title: Evaluation of an oral mandibular advancement titration appliance.
abstract: OBJECTIVE
  To determine whether a manually adjustable oral mandibular advancement titration appliance (EMA-T) predicts successful long-term treatment with an oral mandibular advancement appliance (MAA).
  
  
  METHODS
  At an academic medical center, 21 adults with obstructive sleep apnea (AHI > 10 events/hr) performed baseline, titration, and MAA (Klearway) polysomnograms. During the titration polysomnogram with EMA-T, the mandible was advanced until apneas and hypopneas were eliminated or maximum tolerable advancement was reached. Participants then used the MAA at home and, once the mandible was advanced to the amount determined during the titration polysomnogram, a polysomnogram with MAA was performed.
  
  
  RESULTS
  Mean AHI at baseline was 33.5 +/- 18.3 (SD) events/hr. During the titration polysomnogram, 9 subjects achieved an AHI < 10 and at least a 50% reduction in AHI. None of the subjects met these criteria on the MAA polysomnogram.
  
  
  CONCLUSIONS
  EMA-T lowered the AHI to efficacious levels in 43% of patients but this acute response did not predict the efficacy of long-term MAA treatment.
authors.affiliation: Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA. skuna@mail.med.upenn.edu
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Kuna
authors.forename: Philip C
authors.initials: PC
authors.lastname: Giarraputo
authors.forename: David C
authors.initials: DC
authors.lastname: Stanton
authors.forename: Lawrence M
authors.initials: LM
authors.lastname: Levin
authors.forename: Don
authors.initials: D
authors.lastname: Frantz
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D009967:Orthodontic Appliances; D017286:Polysomnography / Q000295:instrumentation; D011379:Prognosis; D020181:Sleep Apnea, Obstructive / Q000628:therapy*