title: Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea.
abstract: OBJECTIVE
  To evaluate an adjustable mandibular positioning appliance for treatment of snoring and sleep apnea.
  
  
  METHODS
  One hundred thirty-four patients with baseline apnea/hypopnea index (AHI) of 37 +/- 28 events/h (mean +/- SD) received the appliance. The efficacy of the appliance was assessed by the following investigations, performed at baseline and with the appliance: polysomnography, Epworth sleepiness scale, bedpartners' assessment of snoring severity, patients' assessment of side effects, and overall satisfaction.
  
  
  RESULTS
  Thirteen patients were lost to follow-up. An additional 46 patients had no follow-up polysomnography, but answered the questionnaires. A total of 75 patients had polysomnography at baseline and with the appliance. We found a significant reduction in AHI from 44 +/- 28 events/h to 12 +/- 15 events/h (p < 0.0005) and a reduction in the arousal index from 37 +/- 27 events/h to 16 +/- 13 events/h (p < 0.05). Epworth scores fell from 11 +/- 5 to 7 +/- 3 (p < 0.0005). Bedpartners' assessment revealed marked improvement in snoring. For example, at baseline 96% of patients were judged to snore loudly "often" or "always" by their bedpartners, whereas only 2% were judged so while using dental appliance. The most frequent side effect was teeth discomfort, present "sometimes" or "often" in up to 32% of patients. Follow-up clinical assessment in 121 patients conducted on the average 350 days after the insertion of the appliance revealed that 86% of patients continued to use the appliance nightly; 60% were very satisfied with the appliance, 27% were moderately satisfied, 11% were moderately dissatisfied, and 2% were very dissatisfied.
  
  
  CONCLUSIONS
  We conclude that the adjustable mandibular positioning appliance is an effective treatment alternative for some patients with snoring and sleep apnea.
authors.affiliation: Department of Medicine, Respiratory Division, St. Michael's Hospital, University of Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Pancer
authors.forename: S
authors.initials: S
authors.lastname: Al-Faifi
authors.forename: M
authors.initials: M
authors.lastname: Al-Faifi
authors.forename: V
authors.initials: V
authors.lastname: Hoffstein
mesh_terms: D005069:Evaluation Studies as Topic; D006801:Humans; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation*; D017286:Polysomnography; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D012913:Snoring / Q000628:therapy*; D016896:Treatment Outcome