The mandibular advancement device and patient selection in the treatment of obstructive sleep apnea.
OBJECTIVE
To evaluate retrospectively the efficacy of the mandibular advancement device (MAD) in Korean patients with obstructive sleep apnea (OSA) in terms of severity and to evaluate prognostic factors deciding the success of MAD application.


METHODS
Retrospective analysis.


METHODS
Academic tertiary referral center.


METHODS
Of 142 patients who underwent MAD application for OSA management, 50 (46 men and 4 women; mean [SD] age, 50.2 [9.8] years) were included from March 2005 through August 2007.


METHODS
Full-overnight polysomnography was performed before and at least 3 months after intraoral MAD application in 50 patients. Questionnaires for sleep quality, Epworth sleepiness scale, and cephalometry were also studied.


METHODS
Treatment results were evaluated and prognostic factors deciding success of MAD application were assessed.


RESULTS
The mean (SD) apnea-hypopnea index (AHI) decreased significantly (P < .001) from 36.6 (18.9) to 12.3 (11.4). The success rate, defined by an AHI of lower than 20 and a 50% decrease in AHI, were 74% (37 of 50 patients). Even patients who were not categorized into the success group had a decreased AHI. The success rates of patients with mild, moderate, and severe OSA were 43% (3 of 7), 82% (22 of 27), and 75% (12 of 16), respectively, and a higher success rate in patients with severe OSA showed that MAD could be applied even in patients with severe OSA. The duration of apnea and hypopnea, percentage of patients with snoring, and the Pittsburgh Sleep Quality Index were improved significantly after treatment. Epworth sleepiness scale scores and lowest oxygen saturation did not change significantly. An analysis of prognostic factors did not reveal any significant difference between the success and nonsuccess groups.


CONCLUSIONS
The application of MAD significantly improved nocturnal respiratory function and sleep quality in patients with OSA, even in patients with severe OSA. In patients with OSA, MAD can be used as a good alternative treatment modality regardless of severity because it is noninvasive, easy to manufacture, and has good treatment results.
Lee
Chul Hee
CH
Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Mo
Ji-Hun
JH
Choi
Ik-Joon
IJ
Lee
Hyun Jong
HJ
Seo
Beom Seok
BS
Kim
Dong-Young
DY
Yun
Phil-Young
PY
Yoon
In-Young
IY
Won Lee
Hye
H
Kim
Jeong-Whun
JW
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D009967:Orthodontic Appliances; D018579:Patient Selection; D011379:Prognosis; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D055815:Young Adult