Mandibular advancement device in Parkinson's disease: a pilot study on efficacy and usability.

BACKGROUND/OBJECTIVES: Continuous positive airway pressure (CPAP) is efficacious in the treatment of obstructive sleep apnea syndrome (OSAS) in patients with Parkinson's disease (PD). However, this treatment is often not well tolerated in this disabled population. We explored, in a pilot study, the efficacy, observance, and usability of mandibular advancement device (MAD) for the treatment of OSAS in this peculiar population. PATIENTS/METHODS: Twenty patients with PD and moderate or severe OSAS were included in the study. Ten patients had refused or not tolerated the validated treatment with CPAP so that they were treated with MAD. The patients treated with MAD were matched for sex, age and body mass index (BMI) to 10 patients with PD treated with CPAP. We explored the efficacy of MAD on sleep disorders complaints (PDSS-2) and on sleep recordings. We compared adherence, tolerance and usability with MAD and with CPAP. RESULTS: MAD improved sleep complaints increasing PDSS-2 scores (85 [55-106] vs 106 [88-126], p < 0.005), and sleep respiratory measures reducing apnea/hypopnea index (AHI) (50.8 [30.0-76.4] vs 9.4 [5.0-45.2], <0.001) and oxygen desaturation index (22.9 [2.1-92.0] vs 3.8 [0.2-34.2], p < 0.05). Observance was higher with MAD than with CPAP. Usability and caregiver satisfaction were higher with MAD than with CPAP whereas side effects were similarly reported. CONCLUSION: Mandibular advancement device may be an noteworthy alternative treatment of OSAS in patients with PD.

[OSA in adults: Role of the mandibular advancement device (MAD)]. / Troubles respiratoires obstructifs du sommeil de l'adulte : place de l'orthèse d'avancée mandibulaire.

Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/ hypopnea syndrome (OSA). Oral appliances advance the mandible and tongue, enlarge and stabilize the upper airways during sleep. Clinical examination is used to select candidates for oral appliances and a particular appliance for a given patient. Titration of the advancement will optimize its effectiveness by resolving subjective clinical symptoms. Polygraphic or ventilatory polysomnography controls the effectiveness of the treatment (IAH reduction, increase of oxygen saturation and improvement of the main symptoms). Clinical follow-up is required to assess longterm outcomes, side effects and treatment adherence. Oral appliances are effective in the short-term provided they achieved a 50% reduction in IAH and complete symptom resolution.