Therapeutic Effect of Mandibular Advancement Device in Sleep-Related Breathing Disorders

ABSTRACT

BACKGROUND: The Mandibular advancement device (MAD) was known to be one of the effective treatments for the broad spectrum of sleep related breathing disorders. The aim of the present study was to evaluate the therapeutic effects and the determinants of success or failure of MAD in patients with sleep-related breathing disorders (SRBD). METHODS: We enrolled 20 patients with SRBD confirmed by overnight polysomnography. All patients were fitted with temporary MAD. Apnea-hypopnea index (AHI) and risk index (RI) were measured by a portable respiratory- monitoring device (MESAM IV) before and after temporary MAD use. RESULTS: Overall, MAD significantly reduced AHI (18.9+/-11.6/hr to 13.8+/-11.9/hr, p=0.029), but Epworth sleepiness scale was not improved (10.9+/-3.9 to 9.8+/-3.9, p=0.086). More than 50% of reduction in AHI was observed in 6 patients (30%, 6/20). When subjects were divided into patients who were satisfied with the temporary MAD and decided to keep wearing permanent MAD during the night (good response, GR, N=12) and patients who refuse to wear permanent MAD because they could not get accustomed to the temporary MAD (poor response, PR, N=8), There were no differences in age, body mass index, and pre-treatment AHI during the overnight polysomnography between both groups. There were significant reductions in AHI, and ESS were observed in GR, not in PR. Seven patients in GR group decided to apply the permanent MAD (two-piece Herbst type). CONCLUSIONS: These findings suggested that having good response to MAD determined the improvement of SRBD and daytime sleepiness. However, it is uncertain whether other factors affected the patients' compliance to MAD.