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Clinical Investigations: SLEEP AND BREATHING |

Mandibular Advancement Device in Patients With Obstructive Sleep Apnea*: Long-term Effects on Apnea and Sleep

Marie Marklund, DDS; Carin Sahlin, RTA; Hans Stenlund, PhD; Maurits Persson, DDS, PhD; Karl A. Franklin, MD, PhD, FCCP
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*From the Departments of Orthodontics (Drs. Marklund and Persson), Respiratory Medicine (Dr. Franklin and Ms. Sahlin), and Epidemiology and Public Health (Dr. Stenlund), Umeå University, Umeå, Sweden.

Correspondence to: Marie Marklund, DDS, Department of Orthodontics, Umeå University, SE-901 87 Umeå, Sweden; e-mail: Marie.Marklund@odont.umu.se



Chest. 2001;120(1):162-169. doi:10.1378/chest.120.1.162
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Study objectives: To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement device in patients with obstructive sleep apnea.

Design: Prospective study.

Setting: Department of Respiratory Medicine, University Hospital, Umeå, Sweden.

Patients: Thirty-three consecutively treated patients.

Interventions: Individually adjusted mandibular advancement devices.

Measurements and results: Polysomnographic sleep recordings on 1 night without the device and 1 night with the device were performed after 0.7 ± 0.5 years (mean ± SD) and after 5.2 ± 0.4 years from the start of treatment. Nineteen of the 33 patients experienced a short-term satisfactory treatment result with an apnea-hypopnea index of < 10 events per hour and a satisfactory reduction in snoring. Fourteen patients were regarded as being insufficiently treated with the device. Seventeen of the short-term satisfactorily treated patients (90%) and 2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 ± 17 to 4.9 ± 5.1 events per hour (p < 0.001) in these 19 long-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients. Patients with their devices replaced or adjusted experienced a better long-term effect than patients still using their original devices (p < 0.05).

Conclusions: The long-term effect and tolerability of a mandibular advancement device are good in patients who are recommended the treatment on the basis of a short-term sleep recording, provided that the device is continuously adjusted or replaced with a new one when needed. A short-term follow-up is valuable in the selection of patients who will benefit from long-term treatment with a mandibular advancement device.

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