Mandibular Advancement Titration for Obstructive Sleep Apnea

Fleury, Bernard; Rakotonanahary, Dominique; Pételle, Boris; Gerard, Vincent; Pelletier‐Fleury, Nathalie; Meyer, B.; Lebeau, B.

doi:10.1378/chest.125.5.1761

Cited by 89 publications

(13 citation statements)

References 28 publications

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“…This appears to be higher than the 52% average ability of an MAD to decrease the AHI below 10/h5 but is close to that recently reported in other studies 17. Such a high success rate can also be accounted for by the use of an abbreviated sleep recording to optimise MAD titration 16. The better success rate previously observed by Fleury et al using this strategy (complete response in 63.6% and partial response in 18.2%) may relate to the difference in the population studied.…”

Section: Discussionsupporting

confidence: 81%

“…The choice of the device (ORM, ResMed, SanDiego, California, USA; TAP or Silent Nite, Glidewell Laboratories, Newport Beach, California, USA) was made by this investigator according to his clinical experience. Following an initial acclimatisation period, the MAD was progressively advanced to obtain an optimal response based on the assessment of subjective (symptoms resolution, abolition of snoring, improvement in daytime sleepiness according to the Epworth Sleepiness Score (ESS)) and objective (abbreviated home respiratory recording: Apnoea link, version 6.0, ResMed, Poway, California, USA)16 variables or until maximal tolerance.…”

Section: Methodsmentioning

confidence: 99%

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Prediction of oral appliance efficiency in patients with apnoea using phrenic nerve stimulation while awake

Bosshard

Masse

Sériès

2011

Thorax

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BackgroundIn patients with sleep apnoea, primary oropharyngeal collapse of the upper airway during sleep is an important predictor of treatment success with an oral appliance. Phrenic nerve stimulation is able to induce upper airway obstruction and was therefore used to mimic the target for an efficient treatment with an oral appliance. Objective To test if the site(s) of upper airway collapse identified by means of bilateral anterior magnetic stimulation during wakefulness could predict the efficacy of treatment with an oral appliance in patients with obstructive sleep apnoea. Methods The site(s) of upper airway collapse while awake were identified by examining the flowepressure relationship of flow-limited twitches when measuring velopharyngeal and oropharyngeal pressure. Once the mandibular advancement titration had been completed, the efficacy of mandibular advancement was documented during an in-lab sleep study. Results 33 patients (24 men and 9 women, apnoeaehypopnoea index (AHI) 32.5617

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Section: Discussionsupporting

confidence: 81%

Section: Methodsmentioning

confidence: 99%

Prediction of oral appliance efficiency in patients with apnoea using phrenic nerve stimulation while awake

Bosshard

Masse

Sériès

2011

Thorax

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“…Most outcome studies on MAD therapy are using a so-called "subjective titration protocol," relying on both the physical limits of the patient's mandibular protrusion and the self-reported evolution of symptoms, such as snoring and/or daytime sleepiness [25][26][27][28]. However, such subjective improvement in symptoms may not provide the most accurate indicator for efficient titration of the MAD: it may result in a suboptimal treatment outcome, since the reduction of the subjective complaints may encourage a premature interruption of the titration [29,30]. So, at this stage, MAD titration remains a "trial and error" approach [31].…”

Section: Types Of Oral Appliancesmentioning

confidence: 99%

Oral Appliances in Obstructive Sleep Apnea

Dieltjens

Vanderveken

2019

Healthcare

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Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

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“…A titration procedure millimeter by millimeter has, therefore, been recommended in order to achieve optimal results. [6]…”

Section: Aimmentioning

confidence: 99%