Titrated mandibular advancement versus positive pressure for sleep apnoea

Département de Pneumologie, CHU, Angers, France.
European Respiratory Journal (Impact Factor: 7.64). 04/2009; 34(4):914-20. DOI: 10.1183/09031936.00148208
Source: PubMed


The aim of this study was to compare mandibular advancement device (MAd) therapy and continuous positive airway pressure (CPAP) for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) after one-night polysomnographic (PSG) titration of both treatments. 59 OSAHS patients (apnoea/hypopnoea index (AHI): 34+/-13 events x h(-1); Epworth scale: 10.6+/-4.5) were included in a crossover trial of 8 weeks of MAd and 8 weeks of CPAP after effective titration. Outcome measurements included home sleep study, sleepiness, health-related quality of life (HRQoL), cognitive tests, side-effects, compliance and preference. The median (interquartile range) AHI was 2 (1-8) events x h(-1) with CPAP and 6 (3-14) events x h(-1) with MAd (p<0.001). Positive and negative predictive values of MAd titration PSG for treatment success were 85% and 45%, respectively. Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL. The reported compliance was higher for MAd (p<0.001) with >70% of patients preferring this treatment. These results support titrated MAd as an effective therapy in moderately sleepy and overweight OSAHS patients. Although less effective than CPAP, successfully titrated MAd was very effective at reducing the AHI and was associated with a higher reported compliance. Both treatments improved functional outcomes to a similar degree. One-night titration of MAd had a low negative predictive value for treatment success.

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    • "Although CPAP shows greater efficacy, mandibular advancement devices can lead to higher compliance with therapy (Phillips et al, 2013). In one study, both treatments improved subjective and objective EDS, cognitive performance, and quality of life (Gagnadoux et al, 2009). However, more than 70% of patients reported that they preferred the oral appliance. "
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    • "Mandibular advancement devices (MADs) are currently the most common class of oral appliances used to treat OSA and custommade MADs are to be preferred and recommended over prefabricated devices (Vanderveken et al., 2008). MADs are worn intra-orally during the night and mechanically protrude the mandible, commonly with a design to gradually protrude the mandible applying a mechanical advancing mechanism (Dieltjens et al., 2012b; Gagnadoux et al., 2009). The aim is to prevent UA collapse and increase the cross-sectional airway dimensions, and thereby reduce snoring and obstructive sleep apneas (Tsuiki et al., 2004). "
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    • "However, OA is less systematically effective than CPAP at improving polysomnographic data; approximately 50% of patients with OA have an AHI <5, and 70% reduce their AHI by >50% (Fleury et al., 2004; Lim et al., 2009). Even so, OA is often preferred by patients (Gagnadoux et al., 2009). The use of OA may provide better compliance during sleep and, in a number of cases, control of OSAS is at least as effective as it is with Table 3 Validity of the decision board tested in healthy volunteers: changes in the number of participants who would still choose oral appliance (OA) according to changes in its rates of effectiveness and modification of occlusal contacts (n = 20) "
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