title: Mandibular advancement for obstructive sleep apnea: dose effect on apnea, long-term use and tolerance.
abstract: BACKGROUND
  Previous studies have documented an effect of mandibular advancement (MA) on pharyngeal airway size and collapsibility.
  
  
  OBJECTIVE
  We aimed to describe the course of the apnea-hypopnea index (AHI) and the snoring index (SI) during progressive MA and to evaluate the long-term efficacy, tolerance and usage of MA therapy after progressive MA titration in sleep apnea patients.
  
  
  METHODS
  Sixty-six patients with obstructive sleep apnea syndrome underwent sequential sleep recordings during progressive MA titration. Long-term effectiveness, compliance and side effects of oral appliance (OA) in the titrated position were evaluated by questionnaires.
  
  
  RESULTS
  OA therapy was started at 80% of the maximum MA. Seventy percent of the patients had only one increment in MA with a marked decrease in mean AHI from 36 to 10. In the remaining cases, further increments in MA were associated with a progressive reduction in AHI and an increase in the number of patients responding to treatment. OA in the titrated position resulted in a 70% decrease in AHI, with 54% of patients showing complete responses, 29% partial responses and 17% no response. Daytime sleepiness and quality of life improved, too. Seventeen months after the start of treatment, 82% of the patients declared that they were still using OA almost all nights. Reported side effects including subjective occlusal changes were frequent but mild.
  
  
  CONCLUSIONS
  Improvement in AHI during OA is dependent on the amount of MA. Sequential sleep recordings facilitate MA titration. Long-term MA therapy in the titrated position is effective and well tolerated. Reported side effects are frequent but mild.
authors.affiliation: Département de Pneumologie, CHU, Angers, France.
authors.forename: Louise
authors.initials: L
authors.lastname: Gindre
authors.forename: Frédéric
authors.initials: F
authors.lastname: Gagnadoux
authors.forename: Nicole
authors.initials: N
authors.lastname: Meslier
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Gustin
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Racineux
mesh_terms: D000202:Activator Appliances; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects; D008875:Middle Aged; D010349:Patient Compliance; D017060:Patient Satisfaction; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012913:Snoring / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome