Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome

Renato Prescinotto,Fernanda Louise Martinho Haddad,Ilana Fukuchi,Luiz Carlos Gregório,Paulo Afonso Cunali,Sérgio Tufik,Lia Rita Azeredo Bittencourt

doi:10.1016/j.bjorl.2015.08.005

Abstract

IntroductionThe mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). ObjectiveTo assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. MethodsProspective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. Results28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p=0.02), smaller cervical circumference (p=0.05), and lower AHI at baseline (p=0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p=0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. ConclusionMAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.

Highlights

The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS)
There have been studies demonstrating the presence or absence of an association between nasal alterations and their treatment with continuous positive airway pressure (CPAP) adherence,3---5 no studies have demonstrated whether the nasal and upper airway (UA) alterations might or might not interfere with successful treatment by or adherence to MAD
The scarcity of studies that have assessed the presence of UA and facial skeleton alterations using otorhinolaryngological physical examination in patients with OSAS referred for treatment with MAD, and have evaluated the association of these alterations with treatment success and adherence, were the reasons that prompted this research

Summary

Introduction

The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). Objective: To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. The treatment of choice for Obstructive Sleep Apnea Syndrome (OSAS) is the use of continuous positive airway pressure (CPAP), especially in severe cases.[1] In mild to moderate and primary snoring cases, other treatments can be used, such as the mandibular advancement device (MAD).[1,2]. The scarcity of studies that have assessed the presence of UA and facial skeleton alterations using otorhinolaryngological physical examination in patients with OSAS referred for treatment with MAD, and have evaluated the association of these alterations with treatment success and adherence, were the reasons that prompted this research.

Objectives

Methods

Results