A combination appliance for obstructive sleep apnea: the effectiveness of mandibular advancement and tongue retention.
OBJECTIVE
The purpose of this study was to determine if subjects with moderate-to-severe obstructive sleep apnea would experience increasing treatment effect when a tongue retention component was added to a mandibular repositioning appliance.


METHODS
Cohort study.


METHODS
Sleep clinic.


METHODS
Forty-four sequentially recruited patients with moderate-to-severe obstructive sleep apnea.


METHODS
Subjects were sleep tested at 4 treatment stages of oral appliance therapy. The 4 stages were: 6-mm mandibular protrusion, 8-mm protrusion, 6-mm protrusion with a tongue retention bulb, and 8-mm protrusion with a tongue retention bulb.


RESULTS
Forty-one of 44 subjects completed the protocol. There was a decrease in mean respiratory disturbance index from 33.5 events/h at baseline to 18.1 events/h at stage 4 (p = 0.001). Mean Epworth Sleepiness Scale (ESS) decreased from 12.3 at baseline to 9.0 at stage 4 (p = 0.0001.


CONCLUSIONS
A combined approach utilizing both mandibular protrusion and tongue retention can provide effective treatment for moderate-to-severe obstructive sleep apnea. The addition of a tongue bulb may provide further treatment effect when mandibular protrusion is limited. Appliance designs that allow for convenient combination therapy need to be developed for this purpose.
University of Calgary, Calgary, AB, Canada. dort@ucalgary.ca
Leslie
L
Dort
John
J
Remmers
D006801:Humans; D008334:Mandible / Q000033:anatomy & histology; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019736:Prostheses and Implants; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D014059:Tongue / Q000033:anatomy & histology; D016896:Treatment Outcome; D014851:Wakefulness