Non-CPAP therapies in obstructive sleep apnoea: Mandibular advancement device therapy

Dept of Orthodontics, Faculty of Medicine, Umeå University, Umeå, Sweden.
European Respiratory Journal (Impact Factor: 7.64). 11/2011; 39(5):1241-7. DOI: 10.1183/09031936.00144711
Source: PubMed


Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report. Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA. In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

Download full-text


Available from: Johan Verbraecken,
  • Source
    • "The most recent joint recommendations of the American Academy of Sleep Medicine (AASM) and the American Academy of Dental Sleep Medicine (AADSM) suggest a qualified dentist to use a custom or bespoke, titratable MRD when a sleep physician prescribes oral appliance therapy for the treatment of OSA [4] [5]. Indeed, the custom or bespoke, titratable oral appliances are the most commonly prescribed and the recommended type of oral appliances for the treatment of OSA [6] [7] [8] [9]. A recent randomized controlled trial comparing therapy for OSA using a custom, titratable MRD with CPAP treatment indicated that both have similar health effects and a comparable effect on blood pressure [10]. "

    Sleep Medicine 10/2015; DOI:10.1016/j.sleep.2015.08.011 · 3.15 Impact Factor
  • Source
    • "Obstructive sleep apnoea (OSA) is characterized by recurrent pharyngeal collapse with intermittent hypoxemia during sleep and subsequent repetitive arousal to maintain ventilation. Concomitant COPD and OSA, termed the overlap syndrome, is not rare and affects at least 1% of the general population [11-13]. Nocturnal continuous positive airway pressure (CPAP) via a pneumatic splint is effective in maintaining upper airway patency, and is standard treatment for OSA [14]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Exercise limitation is an important issue in patients with chronic obstructive pulmonary disease (COPD), and it often co-exists with obstructive sleep apnoea (overlap syndrome). This study examined the effects of nocturnal continuous positive airway pressure (CPAP) treatment on walking capacity in COPD patients with or without obstructive sleep apnoea. Forty-four stable moderate-to-severe COPD patients were recruited and completed this study. They all underwent polysomnography, CPAP titration, accommodation, and treatment with adequate pressure. The incremental shuttle walking test was used to measure walking capacity at baseline and after two nights of CPAP treatment. Urinary catecholamine and heart rate variability were measured before and after CPAP treatment. After two nights of CPAP treatment, the apnoea-hypopnoea index and oxygen desaturation index significantly improved in both overlap syndrome and COPD patients, however these changes were significantly greater in the overlap syndrome than in the COPD group. Sleep architecture and autonomic dysfunction significantly improved in the overlap syndrome group but not in the COPD group. CPAP treatment was associated with an increased walking capacity from baseline from 226.4 ± 95.3 m to 288.6 ± 94.6 m (P < 0.05), and decreased urinary catecholamine levels, pre-exercise heart rate, oxygenation, and Borg scale in the overlap syndrome group. An improvement in the apnoea-hypopnoea index was an independent factor associated with the increase in walking distance (r = 0.564). Nocturnal CPAP may improve walking capacity in COPD patients with overlap syndrome. Trial registration NCT00914264
    Respiratory research 06/2013; 14(1):66. DOI:10.1186/1465-9921-14-66 · 3.09 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Mandibular Advancement Devices (MAD) advance the lower jaw in a non-invasive treatment of sleep-disordered breathing. The device can be custom made (CM) in the dental lab, or fitted chair-sided using thermoplastic (TP) boil and bite' devices. Objectives: To measure the forces required to seat and remove a CM-MAD and a TP-MAD, both monoblocs, on a patient's dental models, at 2 protrusive positions. Methods: Dental impressions (Impregum Pentasoft Medium, 3M ESPE AG, Germany) were made and epoxy models were poured. CM-MAD was made by vacuum thermoforming (Ercoflex, Erkodent Pfalzgrafenweiler, Germany). TP-MAD (SomnoGuard, Tomed Dr. Toussaint GmbH Bensheim, Germany) was fitted intraorally after softening, as per manufacturer instructions. CM- and TP-MADs were made each at 3mm (n=4) and 8mm (n=4) protrusion. The models were mounted in an hydraulic test machine (Dartec HC10, Dartec, UK). The forces required for seating and removal of MADs were continuously recorded (7.5mm/s crosshead speed), 730 cycles @ 35C, dry. Results: Fig 1 compares a typical force curve of CM-MAD to TP-MAD for the given patient. Fig 2 shows the mean peak loads (SD) at seating and removal for both protrusions. The removal forces for CM-MAD are significantly higher at 3mm (p<0.0002) and 8mm (p<0.017) protrusions as compared to TP-MAD. In CM-MAD the higher protrusive position yields to significantly higher removal forces (p<0.005), due to an increasing divergence between upper and lower jaw. Conclusions: Removal forces mimic the retention of MADs. Although CM-MAD requires more effort and costs to be constructed, it shows significantly higher retentive forces as compared to TP-MAD. Since it is known that many treatment failures and discontinuation of therapy with MADs can be attributed to lack and/or loss of retention, a higher retentive force offers a distinct advantage.
    IADR General Session 2009; 04/2009
Show more