Mandibular advancement devices for the control of snoring

Abstract

Patients presenting with the complaint of antisocial snoring have very few options available to them of proven efficiency. Mandibular advancement devices worn intra-orally at night, have recently been shown in controlled trials to help mild to moderate obstructive sleep apnoea. However, there are no properly controlled studies with objective measurements on the use of such appliances for the management of antisocial snoring. Fifteen patients, already established on mandibular advancement devices for the control of snoring, were asked to participate in this study. They were studied over two nights, using a portable sleep monitoring device at home, both with and without their mandibular advancement devices in place (in randomized order). Snoring was measured using a surface throat microphone. In addition oxygen saturation and indirect beat to beat blood pressure were measured. The latter (using pulse transit time) provided an index of autonomic "arousals" and a measure of inspiratory effort. In nearly all of these highly selected patients the mandibular advancement devices reduced significantly the amount of snoring from a median of 193 to 20 snores x h(-1) (p<0.0001). In addition there was a reduction in respiratory effort, implying enlargement of the upper airway whilst wearing the appliance. These patients only represent those who were able to tolerate the appliance. With such clear evidence of their potential efficacy, and no suggestion from other studies of any harm, it would seem reasonable to introduce this approach into the management of antisocial snoring.

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

“…in patients following laser assisted uvuloplasty [14]. STRADLING et al [15] measured snoring objectively at home in 15 patients using MAS who all claimed a subjective w50% improvement in snoring, and showed a clear and consistent improvement in snoring measured as snores per hour (median Table 2 193 versus 20 snores per hour, pv0.0001) or time spent snoring (818 versus 50 s, pv0.0002). This is the only study directly comparing objective and subjective measures of snoring with MAS, although two other studies have demonstrated objective snoring reduction [8,16].…”

Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure?

“…1 Construction of the appliance requires upper and lower dental impressions from which plaster models are cast. A wax interocclusal record is taken with the patient posturing the lower jaw forward to about 75% of the maximum possible.…”

“…M andibular advancement devices (MADs) have been used successfully to control both snoring 1 and obstructive sleep apnoea (OSA). 2 It is assumed that they work by increasing the volume of the pharynx and rendering it less collapsible during sleep.…”

Dentistry's role in the diagnosis and co-management of patients with sleep apnoea/hypopnoea syndrome

“…Consistent with the team approach to care and because efficacy varies, patients using these appliances should have a follow up polysomnogram in order to assure therapeutic adequacy. 47,48 Individuals with SAHS may require surgery if they are unable to comply with CPAP, tolerate a prosthetic device or if larger movements (6 to 12 mm) of the tongue are necessary in order to move it anteriorly and away from the posterior pharyngeal wall. If the respiratory obstruction can be documented as occurring in the retropalatal area, the otolaryngologist or oral and maxillofacial surgeon will resect tissue from the free border of the soft palate (including the uvula), posterior tonsillar pillars, the palatine tonsils (if still present) and excessive mucosa from the anterior pillars and posterior pharyngeal walls using a scalpel and general anesthesia in a hospital operating room (uvulopalatopharyngoplasty: UPPP).…”