title: Minimizing the mandibular advancement in an oral appliance for the treatment of obstructive sleep apnea.
abstract: OBJECTIVE
  In the treatment of obstructive sleep apnea (OSA) with an oral appliance (OA), there is no gold standard method to fine-tune the mandibular advancement. This study aimed to analyze the effect of gradual increment of mandibular advancement on the evolution of the apnea-hypopnea index (AHI).
  
  
  METHODS
  OSA patients were recruited from a sleep unit. All treatments started with an oral appliance without mandibular advancement. After two weeks, the AHI was assessed with respiratory polygraphy. Mandibular advancement was initiated with a step size of 1 mm and evolution in the AHI was assessed. The target protrusion was the one that achieved the highest reduction in AHI and the least side effects. Anthropometric data, sleep questionnaire and Epworth sleepiness scale score were obtained.
  
  
  RESULTS
  Thirty six patients (22 men) participated in this study. The patient's mean age was 57 ± 12 years and the body mass index was 25.4 ± 4.1 kg/m2. The oral appliance reduced the AHI from 20.8 ± 12.9/h to 8.4 ± 5.1/h (P = 0.000). Ten of the 26 patients with ≥50% reduction in AHI (39%) had zero advancement. The mean mandibular advancement was 1.7 ± 1.5 mm achieving ≥50% reduction in AHI in 72% of the patients. Twenty seven patients had an AHI <10/h. Of the 21 patients with moderate-severe OSA, 17 had the highest decrease in the AHI in a mandibular advancement ≤3 mm.
  
  
  CONCLUSIONS
  Monitoring the subjective symptoms of the patient and objective evolution in the AHI could minimize the mandibular advancement needed for the treatment of OSA.
authors.affiliation: Clínica Eduardo Anitua, Vitoria, Spain; BTI Biotechnology Institute, Vitoria, Spain. Electronic address: eduardoanitua@eduardoanitua.com.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Anitua
authors.affiliation: Clínica Eduardo Anitua, Vitoria, Spain; Bioaraba Research Institute, OSI Araba University Hospital, Vitoria, Spain; Interdisciplinary Sleep Unit, OSI Araba University Hospital, Vitoria, Spain; Basque Country University, Medicine Department, Vitoria, Spain; Ciber de Enfermedades Respiratorias (CIBERES), Madrid, Spain.
authors.forename: Joaquín
authors.initials: J
authors.lastname: Durán-Cantolla
authors.affiliation: Clínica Eduardo Anitua, Vitoria, Spain; Interdisciplinary Sleep Unit, OSI Araba University Hospital, Vitoria, Spain.
authors.forename: Gabriela Zamora
authors.initials: GZ
authors.lastname: Almeida
authors.affiliation: BTI Biotechnology Institute, Vitoria, Spain.
authors.forename: Mohammad Hamdan
authors.initials: MH
authors.lastname: Alkhraisat
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003735:Dental Casting Technique; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects / Q000295:instrumentation; D008875:Middle Aged; D009968:Orthodontic Appliances, Removable; D010100:Oxygen / Q000097:blood; D012119:Respiration; D012720:Severity of Illness Index; D016037:Single-Blind Method; D012890:Sleep / Q000502:physiology; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology / Q000628:therapy*; D016683:Supine Position / Q000502:physiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010100:Oxygen
keywords: Apnea–hypopnea index; Mandibular advancement; Mandibular advancement device; Obstructive sleep apnea; Respiratory polygraphy