title: The mandibular advancement device and patient selection in the treatment of obstructive sleep apnea.
abstract: 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.
authors.affiliation: Department of Otorhinolaryngology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Chul Hee
authors.initials: CH
authors.lastname: Lee
authors.forename: Ji-Hun
authors.initials: JH
authors.lastname: Mo
authors.forename: Ik-Joon
authors.initials: IJ
authors.lastname: Choi
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Beom Seok
authors.initials: BS
authors.lastname: Seo
authors.forename: Dong-Young
authors.initials: DY
authors.lastname: Kim
authors.forename: Phil-Young
authors.initials: PY
authors.lastname: Yun
authors.forename: In-Young
authors.initials: IY
authors.lastname: Yoon
authors.forename: Hye
authors.initials: H
authors.lastname: Won Lee
authors.forename: Jeong-Whun
authors.initials: JW
authors.lastname: Kim
mesh_terms: 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