Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea

Abstract

Study Objectives: To compare the effi cacy of adjustable and fi xed oral appliances for the treatment of OSA. Methods: Retrospective review of consecutive patients with OSA treated with either adjustable or fi xed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defi ned as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared effi cacy rates between fi xed and adjustable appliances and sought to identify factors associated with greater success. Results: We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fi xed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was signifi cantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fi xed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fi xed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. Conclusions: Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these fi ndings, the baseline AHI should be considered when selecting the type of oral appliance. Keywords: Oral appliance, mandibular advancement device, obstructive sleep apnea, effi cacy Citation: Lettieri CJ; Paolino N; Eliasson AH; Shah AA; Holley AB. Comparison of adjustable and fi xed oral appliances for the treatment of obstructive sleep apnea.

MADs and Positional Sleep Apnea: More than Meets the Eye!

“…However, practice trends elsewhere show that duoblocs are increasingly being used. Given conflicting results between earlier studies with monoblocs [2][3][4][5] including present study by Takaesu et al 7 and recent study by Sutherland et al 11 that used a particular type of duobloc, large-scale randomized controlled trials that test different device designs on different populations with a uniform definition of P-OSA are warranted to provide more clarity. Until then, the association between MADs and P-OSA is more complex than meets the eye!…”

“…either monobloc 4,5 or duobloc. 2,3 A common feature of these devices studied in earlier studies [2][3][4][5] was their inability to allow jaw opening in sleep. The most recent study by Sutherland et al 11 used a duobloc which does allow jaw opening in sleep.…”

“…1 However, prediction of treatment outcome with MADs remains a key unresolved issue, this perhaps becoming more complicated as a plethora of devices have evolved that differ in their design, fabrication, adjustability, allowance of either vertical or lateral jaw movement, and plate connectors. Based on data from earlier studies, [2][3][4][5] factors that predict successful MAD treatment include younger age, lower body mass index (BMI), smaller neck circumference, and supinedependent or positional OSA (P-OSA). 6 However, none of the prior studies 2-5 compared the efficacy of MADs with continuous positive airway pressure (CPAP).…”

A Comparison of Different Success Definitions in Non-Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Using Cardiopulmonary Coupling

“…Most criteria were based on the AHI value ( Table 1). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] However, sleep clinicians encounter patients who state that their quality of sleep improved with non-CPAP treatment, even though their AHI had not improved. Therefore, we analyzed each criterion, based on sleep quality, as assessed by the cardiopulmonary coupling (CPC) technique.…”

Efficiency of Mandibular Advancement Device and Bilevel Positive Airway Pressure Treatment for Severe Obstructive Sleep Apnea

“…Treatment success is commonly defined by a reduction in RDI to <5 or <10 in addition to a <50% reduction in baseline RDI. [5][6][7][8]17,18 The patient's RDI decreased from 62.7…”