Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea.
BACKGROUND
Temporomandibular disorder (TMD) has been the most common contraindication for mandibular advancement device (MAD) as a treatment for obstructive sleep apnea syndrome (OSAS). Exercising the mandible is a recommended form of therapy for TMD.


OBJECTIVE
To assess the efficacy of mandibular exercises in the control of pain, changes of quality of life and to assess the impact of MAD compliance in OSAS patients with previously diagnosed TMD.


METHODS
A blind, randomized, and controlled trial was used to evaluate 29 OSAS patients with TMDs were divided in two groups: the exercise support therapy (ST) and placebo therapy (PT), who were evaluated prior to and 120 days after MAD treatment. Treatment outcomes were measured using the Fletcher and Luckett sleep questionnaire, Epworth sleepiness scale, SF-36 inventory of quality of life, polysomnography, diary of MAD usage, and the research diagnostic criteria for TMD.


RESULTS
ST group showed significant improvement in their sleep quality and life quality when compared to the PT group (p < 0.05). Higher number of patients with persistent pain was observed in the PT group (p = 0.01). There was a reduction of pain intensity in the ST group, but not in the PT group (p < 0.05). Higher MAD compliance was observed in the ST group (p < 0.05).


CONCLUSIONS
Mandibular exercises enable patients with TMD to use MAD; exercises were found to be effective in reducing pain and increasing MAD compliance and produced a significant improvement in the quality of life and quality of sleep.
Department of Dentistry, Universidade Federal do Parana, Curitiba, PR, Brazil. pacunali@onda.com.br
Paulo Afonso
PA
Cunali
Fernanda R
FR
Almeida
Camila D
CD
Santos
Natália Y
NY
Valdrichi
Liliane S
LS
Nascimento
Cibele
C
Dal-Fabbro
Sérgio
S
Tufik
Lia Rita A
LR
Bittencourt
D000328:Adult; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D009967:Orthodontic Appliances; D017286:Polysomnography; D011174:Portugal; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000534:rehabilitation*; D011795:Surveys and Questionnaires