The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome.
OBJECTIVE
The tongue-retaining device is a customized monobloc oral appliance used in the treatment of obstructive sleep apnea syndrome (OSAS). This study evaluated tongue-retaining device efficacy and its tolerance by patients with OSAS.


METHODS
The charts of 84 apneic patients were retrospectively analyzed, and patients were contacted by telephone to answer an oral questionnaire. The median follow-up time was 5 years.


RESULTS
Based on the apnea-hypopnea index, a complete or partial response was obtained in 71% of the cases. The mean apnea-hypopnea index decreased significantly from 38 to 14 (p < 0.001) with the tongue-retaining device. The subjective intensity of snoring decreased by 68% (p < 0.0001) and the Epworth Sleepiness Scale score decreased from 9 to 6 (p < 0.05). An age of more than 60 years associated with a mandibular protrusion distance inferior or equal to 7 mm was predictive of a nonresponse (odds ratio [OR]: 7.25; 95% confidence interval [CI]: 1.43-36.7; p < 0.02). The compliance rate, as determined by answers to the questionnaire, was 52% after 5 years of follow-up. Nasal obstruction was a negative predictor of good compliance (OR: 6.94; 95% CI: 0.28-0.79; p < 0.005), whereas patients with Class I occlusion were more compliant than patients with Class II or III occlusions (OR: 3.83; 95% CI: 1.00-2.81; p < 0.05).


CONCLUSIONS
Tongue-retaining device performance tended to be similar to that of the mandibular advancement device. Thus, teams trained in tongue-retaining device fabrication and fitting may propose it as an alternative to continuous positive airway pressure, taking nasal obstruction into consideration as a contraindication.
Lazard
Diane S
DS
Assistance Publique-Hôpitaux de Paris, Hôpital Beaujon, Service d'ORL et de Chirurgie Cervico-Faciale, Clichy, France. diane.lazard@bjn.aphp.fr
Blumen
Marc
M
Lévy
Pierre
P
Chauvin
Pierre
P
Fragny
Dorothée
D
Buchet
Isabelle
I
Chabolle
Frédéric
F
D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015508:Nasal Obstruction / Q000150:complications; D016017:Odds Ratio; D009968:Orthodontic Appliances, Removable / Q000009:adverse effects / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy*; D012913:Snoring / Q000150:complications; D011795:Surveys and Questionnaires; D014059:Tongue; D016896:Treatment Outcome