Treatment of Snoring and Obstructive Sleep Apnea with a Mandibular Protruding Device: An Open-Label Study

ABSTRACT

The study objectives were to describe the changes in signs and symptoms of obstructive sleep apnea (OSA) and snoring using a mandibular protruding device (MPD) and to define the group of responders. The design of the study was a nonrandomized, open-labeled, prospective clinical study with a duration of 6 months. The setting was a hospital sleep laboratory and an ear, nose, and throat and dental outpatient clinic. Patients included 35 individuals treated: 22 with a diagnosis of OSA and 13 who snored without apnea.

The intervention before MPD prescription entailed a medical examination, a one-night somnographic registration, a questionnaire, and a clinical jaw function examination. All procedures were iterated at the 6-month follow-up. When the patients used the MPD, the subjective symptoms decreased significantly (p < 0.001). Twenty-four of the 35 patients were classified as responders, i.e., reduced their symptoms ≥50%. In the groups of OSA patients, the mean peak intensity of the snoring sound decreased from 71.6 dB to 62.0 dB (p < 0.001) and in the group of snorers, from 63.5 dB to 57.5 dB (p < 0.05). Eighteen of the 22 OSA patients decreased their ODI values by ≥50% (responders). The mean ODI decreased from 15.4 to 3.5 (p < 0.001) and the blood oxygen saturation, SaO₂ nadir, increased from mean 81.9 to 85.7 (n.s.). Most patients with tongue base hyperplasia were classified as responders to the MPD treatment.

In conclusion, a 6-month perspective shows that the MPD could be an effective treatment in reducing signs and symptoms of OSA and/or snoring, the compliance was acceptable and only minor adverse events occurred.

KEYWORD

Snoring - obstructive sleep apnea - mandibular advancement - dental appliance

REFERENCES

• 1 Young T, Palta M, Dempsey J. The occurrence of sleep-disordered breathing among middle-aged adults.  N Engl J Med . 1993;  328 1230-1235
• 2 Waite P D. Obstructive sleep apnea: a review of the pathophysiology and surgical management.  Oral Surg Oral Med Oral Pathol Oral Radiol . 1998;  85 352-361
• 3 Mooe T, Rabben T, Wiklund U. Sleep-disordered breathing in men with coronary artery disease.  Chest . 1996;  109 659-663
• 4 Hans M G, Nelson S, Luks V G. Comparison of two dental devices for treatment of obstructive sleep apnea syndrome (OSAS).  Am J Orthod Dentofacial Orthop . 1997;  111 562-570
• 5 Clark G T, Arand D, Chung E, Tong D. Effect of anterior mandibular positioning on obstructive sleep apnea.  Am Rev Respir Dis . 1993;  147 624-629
• 6 O'Sullivan R A, Hillman D R, Mateljan R. Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea.  Am J Respir Crit Care Med . 1995;  151 194-198
• 7 Millman R P, Rosenberg C L, Carlisle C C. The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty.  Chest . 1998;  113 992-996
• 8 Ferguson K A, Ono T, Lowe A A. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea.  Thorax . 1997;  52 362-368
• 9 Schmidt-Nowara W, Lowe A, Wiegand L. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review.  Sleep . 1995;  18 501-510
• 10 Ayas N T, Epstein L J. Oral appliances in the treatment of obstructive sleep apnea and snoring.  Curr Opin Pulm Med . 1998;  4 355-360
• 11 Ferguson K A, Ono T, Lowe A A. A randomized crossover study of an oral appliance versus nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea.  Chest . 1996;  109 1269-1275
• 12 Marklund M, Franklin K A, Sahlin C, Lundgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea.  Chest . 1998;  113 707-713
• 13 Menn S J, Loube D I, Morgan T D. The mandibular repositioning device: role in the treatment of obstructive sleep apnea.  Sleep . 1996;  19 794-800
• 14 Cohen R. Obstructive sleep apnea: oral appliance therapy and severity of condition.  Oral Surg Oral Med Oral Pathol Oral Radiol Endodont . 1998;  85 388-392
• 15 Thornton W K. Should the dentist independently assess and treat sleep-disordered breathing?.  Cal Dent Assoc J . 1998;  26 599-608
• 16 Karlebo S. Karlebo handbok. Kristianstads Boktryckeri AB, Kristianstad, Sweden; 1967; 886-887
• 17 Sjoholm T T, Polo O J, Rauhala E R. Mandibular advancement with dental appliances in obstructive sleep apnoea.  J Oral Rehabil . 1994;  21 595-603
• 18 Pantin C C, Hillman D R, Tennant M. Dental side effects of an oral device to treat snoring and obstructive sleep apnea.  Sleep . 1999;  22 237-240
• 19 Schmidt-Nowara W W, Meade T E, Hays M B. Treatment of snoring and obstructive sleep apnea with a dental orthosis.  Chest . 1991;  99 1378-1385
• 20 Marklund M, Franklin K A. Dental appliances in the treatment of snoring. A comparison between an activator, a soft-palate lifter, and a mouth-shield.  Swed Dent J . 1996;  20 183-188