP, participated in the study. The clinical, analytical and sleep apnea recordings were evaluated before and after application of MAD. Each subject underwent 2 sleep studies, before treatment and after a period of 30 days with MAD at the maximum protrusion. Results Of 27 patients, 20 (74.1 %) were men with a middle age of 53.15 (SD 9.6) and 7 were women (25.9 %) with a middle age of 60.43 (SD 4.5). The treatment with MAD improved the roncopathy in 25 patients. The median initial Epworth’s scale reduced from 11.13 ±to 7.67 ± 3.9, p 0.05. The mean disturbed respiratory index (RDI) statistically decreased with MAD (16.8 ± 23 vs 27.1 ± 16, p 0.05. In addition, oxygen desaturation index (ODI) improved with MAD (19.84 ± 21.2 with MAD vs 26.42 ± 19 before MAD; p 0.05). The percentage of time spent below 90% saturation improved from 24.9 ± 31.21% to 14.75 ± 21.12, p > 0.05). Of the 27 patients, who had previously experienced CPAP, 26 of them felt it was easier to tolerate the MAD. 85% of these patients stated the appliance was more portable and acceptable to their bed partner. Conclusion MAD may be considered for patients not compliant with CPAP treatment or those who refuse to use it. Even though CPAP is the more effective treatment modality, in the individual case, the better compliance seen in some patients with the MAD may be advantageous.