The Efficacy of Mandibular Advancement Appliances as a Treatment Alternative to Continuous Positive Airway Pressure in Moderate OSAHS

Ama Johal

doi:10.23937/2572-4053.1510013

Abstract

A long-term prospective observational study was undertaken in which patients with moderate OSAHS and in whom CPAP use had failed, to determine treatment compliance with MAA therapy, after a minimum period of 18 months, using an objective monitor. Treatment outcomes included both objective sleep monitoring and a determination of the therapeutic efficacy based on the calculation of the mean disease alleviation (MDA).

Highlights

Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a condition characterised by the repeated collapse of the pharyngeal airway, resulting in either complete or partial obstruction during sleep
We hypothesised that a more simplistic and clinically safe manner of attaching the compliance device to an mandibular advancement appliances (MAA) could be achieved for everyday use and that an equivalent level of therapeutic efficacy to continuous positive airways pressure (CPAP) therapy could be achieved in patients diagnosed with moderate OSAHS
Participants referred for MAA therapy to a Specialist clinic within the Institute of Dentistry were consecutively recruited on the basis of meeting the following study selection criteria: Failed or were intolerant of CPAP therapy, a confirmed diagnosis of obstructive sleep apnoea hypopnoea syndrome (AHI > 5 events per hour), an Epworth sleepiness scale score suggestive of daytime sleepiness (> 101) with optimal dental/ periodontal health and free of temporomandibular joint disease (TMJ)

Summary

Introduction

Obstructive sleep apnoea hypopnoea syndrome (OSAHS) is a condition characterised by the repeated collapse of the pharyngeal airway, resulting in either complete (apnoea) or partial obstruction (hypopnoea) during sleep. Davies and Stradling, [4] reviewed 12 major worldwide prevalence studies for obstructive sleep apnoea and suggested that once methodological and disease definition factors are considered, 1 to 5 per cent of adult men and fewer women have sleep apnoea syndrome. Applied continuous positive airways pressure (CPAP) is regarded as the major non-surgical, long-term treatment - the so-called ‘Gold standard’ for OSAHS, with significant reversal of symptoms whilst maintaining airway patency. Its main limitation remains patient compliance, with a recent study demonstrating the overall efficacy of the sub-optimally used CPAP being similar to surgical treatment [6]. The role of mandibular advancement appliances (MAA) therapy in the treatment of OSAHS is being recognised, with the American Academy of Sleep Medicine considering it as the first line alternative to CPAP in the management of mild-moderate OSA [7]

Methods

Results

Conclusion