title: Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial.
abstract: OBJECTIVE
  This study aimed to assess the efficacy of a custom-made mandibular advancement splint for the treatment of obstructive sleep apnea with respect to neuropsychological functioning and mood state.
  
  
  METHODS
  A randomized controlled crossover design was used in which 73 participants (mean age = 48.4, SD = 11.0, % men = 80.8) with at least 2 symptoms of obstructive sleep apnea and an apnea hypopnea index > or = 10 per hour underwent treatment with both mandibular advancement splint and an inactive oral device. Polysomnographic, neuropsychological and self-report measures were conducted at baseline and repeated after each of the two 4-week treatment phases.
  
  
  RESULTS
  MAS treatment was associated with improvements on the somatic component of the Beck Depression Inventory and the Vigor-Activity and Fatigue-Inertia scales of the Profile of Mood States. While there were no improvements within the neuropsychological domains of attention/working memory, verbal memory, visuospatial or executive functioning, treatment with the mandibular advancement splint was associated with faster performance on a test of vigilance/psychomotor speed. These changes, however, did not correspond to the improved subjective sleepiness or apnea-hypopnea index during treatment.
  
  
  CONCLUSIONS
  Treatment with the mandibular advancement splint results in improvements in self-reported sleepiness, fatigue/energy levels and vigilance/psychomotor speed in patients with obstructive sleep apnea.
authors.affiliation: Department of Respiratory & Sleep Medicine, St George Hospital, The University of New South Wales, Sydney, Australia. snaismith@med.usyd.edu.au
authors.forename: Sharon L
authors.initials: SL
authors.lastname: Naismith
authors.forename: Virginia R
authors.initials: VR
authors.lastname: Winter
authors.forename: Ian B
authors.initials: IB
authors.lastname: Hickie
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cistulli
mesh_terms: D000202:Activator Appliances; D001921:Brain / Q000503:physiopathology*; D018592:Cross-Over Studies; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008569:Memory Disorders / Q000175:diagnosis / Q000453:epidemiology; D008875:Middle Aged; D009483:Neuropsychological Tests; D009960:Oropharynx / Q000503:physiopathology*; D017286:Polysomnography; D011446:Prospective Studies; D016037:Single-Blind Method; D020181:Sleep Apnea, Obstructive / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy*; D012895:Sleep, REM / Q000502:physiology; D014706:Verbal Learning