Evaluation of an oral mandibular advancement titration appliance

Abstract

To determine whether a manually adjustable oral mandibular advancement titration appliance (EMA-T) predicts successful long-term treatment with an oral mandibular advancement appliance (MAA). At an academic medical center, 21 adults with obstructive sleep apnea (AHI > 10 events/hr) performed baseline, titration, and MAA (Klearway) polysomnograms. During the titration polysomnogram with EMA-T, the mandible was advanced until apneas and hypopneas were eliminated or maximum tolerable advancement was reached. Participants then used the MAA at home and, once the mandible was advanced to the amount determined during the titration polysomnogram, a polysomnogram with MAA was performed. Mean AHI at baseline was 33.5 +/- 18.3 (SD) events/hr. During the titration polysomnogram, 9 subjects achieved an AHI < 10 and at least a 50% reduction in AHI. None of the subjects met these criteria on the MAA polysomnogram. EMA-T lowered the AHI to efficacious levels in 43% of patients but this acute response did not predict the efficacy of long-term MAA treatment.