title: Mandibular advancement splint as short-term alternative treatment in patients with obstructive sleep apnea already effectively treated with continuous positive airway pressure.
abstract: OBJECTIVE
  CPAP is used as the first-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP.
  
  
  METHODS
  Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months.
  
  
  RESULTS
  Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m² completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased significantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no significant differences in SAQLI between MAS and CPAP treatment, while ESS decreased significantly on MAS. MAS self-reported usage was correlated with treatment efficacy (r = 0.52; p < 0.05). Seventy-five percent of the patients reported being sufficiently satisfied with MAS to continue to use it as an alternative short-term therapy.
  
  
  CONCLUSIONS
  MAS partially or completely reduced sleep disordered breathing in the majority of selected, successfully CPAP-treated severe OSA patients. Many patients can probably effectively use MAS as a short-term treatment alternative to CPAP.
authors.affiliation: Department of Oral Health Sciences, University of British Columbia, Vancouver, BC, Canada. falmeida@dentistry.ubc.ca
authors.forename: Fernanda R
authors.initials: FR
authors.lastname: Almeida
authors.forename: Alan
authors.initials: A
authors.lastname: Mulgrew
authors.forename: Najib
authors.initials: N
authors.lastname: Ayas
authors.forename: Hiroko
authors.initials: H
authors.lastname: Tsuda
authors.forename: Alan A
authors.initials: AA
authors.lastname: Lowe
authors.forename: Nurit
authors.initials: N
authors.lastname: Fox
authors.forename: Sandra
authors.initials: S
authors.lastname: Harrison
authors.forename: John A
authors.initials: JA
authors.lastname: Fleetham
mesh_terms: D006801:Humans; D019186:Mandibular Advancement / Q000379:methods*; D017060:Patient Satisfaction; D012891:Sleep Apnea Syndromes / Q000628:therapy*
keywords: CPAP; Obstructive sleep apnea; alternative treatment; mandibular advancement splint; oral appliance