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Original Research: SLEEP DISORDERS |

Does Propulsion Mechanism Influence the Long-term Side Effects of Oral Appliances in the Treatment of Sleep-Disordered Breathing?Oral Appliances and Sleep-Disordered Breathing

Jean-Philippe Vezina, MD; Marc B. Blumen, MD; Isabelle Buchet, MD; Chantal Hausser-Hauw, MD; Frederic Chabolle, MD
Author and Funding Information

From the Department of Otolaryngology–Head and Neck Surgery (Drs Vezina, Blumen, and Chabolle), the Department of Stomatology (Dr Buchet), and the Department of Neurology (Dr Hausser-Hauw), Foch Hospital, Suresnes, France.

Correspondence to: Frederic Chabolle, MD, Hôpital Foch, Service Orl-Chirurgie de la Face et du Cou, 40 rue Worth, 92151 Suresnes, France; e-mail: f.chabolle@hopital-foch.org


Funding/Support: Supported by a research grant from the French Society of Otolaryngology.

For editorial comment see page 1110

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(5):1184-1191. doi:10.1378/chest.10-3123
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Background:  Mandibular advancement appliances (MAAs) can be used to treat sleep-disordered breathing, and differences in their designs have been thought to influence the occurrence of secondary effects. With bibloc devices, the lateral attachments producing mandibular propulsion can be inserted to generate traction or compression. We evaluated the clinical impact of this difference by comparing the long-term secondary effects and compliance of two devices.

Methods:  One hundred sixty-two records of patients fitted with a traction-based or compression-based MAA before January 2008 were reviewed retrospectively for physical examination findings and cephalometry. Patients were sent a postal survey and contacted by phone 2 weeks later. They were offered a follow-up medical visit with repeat cephalometry. Main outcomes were long-term (> 2 years) secondary effects, compliance, or satisfaction.

Results:  Of the patients who attended the follow-up visit, 48 had worn the MAA for > 2 years (16 traction based and 32 compression based), and nine for < 6 months (used as control subjects). Mean follow-up times for the traction and compression groups were 3.7 ± 1.2 years and 3.6 ± 1.2 years, respectively. No difference was found between the MAAs for subjective and objective side effects, except for greater early pain to the masticatory muscles (P = .02) and residual tongue pain (P = .04) in the compression group. However, pain intensity was low and clinical relevance was uncertain. No difference was found for compliance, satisfaction, and objective or subjective efficacy.

Conclusions:  This study suggests that traction-based appliances are similar to compression-based devices with regard to secondary effects and compliance.

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