Therapeutic outcomes of mandibular advancement devices as an initial treatment modality for obstructive sleep apnea

Abstract

Although continuous positive airway pressure (CPAP) is a highly efficacious treatment for obstructive sleep apnea (OSA), there is a need for alternative treatment options, such as sleep surgeries and mandibular advancement devices (MADs), to overcome the limitations of CPAP.This study aimed to analyze the therapeutic outcomes of OSA subjects who were treated with a MAD, and to estimate the clinical impact of MAD as a first-line treatment for OSA.Forty-seven patients diagnosed with OSA received an adjustable MAD as an initial treatment. Drug-induced sleep endoscopic findings and sleep parameters (both pre-MAD and post-MAD treatment), such as apnea index, oxygen saturation, and degree of daytime sleepiness, were assessed retrospectively.The MAD treatment resulted in a significant reduction in apnea–hypopnea index, and also a significant elevation in lowest oxygen saturation. Satisfactory results of MAD treatment as a first treatment modality were observed in 27 patients, and a successful outcome was reached in approximately 72% of patients. The OSA patients who had lower body mass index and upper airway narrowing at the level of palate and tongue base showed relatively higher rates of a satisfactory outcome even in cases of moderate or severe OSA.These results suggest that the use of a MAD may be an alternative treatment option in OSA patients with retropalatal and retroglossal area narrowing regardless of disease severity. Additionally, MADs can be recommended as an initial treatment modality, and the effectiveness of MADs in achieving success may not be inferior to CPAP.

Efficacy of Oral Appliance Therapy as a First-Line Treatment for Moderate or Severe Obstructive Sleep Apnea: A Korean Prospective Multicenter Observational Study

“…This study evaluated the effect of OAs as a first-line treatment in Korean patients with moderate or severe OSA. The cohorts in previous retrospective 9,16,17 and prospective 10 studies only included some patients with moderate OSA (30-60%) or severe OSA (6-57%). One study evaluated the effect of OA treatment in 34 Chinese patients with severe OSA who refused CPAP therapy.…”

“…A few retrospective Korean studies found that the rates of successful OA treatment in patients with moderate OSA and those with severe OSA were 71-82% and 70-75%, respectively. 8,9 One prospective study performed in Thailand included a subset of these patients, and found success rates of 55% and 75% in individuals with moderate OSA and those with severe OSA, respectively. 10 Since the responses to OA treatment vary, careful patient selection is crucial for achieving treatment success in clinical practice.…”

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

“…A study with drug‐induced sleep endoscopy suggested that oral appliances might not be effective as a first‐line treatment for OSA patients with lateral wall obstruction (Park et al . ). Very recently, in a study run in parallel to our current investigation, tongue base obstruction (rather than palate, pharyngeal lateral walls, or epiglottis) seen on drug‐induced sleep endoscopy was found to increase the probability of a strong oral appliance response (Op De Beeck et al .…”

“…For example, in a small study (n = 12), oropharyngeal collapse (based on a multi-tip pharyngeal pressure catheter) was a predictor of oral appliance responses (Ng et al 2006). A study with drug-induced sleep endoscopy suggested that oral appliances might not be effective as a first-line treatment for OSA patients with lateral wall obstruction (Park et al 2016). Very recently, in a study run in parallel to our current investigation, tongue base obstruction (rather than palate, pharyngeal lateral walls, or epiglottis) seen on drug-induced sleep endoscopy was found to increase the probability of a strong oral appliance response (Op De Beeck et al 2018) Intuitively, patients with tongue-related obstruction are expected to exhibit a preferential improvement in collapsibility with mandibular advancement.…”

The clinical efficacy of relocation pharyngoplasty to improve retropalatal circumferential narrowing in obstructive sleep apnea patients

“…Both upper airway narrowing and increased airway resistance reportedly contribute to the underlying pathogenesis of OSA, leading to sleep-related symptoms such as loud snoring, apnea, fatigue, daytime sleepiness and systemic complications if not properly treated [3][4][5][6][7][8] . OSA occurs due to fixed or dynamic upper-airway obstruction caused by anatomical factors or abnormal upper-airway motor tone, and upper-airway obstruction can be caused by collapse at multiple levels, such as the soft palate, uvula, palatine tonsils, lateral pharyngeal walls, and base of the tongue 5,9 . A palatal pattern of collapse is most frequent and numerous surgical techniques have been designed to modify the palate anatomy in OSA patients 10 .…”