Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea.

Abstract

Snoring and obstructive sleep apnea (OSA) are related to narrowing of the upper airway. A mandibular advancement splint (MAS) could improve both conditions by increasing oropharyngeal and hypopharyngeal dimensions. The effects of a MAS on snoring and OSA was evaluated 3.5 +/- 2.1 (mean +/- SD) mo after issue in 57 subjects with habitual loud snoring, 39 of whom had an apnea-hypopnea index (AHI) > or = 10. Assessment was by questionnaire (all subjects) and polysomnography (51 subjects, 47 male) including measurement of sound intensity. Use of the MAS was randomized to first or second half of study. Snores were scored where inspiratory noise was greater than 5 dB above background. Total sleep time, sleep efficiency, % REM sleep, and % sleep spent supine were similar (p > 0.05) with and without the MAS. Snores per sleep minute, corrected for time in apnea, and sound intensity of snores (% snores > or = 50 dB) decreased with the MAS from 11.0 +/- 5.8 and 42.0 +/- 25.0% to 9.0 +/- 6.0 (p < 0.01) and 26.2 +/- 25.2% (p < 0.01), respectively. Using the MAS significantly improved OSA: AHI decreased from 32.2 +/- 28.5 to 17.5 +/- 22.7 (p < 0.01) and arousal index decreased from 31.4 +/- 20.6 to 19.0 +/- 14.6 (p < 0.01). AHI decreased to < 20 with the MAS in 12 of 17 subjects where untreated AHI was between 20 and 60, and in 2 of 9 subjects where untreated AHI was > 60. Forty-five patients continued to use the MAS regularly.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of moderate alcohol upon obstructive sleep apnoea

“…Although snoring is a hallmark symptom of OSA, it is rarely measured objectively, and there is no standard method to do so. In this study, snoring intensity was objectively measured with an audiometer placed 1 m from the mouth, a technique similar to that used by previous groups [28,29]. Analysis was performed using the maximum for NREM and REM stages of sleep, with the area under the curve and the % sleep time >50 dB; therefore, the recordings are believed to be accurate.…”

The effect of a mandibular advancement splint in subjects with sleep-related breathing disorders

“…The risk of exacerbating the sleep-related breathing disorder by mandibular advancement splint therapy has been previously reported and indeed is the reasoning behind undertaking a follow-up objective assessment. 23,32,33 Mandibular advancement splints are thought to act by increasing the size and/or reducing the collapsibility of the pharyngeal airway. 15 Cephalometric predictors have been suggested where a favourable response to MAS therapy can be expected 15 but the technique at best only provides a two-dimensional image.…”

“…Objective reduction in snoring by way of a decrease in the number of snores per hour, time spent snoring and mean sound level across the night has been demonstrated. 23,24 The study by Johnston et al 22 demonstrated the mandibular advancement splint as being significantly more effective than a placebo in reducing the frequency and loudness of snoring.…”

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

“…39 Bolstering these results are additional studies which have shown that the oral appliances decrease the AHI by more than half and improve both arterial oxygen saturation and sleep quality in approximately 50% of patients with SAHS. [40][41][42] Removable mandibular repositioning devices are constructed so that the lower jaw …”