title: A mandibular advancement device for the treatment of obstructive sleep apnea: long-term use and tolerance.
abstract: Long-term efficacy and compliance with mandibular advancement devices (MAD) in the treatment of obstructive sleep apnea syndrome (OSAS) are under-studied. Our objective was to conduct a long-term assessment of the OPM4J device, measuring symptoms, compliance rate, and adverse effects in a cohort of consecutive patients treated with OPM4J for an average period of nearly three years. Out of 140 patients aged 62 ± 10 years with body mass index (BMI) 27 ± 4 kg/m(2) and initial apnea-hypopnea index (AHI) 27 ± 16, complete reversal of OSAS was achieved in 65%. A total of 76% reported regular MAD use, with 24% stopping treatment and half of those 24% falling back on continuous positive airway pressure (CPAP). Patients with lower residual AHI or residual Epworth scores at month 3 were more likely to continue treatment (P < 0.007 and P < 0.02). Reasons for discontinuing treatment included tooth pain, persistent snoring or fatigue, loss or breakage of the device, and the cost of replacing it. OPM4J reduced OSAS symptoms in the long-term. Regular use was reported in 76% of patients. Adverse effects were common but minor. Half of non-users were lost to follow-up and probably remain without treatment.
authors.affiliation: Centre de médecine du sommeil (Sleep Medicine Center), hôpital Antoine-Béclère, 92141 Clamart, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Brette
authors.forename: Hassina
authors.initials: H
authors.lastname: Ramanantsoa
authors.forename: Joël
authors.initials: J
authors.lastname: Renouardiere
authors.forename: Rosine
authors.initials: R
authors.lastname: Renouardiere
authors.forename: Gabriel
authors.initials: G
authors.lastname: Roisman
authors.forename: Pierre
authors.initials: P
authors.lastname: Escourrou
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017090:Occlusal Splints / Q000009:adverse effects; D016382:Orthodontic Appliance Design; D010349:Patient Compliance; D017286:Polysomnography; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D012913:Snoring / Q000628:therapy; D011795:Surveys and Questionnaires; D013997:Time Factors