J Oral Med Pain.  2023 Sep;48(3):96-105. 10.14476/jomp.2023.48.3.96.

Treatment Outcomes of Mandibular Advancement Devices in Mild, Moderate, and Severe Obstructive Sleep Apnea: A Preliminary Study

• Kim HK
• Kim ME

• KMID: 2552126
• DOI: http://doi.org/10.14476/jomp.2023.48.3.96

Abstract

Purpose
Mandibular advancement devices (MAD) are known to be insufficiently effective in all patients with obstructive sleep apnea (OSA). This study aimed to compare the treatment outcomes of MAD therapy according to OSA severity and to investigate the risk factors for the lack of response to MAD therapy.
Methods
A total of 29 patients diagnosed with OSA received an adjustable two-piece MAD treatment. Sleep parameters measured with the home sleep apnea test device, including apnea–hypopnea index (AHI) and oxygen saturation (SpO₂), and daytime sleepiness using the Epworth Sleepiness Scale (ESS) were retrospectively assessed both before and after the MAD treatment.
Results
The patients were classified into three groups according to AHI severity: mild (n=16, AHI<15), moderate (n=6, 15≤AHI<30), and severe OSA (n=7, AHI≥30). MAD therapy significantly improved the sleep parameters (p<0.001 for AHI and p=0.004 for minimum SpO₂) and daytime sleepiness (p<0.001 for ESS). Furthermore, successful outcomes (reduction in AHI>50% and AHI<10 events/h) were achieved in 83.3% and 71.4% of moderate and severe OSA cases, respectively. Of 13 patients with moderate and severe OSA, 10 were classified as responders and 3 as non-responders. The non-responders had significantly lower baseline value of SpO₂ (p=0.049 for average SpO₂ and p=0.007 for minimum SpO₂) and higher baseline AHI (p=0.049) than the responders.
Conclusions
The results of the present study suggest that MAD is effective in the majority of patients with OSA of varying severities. The success of MAD therapy does not seem to depend solely on AHI severity. In addition to AHI, minimum SpO₂ may be a prognostic measure of the efficacy of MAD treatment in clinical dental practice.

Keyword

Appliance; Efficacy; Hypoxia; Mandibular advancement; Obstructive; Sleep apnea syndromes