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The Effect of a Mandibular Advancement Device on Apneas and Sleep in Patients With Obstructive Sleep Apnea

Marie Marklund; Karl A. Franklin; Carin Sahlin; Rune Lundgren
Author and Funding Information

Affiliations: From the Department of Orthodontics, University Hospital, Umeå, Sweden,  From the Umeå University, and the Department of Pulmonary Medicine and Allergology, University Hospital, Umeå, Sweden

Affiliations: From the Department of Orthodontics, University Hospital, Umeå, Sweden,  From the Umeå University, and the Department of Pulmonary Medicine and Allergology, University Hospital, Umeå, Sweden


1998 by the American College of Chest Physicians


Chest. 1998;113(3):707-713. doi:10.1378/chest.113.3.707
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Abstract

Objective: To evaluate the effects of a mandibular advancement device on apneas and sleep in mild, moderate, and severe obstructive sleep apnea.

Design: Prospective study.

Subjects: Forty-four of 47 patients included.

Intervention: Individually adjusted mandibular advancement devices.

Measurements: Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings.

Results: The device reduced the median obstructive apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range, 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range, 44 to 66) to 14 (range, 2 to 32) (p<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=−0.41; p<0.01).

Conclusions: A mandibular advancement device reduces apneas and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.


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