The effect of positional dependency on outcomes of treatment with a mandibular advancement device.
OBJECTIVE
To evaluate retrospectively the efficacy of the mandibular advancement device (MAD) in patients with obstructive sleep apnea in terms of positional dependency.


METHODS
Retrospective analysis.


METHODS
Academic tertiary referral center.


METHODS
One hundred patients with obstructive sleep apnea treated with the MAD at the Department of Otorhinolaryngology sleep clinic were included from January 1, 2005, through December 31, 2010.


METHODS
All patients underwent nocturnal full-night polysomnography before and at least 3 months after intraoral MAD application.


METHODS
Treatment results and prognostic factors deciding the success of MAD application.


RESULTS
Of the 100 patients, 80 showed positional dependency and 20 showed nondependency. In the position-dependent obstructive sleep apnea group, the median (interquartile range) apnea-hypopnea index (AHI) decreased from 32.1 (24.4-41.9) to 8.6 (3.7-13.8) (P < .001); in the nondependent group, from 56.4 (26.2-71.5) to 15.7 (6.8-30.7) (P < .001). The success rate (AHI reduction ≥50% and AHI <10) was 57.5% and 30.0% in position-dependent and position-nondependent groups, respectively (P = .04).


CONCLUSIONS
Identifying patients with obstructive sleep apnea as position dependent or nondependent may have important therapeutic implications in predicting the outcome of MAD treatment.
Department of Otorhinolaryngology, Seoul National University College of Medicine, Seongnam, Korea.
Chul-Hee
CH
Lee
Hahn Jin
HJ
Jung
Woo Hyun
WH
Lee
Chae Seo
CS
Rhee
In-Young
IY
Yoon
Pil-Young
PY
Yun
Jeong-Whun
JW
Kim
D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017286:Polysomnography; D011187:Posture / Q000502:physiology; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome