Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure?

Smith, D. M.; Stradling, J. R.
April 2002
Thorax;Apr2002, Vol. 57 Issue 4, p305
Academic Journal
Background: Mandibular advancement devices (MADs) can successfully control both snoring and obstructive sleep apnoea (OSA). Many patients on nasal continuous positive airway pressure (NCPAP) for OSA would like a more portable alternative, even if only temporarily. This study assesses what proportion of patients with OSA already on NCPAP can successfully use a MAD for short periods (up to 1 month) as a temporary alternative to NCPAP. Methods: Fifty patients with OSA, already on NCPAP for at least 3 months, were recruited by invitation. They were provided with a simple fixed MAD estimated to provide 75% of maximum mandibular protrusion. Sleep studies using a portable home recorder were performed on and after three nights without NCPAP to provide control data. Following acclimatisation to the MAD, sleep studies were also planned after 3, 7, and 28 days while using the MAD. If their overnight >4% Sao2 dips per hour deteriorated to >20 or the Epworth sleepiness score (ESS) rose to >9 (or increased by >4 over baseline) on nights 3 or 7, they were then deemed to have failed the trial and were withdrawn. Results: Of the 50 patients entered, one had inadequate teeth for a MAD and 31 gave up trying to use the device during the acclimatisation period because of side effects. Of the 18 prepared to use the device, two patients failed at night 3, five at night 7, and two at night 28. Thus, nine patients remained controlled by our criteria at night 28. On average, sleep study indices while using the MAD were poor compared with the night on NCPAP. Conclusions: Simple MADs are poorly tolerated by patients with OSA already on NCPAP. OSA was adequately controlled by our criteria in 32% of those recruited for the equivalent of a weekend, in 22% for 1 week, and in 18% for up to 1 month. Better tolerated devices would be likely to improve on these figures.


Related Articles

  • Prosthetic Management of Pharyngeal Flap-Related Snoring. Williams, William N.; Turner, Glenn T.; Lewis, Kelley; Pegoraro-Krook, Maria Inês; Dutka-souza, Jenifter C.R. // Cleft Palate-Craniofacial Journal;Jul2007, Vol. 44 Issue 4, p418 

    Objective: The obturating pharyngeal flap used in correcting velopharyngeal insufficiency has been implicated in creating difficulty in nasal breathing for some patients and/or in causing hyponasal speech, obstructive sleep apnea, and snoring. This is a case report of an individually designed...

  • CONSIDERATIONS ON THE INVOLVEMENT OF THE STOMATOLOGIST IN THE MANAGEMENT OF SLEEP PATHOLOGY. Hasna, Teofana; Hasna, M.; Chirap, I.; Munteanu, B.; Boişteanu, Daniela; Burlui, V. // International Journal of Medical Dentistry;Oct-Dec2012, Vol. 16 Issue 4, p315 

    The implications of dental medicine in sleep disorders include quite few diseases. By the nature of his profession, the stomatologist may be the first to trace the possible modifications produced at the level of the oral cavity and of the upper aerial ducts of the patient. The role of dental...


    The article presents an overview of a study which evaluated the possible significance of psychological and emotional habits on the therapeutic use of a nocturnal positive airway pressure (PAP). The study, an effort of the Bavarian Society of Sleep Medicine, measures the contentment of patients...

  • Treatment options for snoring and sleep apnoea. Kotecha, B.; Shneerson, J. M. // Journal of the Royal Society of Medicine;Jul2003, Vol. 96 Issue 7, p343 

    The article discusses the proper treatment for sleep apnea and snoring. These conditions, a disruptive flow of air through the upper airway which causes multi-segmental obstruction in the different regions of the pharynx, can be treated with oral appliances or surgery and nasal continuous...

  • Internet Prescriptions: Quick Cure or Risky Routine? Holman, Franklin A. // Sleep Review;Nov2008, Vol. 9 Issue 9, p10 

    The author reflects on a variety of issues concerning PureSleep, an intraoral device designed to treat snoring. He argued against the availability of PureSleep to patients even without seeing a physician or dentist. He cited the concerns of sleep health advocates on the online prescribing of...

  • Snoring and Sleep Apnea--Structural Implications. Roth, George B. // American Chiropractor;Apr2005, Vol. 27 Issue 4, p22 

    The article analyzes the mechanism of upper airway obstruction and its relationship with the occurrence of snoring and sleep apnea. The upper airway is constructed of the hard and soft palate above, the posterior pharynx, the tongue, and the epiglottis at the level of the tracheo-esophageal...

  • Treatment of Obstructive Sleep Apnea in Primary Care. Victor, Lyle D. // American Family Physician;2/1/2004, Vol. 69 Issue 3, p561 

    Obstructive sleep apnea should be suspected in patients who are overweight, snore loudly, and have chronic daytime sleepiness. The diagnosis of sleep apnea may be confirmed by sleep laboratory studies. Patients' symptoms and the frequency of respiratory events on laboratory testing are important...

  • Combination Therapy. Khan, Akram // Sleep Review;Apr2008, Vol. 9 Issue 3, p22 

    The article describes the case of a 35-year old male patient with sleep disorder symptoms of snoring and apneic episodes who was treated with uvulopalatopharyngoplasty along with continuous positive airway pressure therapy. The patient showed an increased Epworth Sleepiness Score and recorded...

  • Alcohol ingestion influences the nocturnal cardio-respiratory activity in snoring and non-snoring males. Herzog, Michael; Riemann, Randolf // European Archives of Oto-Rhino-Laryngology;Sep2004, Vol. 261 Issue 8, p459 

    Night time alcohol ingestion influences nocturnal breathing in patients with sleep apnea syndrome or respiratory diseases. To evaluate the influence of nocturnal alcohol ingestion on the cardio-respiratory activity of healthy men, 8 snoring and 13 non-snoring male subjects were measured for 3...


Read the Article


Sign out of this library

Other Topics