Effects of a mandibular repositioning appliance on sleep structure, morning behavior and clinical symptomatology in patients with snoring and sleep-disordered breathing.
BACKGROUND
Mandibular repositioning appliances (MRAs) have become an established treatment for snoring and sleep-disordered breathing - though most studies only focused on the evaluation of respiratory variables.


METHODS
This single-blind, placebo-controlled case-series study investigated the effects of an individually adjustable MRA on psychopathology, macro-/microstructure of sleep, periodic leg movements, morning performance, mood/affect and psychophysiology. Fifty patients (37 males) aged 59.7 +/- 10.3 years, suffering from primary snoring (7), mild (22), moderate (15) and severe apnea (6), spent 4 nights in the sleep laboratory (adaptation, placebo, drug and MRA night). The drug night is not subject of the present paper.


RESULTS
Confirmatory statistics showed an improvement of the snoring index by 72%. Descriptively, the apnea index and the apnea-hypopnea index normalized. A clinical improvement was seen in the Pittsburgh Sleep Quality Index, the Zung Anxiety/Depression Scales and the Epworth Sleepiness Scale. The restless legs syndrome also improved. Polysomnographically, sleep stages REM and 4 as well as REM latency increased, stage 3, movement time, stage shifts and periodic leg movements decreased, as did all arousal measures. Subjectively, morning well-being, drive, affectivity and wakefulness improved. Objectively, attention, motor and reaction time performance, critical flicker frequency as well as muscular strength increased, diastolic blood pressure and the pulse rate decreased.


CONCLUSIONS
Apart from its good therapeutic effects on snoring and respiratory variables (snoring showed complete or partial response in 68%, the apnea-hypopnea index in 67% of the apnea patients), the MRA also improved psychopathology, objective and subjective sleep and awakening quality.
Saletu
A
A
Department of Periodontology, Bernhard Gottlieb University Dental School, Medical University of Vienna, Vienna, Austria. alexander.saletu@meduniwien.ac.at
Anderer
P
P
Parapatics
S
S
Matthai
C
C
Matejka
M
M
Saletu
B
B
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016022:Case-Control Studies; D004569:Electroencephalography / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008875:Middle Aged; D017286:Polysomnography / Q000379:methods; D011601:Psychophysics; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012890:Sleep / Q000502:physiology; D012891:Sleep Apnea Syndromes / Q000503:physiopathology* / Q000628:therapy*; D012913:Snoring / Q000503:physiopathology* / Q000628:therapy*; D016896:Treatment Outcome; D014851:Wakefulness / Q000502:physiology