title: Clinical audit of subjects with snoring & sleep apnoea/hypopnoea syndrome fitted with mandibular repositioning splint.
abstract: Snoring and obstructive sleep apnoea/hypopnoea syndrome (OSAHS) are often treated with mandibular repositioning splints (MRS), but the efficacy and satisfaction of them has not been comprehensively addressed. A survey on the use of and satisfaction with MRS was posted to 177 patients referred by a hospital orthodontic department for custom-fitting of a MRS. Data were analysed using non-parametric techniques. The response rate was 81% (n=144). Responders (30F, 114M) had mean (SD) age of 51 (11) years, apnoea+hypopnoea index (AHI) of 24 (21) per hr and Epworth Score of 10 (5) at diagnosis, and had been supplied with their MRS a median 7 (IQR 5-11) months previously. Fifty of the 144 patients (35%) had been offered continuous positive airway pressure (CPAP) treatment but had declined or abandoned this. Self-reported MRS use was 5 (2) h/night, with 74 of the 144 patients (51%) continuing to use MRS at least occasionally at a median 7 months after fitting. Survival analysis showed 12% still using MRS at 12 months. Epworth score fell slightly with MRS therapy [-2.4 (3.5); P=0.005] and 7 daytime and 2 nocturnal symptoms improved in MRS users (all P<0.05). Marital satisfaction did not change with MRS. Problems preventing MRS use in 70 non-users included: non-retention (n=12), sore mouth (n=13) or jaw (n=7), difficulties falling asleep (n=10) or breathing (n=7), excessive salivation (n=4), dental damage (n=4) and other problems (n=3). Continued use of MRS therapy was associated with a higher number of teeth, low marital satisfaction perceived by partners and greater improvement in symptoms reported by patients and partners. Continuance with MRS may be low and linked to tolerance problems.
authors.affiliation: The Department of Sleep Medicine, University of Edinburgh, 51 Little France, Edinburgh EH16 4SA, Scotland, UK. b.izci@ed.ac.uk
authors.forename: Bilgay
authors.initials: B
authors.lastname: Izci
authors.forename: James P
authors.initials: JP
authors.lastname: McDonald
authors.forename: Emma L
authors.initials: EL
authors.lastname: Coleman
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Mackay
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Douglas
authors.forename: Heather M
authors.initials: HM
authors.lastname: Engleman
mesh_terms: D045422:Continuous Positive Airway Pressure / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000502:physiology; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation*; D008485:Medical Audit; D008875:Middle Aged; D017090:Occlusal Splints / Q000009:adverse effects; D010349:Patient Compliance / Q000523:psychology; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012891:Sleep Apnea Syndromes / Q000503:physiopathology / Q000628:therapy*; D012913:Snoring / Q000503:physiopathology / Q000517:prevention & control*; D018454:Spouses / Q000523:psychology; D016896:Treatment Outcome