Health-related quality of life in patients with sleep-disordered breathing: Effect of mandibular advancement appliances

Abstract

Mandibular advancement appliances (MAAs) are increasingly being recognized in the management of sleep-disordered breathing (SDB). However, there is little available evidence regarding their impact on health-related quality of life. A prospective, nonrandomized controlled clinical trial was undertaken to evaluate the effect of MAA treatment on the quality of life of patients with SDB. Two hundred fifteen consecutively referred patients for MAA therapy who had a diagnosis of SDB confirmed by overnight polysomnography were recruited for study. The test group (n=120) received a Herbst appliance, a removable appliance comprised of separate maxillary and mandibular complete occlusal coverage acrylic splints, connected by means of bilateral telescopic arms. Patients in the control group (n=95) remained untreated for 4 months. All patients completed the Medical Outcomes Study 36-Item Short-Form Health Survey at baseline (T1) and at follow-up (T2). Cross-tabulation was performed for each independent variable against the group (control versus test) to determine the number of subjects and the percentage showing improvement and the level of significance (alpha=.05). Data were dichotomized (improvement versus no improvement), analyzed by simple logistic regression analysis, and expressed as the odds ratio. Eighty-three (87%) control and 107 (89%) test patients completed the study. No statistical differences were observed at baseline in any of the parameters relating to severity of SDB, demographic, anthropometric, or quality of life measures between the 2 groups. Significant differences were observed in relation to the energy/vitality (P=.001) and physical role limitation (P=.025) domains following 4 months of treatment with an MAA. Mandibular advancement appliances have a significant effect on a limited number of health-related quality of life domains for patients with SDB.