title: Mandibular advancement appliances remain effective in lowering respiratory disturbance index for 2.5-4.5 years.
abstract: OBJECTIVE
  The mandibular advancement appliance (MAA) is now recognized as a first-line therapy option for mild to moderate obstructive sleep apnea syndrome (OSAS). The aim of this follow-up study was to re-assess the long-term efficacy of MAAs provided to patients in a previous comparative study.
  
  
  METHODS
  Sixteen subjects had participated in a previous comparative study in which the efficacy and compliance of two MAAs (Klearway - K and Silencer - S) were compared in a randomized cross-over design. At the end of the previous comparative study, subjects selected the MAA they preferred. Nine chose the K and seven the S. Fifteen subjects were available for a follow-up interview and 14 (4 women and 10 men; mean ± SEM: 51.9 ± 1.7 y.o.) agreed to participate in an overnight sleep recording at a hospital sleep laboratory from January to February 2009. The mean time lag between the end of the previous comparative study and the follow-up was 40.9 ± 2.1 months (range of 2.5-4.5 years). Comparisons were made across the three polysomnographic evaluations (PSGE): baseline, the night with the appliance of their choice at the end of the previous comparative study, and the follow-up night. Subjects completed the Epworth sleepiness scale (ESS), the fatigue severity scale (FSS), and a quality of life questionnaire (FOSQ).
  
  
  RESULTS
  At the follow-up, the respiratory disturbance index (RDI) remained significantly lower than baseline (p<0.001). Questionnaire responses revealed that ESS, FSS, and FOSQ remained improved at follow-up (p<0.02). Body mass index (BMI) increased slightly from baseline to follow-up (p<0.05). Diastolic and systolic blood pressure and cardiac rhythm decreased significantly from baseline to follow-up.
  
  
  CONCLUSIONS
  The MAAs remained effective in improving RDI, sleepiness, blood pressure, cardiac rhythm, fatigue, sleep quality, and quality of life over a period of 2.5-4.5 years. The rise in BMI is a concern that merits further examination.
authors.affiliation: Faculté de Médecine Dentaire et Faculté de Médecine, Université de Montréal, 2900 Boul. Édouard-Montpetit, Montréal, Canada. luc.gauthier.csssc@ssss.gouv.qc.ca
authors.forename: Luc
authors.initials: L
authors.lastname: Gauthier
authors.forename: Luc
authors.initials: L
authors.lastname: Laberge
authors.forename: Michel
authors.initials: M
authors.lastname: Beaudry
authors.forename: Mario
authors.initials: M
authors.lastname: Laforte
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Rompré
authors.forename: Gilles J
authors.initials: GJ
authors.lastname: Lavigne
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D015992:Body Mass Index; D018592:Cross-Over Studies; D005221:Fatigue / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000503:physiopathology; D006329:Heart Conduction System / Q000502:physiology; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation / Q000379:methods*; D008875:Middle Aged; D010092:Oximetry; D017060:Patient Satisfaction; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000517:prevention & control* / Q000628:therapy*; D012894:Sleep Stages / Q000502:physiology; D013995:Time; D016896:Treatment Outcome