Abstract
Introduction
For patients with obstructive sleep apnea (OSA) who are either intolerant or otherwise non-compliant with positive airway pressure (PAP) therapy, the use of a mandibular advancement device (MAD) is a viable and minimally invasive alternative for select individuals. Many device variations exist, but the common mechanism of action involves airway augmentation via traction on the lower jaw provided by a dental appliance. Prior studies have identified factors associated with treatment success, however, actual clinical experiences fluctuate widely. To identify patients within the VA that might benefit most from MAD, we conducted a preliminary review of MAD referrals within a one-year period at the West Los Angeles VA (WLA VA).
Report of Case
This retrospective database review was performed to identify areas for improvement in MAD referrals within the West Los Angeles VA network. The need for informed consent was waived as part of reviews preparatory to research as outlined in paragraph 23c of the VHA Directive 1200.05. Our database was queried for all MAD dental referrals between January 1, 2017 and Dec 31, 2017. All patients that completed at least one dental visit were included, those that did not complete referrals were excluded. Patient charts were reviewed for demographic data, comorbidities, dentition quality, pre- and post- MAD sleep studies, prior failed therapies, duration of MAD usage, reasons for discontinuation, and final OSA treatment modality. Between January 1, 2017 and December 31, 2017, 246 patients were referred for MAD dental evaluation. 184 initial evaluations were completed, 55 were discontinued for various reasons, and 7 were cancelled.
*** Preliminary data for first 84 patients***
Of 84 patients seen in dental clinic, 33 (39%) were deemed poor candidates either because of insufficient dentition or because of existing temporal-mandibular joint discomfort, 4 patients declined any intervention. Of 47 patients that received an MAD, 6 patients continued to use MAD alone, 20 switched to PAP or other modalities, and 21 were lost to follow up.
Conclusion
Pending more in depth analysis
An Observation in Acrosclerosis Using the Galvanic Skin Response11From the Division of Dermatology and the Departments of Psychology and Engineering, University of California School of Medicine at Los Angeles and the Medical Service (Dermatology), Veterans Administration Center, General Medical and Surgical Hospital, West Los Angeles 25, California.