Clinical- and Cost-Effectiveness of a Mandibular Advancement Device Versus Continuous Positive Airway Pressure in Moderate Obstructive Sleep Apnea

Aim: Some obstructive sleep apnea (OSA) patients may have mandibular retrognathia (ANB > 4.7° and SNB < 76.2°). Currently, there are no studies that have compared the effectiveness of continuous positive airway pressure (CPAP) versus mandibular advancement device (MAD) in severe OSA patients with mandibular retrognathia. We explored the efficacy of CPAP versus MAD for the treatment of severe OSA patients with mandibular retrognathia. Methods: A total of 105 patients were enrolled. Outcomes were assessed by using polysomnography, Epworth Sleepiness Scale (ESS), Snore Scale (SS), Self-rating Anxiety Scale (SAS), and compliance, before treatment and after 6 and 12 months of treatment. Results: Continuous positive airway pressure was superior to MAD in improving polysomnographic outcomes and SS score, but reported compliance was higher on MAD. There is no significant difference between the 2 treatments in terms of ESS score and SAS score. Obstructive sleep apnea patients with mandibular retrognathia showed greater improvement than those without mandibular retrognathia in terms of apnea-hypopnea index and oxygen desaturation index after MAD. Conclusion: Continuous positive airway pressure and MAD are both effective in treating severe OSA patients with mandibular retrognathia. Mandibular advancement device is a good alternative to CPAP in severe OSA patients with mandibular retrognathia. Mandibular advancement device is more effective in treating OSA patients with mandibular retrognathia than those without. Trial registration: ChiCTR2000032541.

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Cardiovascular effects of a mandibular advancement device versus continuous positive airway pressure in moderate obstructive sleep apnea

10.1183/13993003.congress-2018.pa4344 ◽

2018 ◽

Author(s):

Grietje E. De Vries ◽

Aarnoud Hoekema ◽

Ewout Houwerzijl ◽

Wouter Jacobs ◽

Jan Van Der Maten ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Cardiovascular Effects ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Obstructive Sleep

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Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

European Journal of Dentistry ◽

10.1055/s-0040-1719220 ◽

2021 ◽

Author(s):

Thyagaseely Sheela Premaraj ◽

Jacob Stadiem ◽

Shyamaly Arya Premaraj ◽

Charles R. Davies ◽

Matthew Dennis ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Daytime Sleepiness ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Severe Obstructive Sleep Apnea ◽

Obstructive Sleep ◽

The Mean

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

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PMD9 CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE COMPARED TO USUAL CARE FOR SEVERE OBSTRUCTIVE SLEEP APNEA: A COST-EFFECTIVENESS ANALYSIS

Value in Health ◽

10.1016/j.jval.2019.04.1007 ◽

2019 ◽

Vol 22 ◽

pp. S217

Author(s):

R.C. Lucchetta ◽

M.P. Rosim ◽

L. Okumura ◽

G.O. Pedro ◽

C. Albertini ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Cost Effectiveness ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Usual Care ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Severe Obstructive Sleep Apnea ◽

Effectiveness Analysis ◽

Obstructive Sleep

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Higher Effective Oronasal versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: Effect of Mandibular Stabilization

Canadian Respiratory Journal ◽

10.1155/2014/408073 ◽

2014 ◽

Vol 21 (4) ◽

pp. 234-238 ◽

Cited By ~ 18

Author(s):

M Kaminska ◽

A Montpetit ◽

A Mathieu ◽

V Jobin ◽

F Morisson ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Continuous Positive Airway Pressure ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Mandibular Advancement ◽

Neutral Position ◽

Nasal Cpap ◽

Obstructive Sleep ◽

Oronasal Mask

BACKGROUND: In some individuals with obstructive sleep apnea (OSA), oronasal continuous positive airway pressure (CPAP) leads to poorer OSA correction than nasal CPAP. The authors hypothesized that this results from posterior mandibular displacement caused by the oronasal mask.OBJECTIVE: To test this hypothesis using a mandibular advancement device (MAD) for mandibular stabilization.METHODS: Subjects whose OSA was not adequately corrected by oronasal CPAP at pressures for which nasal CPAP was effective were identified. These subjects underwent polysomnography (PSG) CPAP titration with each nasal and oronasal mask consecutively, with esophageal pressure and leak monitoring, to obtain the effective pressure (Peff) of CPAP for correcting obstructive events with each mask (maximum 20 cmH2O). PSG titration was repeated using a MAD in the neutral position. Cephalometry was performed.RESULTS: Six subjects with mean (± SD) nasal Peff 10.4±3.0 cmH2O were studied. Oronasal Peff was greater than nasal Peff in all subjects, with obstructive events persisting at 20 cmH2O by oronasal mask in four cases. This was not due to excessive leak. With the MAD, oronasal Peff was reduced in three subjects, and Peff <20 cmH2O could be obtained in two of the four subjects with Peff >20 cmH2O by oronasal mask alone. Subjects’ cephalometric variables were similar to published norms.CONCLUSION: In subjects with OSA with higher oronasal than nasal Peff, this is partially explained by posterior mandibular displacement caused by the oronasal mask. Combination treatment with oronasal mask and MAD may be useful in some individuals if a nasal mask is not tolerated.

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