title: Mandibular advancement device in patients with obstructive sleep apnea : long-term effects on apnea and sleep.
abstract: OBJECTIVE
  To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement device in patients with obstructive sleep apnea.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Department of Respiratory Medicine, University Hospital, Umeå, Sweden.
  
  
  METHODS
  Thirty-three consecutively treated patients.
  
  
  METHODS
  Individually adjusted mandibular advancement devices.
  
  
  RESULTS
  Polysomnographic sleep recordings on 1 night without the device and 1 night with the device were performed after 0.7 +/- 0.5 years (mean +/- SD) and after 5.2 +/- 0.4 years from the start of treatment. Nineteen of the 33 patients experienced a short-term satisfactory treatment result with an apnea-hypopnea index of < 10 events per hour and a satisfactory reduction in snoring. Fourteen patients were regarded as being insufficiently treated with the device. Seventeen of the short-term satisfactorily treated patients (90%) and 2 of the remaining patients continued treatment on a long-term basis. The apnea-hypopnea index was reduced by the device from 22 +/- 17 to 4.9 +/- 5.1 events per hour (p < 0.001) in these 19 long-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients. Patients with their devices replaced or adjusted experienced a better long-term effect than patients still using their original devices (p < 0.05).
  
  
  CONCLUSIONS
  The long-term effect and tolerability of a mandibular advancement device are good in patients who are recommended the treatment on the basis of a short-term sleep recording, provided that the device is continuously adjusted or replaced with a new one when needed. A short-term follow-up is valuable in the selection of patients who will benefit from long-term treatment with a mandibular advancement device.
authors.affiliation: Department of Orthodontics, Umeå University, Umeå, Sweden. Marie.Marklund@odont.umu.se
authors.forename: M
authors.initials: M
authors.lastname: Marklund
authors.forename: C
authors.initials: C
authors.lastname: Sahlin
authors.forename: H
authors.initials: H
authors.lastname: Stenlund
authors.forename: M
authors.initials: M
authors.lastname: Persson
authors.forename: K A
authors.initials: KA
authors.lastname: Franklin
mesh_terms: D000202:Activator Appliances; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome