title: Otolaryngology office-based treatment of obstructive sleep apnea-hypopnea syndrome with titratable and nontitratable thermoplastic mandibular advancement devices.
abstract: OBJECTIVE
  1) Share our experiences treating patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) with titratable and nontitratable thermoplastic mandibular advancement devices (MADs) fitted in our otolaryngology clinic. 2) Compare these devices in terms of objective response (OR), as defined by a > or = 50 percent decrease in baseline apnea-hypopnea index (AHI) and an AHI < 20, and subjective parameters, including adherence. 3) Determine overall success, as defined by OR plus adherence at two months follow-up.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Patients with OSAHS who tried and failed or refused both continuous positive airway pressure (CPAP) and surgical therapy were fitted with a nontitratable Snore Guard (n = 38), nontitratable SomnoGuard 2.0 (n = 8), or titratable SomnoGuard AP (n = 41). Pre- and post-treatment assessment included: 1) Epworth Sleepiness Scale, 2) snoring level, 3) polysomnogram. Patients were contacted at two months follow-up to assess adherence and subjective parameters.
  
  
  RESULTS
  OR was achieved in 62.1 percent of patients. Overall mean reduction in AHI was from 39.96 +/- 23.70 to 14.86 +/- 13.46 (P = 0.000). Adherence at two months was 58.5 percent. No significant differences were observed in OR or adherence according to MAD type, though improvements in AHI and minimum oxygen saturation were significantly better for the SomnoGuard AP than for the nontitratable devices. Overall success was 38.6 percent.
  
  
  CONCLUSIONS
  Thermoplastic MADs are a relatively inexpensive treatment alternative for patients with OSAHS who fail/refuse CPAP and upper airway surgery. They can be easily fitted in the otolaryngology clinic. Long-term compliance, efficacy, and safety are unknown at this time.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL 60602, USA. hednnek@aol.com
authors.forename: Michael
authors.initials: M
authors.lastname: Friedman
authors.forename: Tanya
authors.initials: T
authors.lastname: Pulver
authors.forename: Meghan N
authors.initials: MN
authors.lastname: Wilson
authors.forename: Dina
authors.initials: D
authors.lastname: Golbin
authors.forename: Christopher
authors.initials: C
authors.lastname: Leesman
authors.forename: George
authors.initials: G
authors.lastname: Lee
authors.forename: Ninos J
authors.initials: NJ
authors.lastname: Joseph
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D009064:Mouth Protectors; D009967:Orthodontic Appliances; D010349:Patient Compliance; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult