Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey

Abstract

A mandibular advancement splint (MAS) may be an alternative treatment for snoring and obstructive sleep apnoea (OSA). However, there is little subjective or objective information concerning long-term effectiveness, compliance and side effects.A retrospective questionnaire was used to survey these issues plus patient satisfaction and maintenance requirements in 166 patients who could have worn a mandibular advancement splint for over a year.One-hundred and twenty-six (76%) subjects returned the questionnaire, (84 with OSA, 42 snorers), of whom 69 (55%) reported still using the splint regularly, 47 (37%) every night. The most common reported reasons for stopping use were discomfort (29/ 57; 52% of nonusers), and poor perceived efficacy (12 subjects). Users reported more daytime symptoms, and they and their partners were more likely to observe improvements with splint use. Side effects were reported by 49 subjects, more commonly in nonusers. Sixty-five of 67 current users and 23 of 41 nonusers reported less snoring with splint use (p~v0.001).Long-term mandibular advancement splint usage appeared less satisfactory than previously reported, however, splints were considered effective by 97% of current users and even by over half of those who had stopped use. Reasons for stopping use included side effects, social circumstances, dental treatment, as well as lack of perceived efficacy. Snoring and obstructive sleep apnoea (OSA) may result from collapse of the upper airway during sleep because of loss of muscle tone and anatomical factors. Bringing the mandible forward advances the tongue and thus enlarges the retroglossal airway, reducing the tendency to collapse [1]. Mandibular advancement devices are therefore being increasingly used as a treatment for snoring and as a possible alternative to nasal continuous positive airway pressure (CPAP) devices in OSA. Several randomized controlled trials of mandibular advancement splints (MAS) or nasal CPAP have shown splints to be effective in some patients and although they do not always lower the apnoea-hypopnoea index (AHI) as satisfactorily as CPAP, they are preferred by most patients in shortterm trials of 4 -12 weeks treatment [2 -4]. One study of long-term use of CPAP over a median follow up of 22 months, showed that 20% of 1,103 people stopped treatment after taking a machine home [5]. However, follow up with MAS has been limited to much smaller numbers and for a shorter time, with few data on longterm usage [6]. As splints are usually fitted because a patient is symptomatic or their partner complains about their snoring, continued use of the device will depend on the patient and their partner9s perceptions of symptomatic benefit and side effects. A retrospective questionnaire based study of factors affecting continued usage of mandibular advancement splints in 166 consecutive patients who had had a splint for at least one year was carried out. MethodsOne-hundred and sixty-six patients (140 males, 26 females) with sleep disordered breathing (111 OSA, 55 snorers)...

Mandibular Advancement Device Therapy in Obstructive Sleep Apnea and Snoring in Community Dental Care: Two-year Follow-up Study on Self-reported Sleep Quality, Side Effects, and Compliance

“…On the other hand, Jauhar et al reported only modest improvement in sleep quality in their ten-year follow-up study [25]. Nevertheless, McGown et al and Wiman Eriksson et al found improved daytime tiredness compared to baseline in a long-term design [27,28]. This all may be summoned that more intensive control of effect of the treatment, i.e.…”

“…Yet, only few longer-term studies exist in this field [27,28]. Also, the sample size (n=103) in our study may be considered fair [23].…”

Obstructive sleep apnea: Aetiology, diagnosis, treatment

“…potwierdzają lepszą akceptację przez pacjentów aparatów MAD w porównaniu z CPAP ze względu na wygodę i komfort użytkowania. 48 Skuteczność lecznicza aparatów MAD oraz lepsza ich akceptacja w grupie badanych ma często związek z konstrukcją szyn i parametrami według których szyny pozostają względem siebie. 36,[49][50][51] Stwierdzono, że jednoczęściowe aparaty są lepiej tolerowane przez pacjentów w porównaniu z aparatami dwuczęściowymi ze względu na łatwiejsze zakładanie i zdejmowanie oraz utrzymanie wła-ściwej higieny.…”

Patients' and sleeping partners' experience of treatment for sleep-related breathing disorders with a mandibular repositioning splint

“…(Table 2) This is comparable to other response rates in the literature such as 73.7% achieved by Shadaba and 76% by McGown. 12,14 Twelve responses were excluded as the subjects did not complete the questionnaire but returned it with a hand written letter commenting on their treatment. Some subjects failed to answer all of the questions resulting in a smaller number (n) of responders for some of the questions.…”

“…15 Data on long term MRS compliance are limited, with a range of 52-100% reported. 10,13,14,16 Schmidt-Nowara in 1995 reported that patients must receive initial written instruction to produce the best rates of compliance; hence in this study patients were given written instructions at their initial visit and on fitting the MRS. 10 The compliance rate of 68% achieved is comparable with results of other studies such as 75% achieved by Schmidt-Nowara in 1995, 10 and 76% achieved by Johal in 1999. 11…”