title: Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome.
abstract: BACKGROUND
  The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS).
  
  
  OBJECTIVE
  To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS.
  
  
  METHODS
  Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared.
  
  
  RESULTS
  28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p=0.02), smaller cervical circumference (p=0.05), and lower AHI at baseline (p=0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p=0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence.
  
  
  CONCLUSIONS
  MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Otorhinolaryngology, Faculdade de Medicina do ABC, Santo André, SP, Brazil. Electronic address: prescinotto@hotmail.com.
authors.forename: Renato
authors.initials: R
authors.lastname: Prescinotto
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Fernanda Louise Martinho
authors.initials: FL
authors.lastname: Haddad
authors.affiliation: Department of Otorhinolaryngology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.
authors.forename: Ilana
authors.initials: I
authors.lastname: Fukuchi
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Gregório
authors.affiliation: Dentistry Course, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil; Department of Medicine and Sleep Biology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Paulo Afonso
authors.initials: PA
authors.lastname: Cunali
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Sérgio
authors.initials: S
authors.lastname: Tufik
authors.affiliation: Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Medicine and Sleep Biology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Lia Rita Azeredo
authors.initials: LR
authors.lastname: Bittencourt
mesh_terms: D000328:Adult; D000368:Aged; D002508:Cephalometry; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017286:Polysomnography; D011446:Prospective Studies; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Aparelhos ortodônticos removíveis; Apneia do sono tipo obstrutiva; Exame físico; Nariz; Nose; Obstructive sleep apnea; Physical examination; Removable orthodontic appliances