A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea

Abstract

Mandibular advancement appliances (MAAs) are accepted as a treatment option for snoring and mild obstructive sleep disorders. In the present clinical study two differently designed devices were examined for their effectiveness in treating obstructive sleep apnoea (OSA). The study was based on an assessment of 26 patients with a polysomnographic diagnosis of mild OSA [22 men, four women; mean body mass index 27.3 kg/m2 (SD 3.1); mean age 56.8 years (SD 5.2); mean respiratory disturbance index (RDI): 16.0 events/hour (SD 4.4)]. After insertion of the first MAA and a 6-8-week habituation period, a cardio-respiratory home-sleep study was carried out. Following a 2-3-week period with no treatment, the second appliance was inserted. The sequence of the devices was randomized. Once the patients had become accustomed to the second appliance, another somnographic registration was carried out. Daytime sleepiness, snoring, and sleep quality were assessed subjectively on a visual analogue scale. The results showed that a statistically significant improvement in the respiratory parameters was achieved with both appliances (P < 0.01). However, the activator [RDI: 5.5 events/hour, SD 3.3; apnoea index (AI): 3.4 events/hour, SD 2.1] was significantly more effective (P < 0.01) than the Silencor (RDI, 7.3 events/hour, SD 5.3; AI: 5.8 events/hour, SD 3.2). No difference was recorded in the subjective assessment of the therapeutic effects. Both appliances reduced daytime sleepiness and snoring and improved sleep quality, and both influenced the treatment outcome.

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

“…The RCTs evaluated the effects of MADs compared with placebo treatment [11,13,14,22,23,25,[28][29][30], CPAP [11, 13, 16-19, 24, 26, 32, 34] or between appliance designs [15,20,27,31,33,35,36,38]. Three studies reported longer-term results from MAD treatment after 1-4 yrs, compared with CPAP [12], surgery [37] or between two types of MAD [21].…”

“…Patients included in the RCTs had mild to severe OSA [13,14,17,18,20,[24][25][26][27][29][30][31][32][33][34][35][36][37][38], with mean AHI or RDI of 10-50. With MADs, AHI or RDI decreased to mean values of 4.5-34, which corresponded to reductions in the frequency of respiratory disturbances of means of 28-80% (mean reduction from all studies of 55%).…”

“…Comparison studies between the many custom-made device designs are few in number. These studies have indicated that there may be some differences in treatment effects, albeit minor [15,20,27,33]. The stability of the device is probably a limiting factor for its effectiveness [38].…”

Efetividade do aparelho ortopédico Bionator de Balters no tratamento do ronco e apnéia do sono

“…Com a utilização habitual do dispositivo, os pacientes que chegaram ao final do tratamento foram encaminhados para uma nova polissonografia, a qual foi realizada com o paciente fazendo o uso do aparelho ortopédico Bionator de Balters para avaliar e quantificar a eficácia deste dispositivo no tratamento do ronco e da apnéia. Observou-se melhora estatisticamente significante em relação ao IDR (índice de distúrbio respiratório), mostrando a efetividade deste dispositivo e corroborando outros estudos 1,9,12,13,15,17,26,33 que também utilizaram dispositivos intrabucais para o tratamento da SAOS. Este exame, assim como no inicial, realiza uma monitorização das características do sono em condições o mais próximo possível das normais e semelhantes às do paciente em sua casa.…”

Dental Considerations in Obstructive Sleep Apnea Patients: A review

“…AveoTSD, or "Tongue Stabilizing Device" The aveoTSD is made from a soft medical silicone for comfort and works by holding the tongue forward by gentle suction preventing it from falling back against the back of the throat, keeping the airway open during sleep (George et al, 1987;Schmidt-Nowara et al, 1991;Meyer-Ewert et al, 2002;Wade, 2003;Chen et al, 2012). (Ferguson et al, 2006;Chan et al, 2007;Ogawa et al, 2015;Ballanti et al, 2015).…”