Chest
Volume 122, Issue 2, August 2002, Pages 569-575
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Clinical Investigations
SLEEP AND BREATHING
An Individually Adjustable Oral Appliance vs Continuous Positive Airway Pressure in Mild-to-Moderate Obstructive Sleep Apnea Syndrome

https://doi.org/10.1378/chest.122.2.569Get rights and content

Background

For the treatment of nonsevere obstructive sleep apnea syndrome (OSAS), mandibular advancement devices (MADs) are employed as an alternative to nasal continuous positive airway pressure (CPAP) therapy. However, very few specific data on the effectiveness of MADs in this group of patients are available. We therefore compared an individually adjustable intraoral sleep apnea device (ISAD) that permits movements of the lower jaw in three dimensions, with CPAP in the treatment of patients with an apnea/hypopnea index (AHI) ≤ 30/h.

Methods

In a randomized crossover study, 16 men and 4 women (mean ± SD age, 56.5 ± 10.2 years; body mass index, 31.2 ± 6.4; AHI, 17.5 ± 7.7/h) were treated for 6 weeks with each modality.

Results

In the initial phase, a significant improvement in AHI (baseline, 17.5 ± 7.7/h; ISAD, 10.5 ± 7.5/h [p < 0.05]; CPAP, 3.5 ± 2.9/h [p < 0.01]) and in breathing-related arousals (baseline, 8.9 ± 6.1/h; ISAD, 3.7 ± 3.3/h [p < 0.01]; CPAP, 1.4 ± 1.6/h [p < 0.01]) was achieved with both modalities. Considering all 20 subjects, after 6 weeks of treatment, normalization of the respiratory parameters was seen only with CPAP. However, 30% of the patients had a lasting reduction in AHI to < 10/h with the ISAD also. The patients considered the ISAD to be easier to use (scale of 1 to 6: ISAD, 1.8 ± 1.1; CPAP, 3.1 ± 1.5 [p < 0.05]), and indicated greater utilization of the device in comparison with CPAP.

Conclusion

Even in patients with mild-to-moderate OSAS, CPAP is the more effective long-term treatment modality. In the individual case, the better compliance seen with the ISAD may be advantageous.

Section snippets

Patients

Twenty patients (16 men and 4 women; mean ± SD age, 56.5 ± 10.2 years; body mass index [BMI], 31.2 ± 6.4), who had been referred to a university sleep laboratory for the diagnosis and treatment of OSAS were investigated between January 1999 and December 1999. Inclusion criteria were an AHI of 5/h minimum and 30/h maximum (mean, 17.5 ± 7.7/h) measured in two diagnostic polysomnographies, and clinical symptoms of OSAS. The patients were submitted to two diagnostic measurements to ensure that, in

Results

With CPAP, a significant improvement in the respiratory parameters (AHI, snoring, Sao2 min) and sleep quality (total number of arousals and respiration-induced arousals) was achieved at both measuring time points (first night and 6 weeks; Table 1). The AHI decreased from 17.5/h ± 7.7 to 3.5 ± 2.9/h (first night) and 3.2 ± 2.9/h (6 weeks) [p < 0.01 in each case]; the arousal index decreased from 21.8 ± 9.9 to 15 ± 7.5/h (first night) and 14.1 ± 5.1/h (6 weeks) [p < 0.05 in each case]; and the

Discussion

The ASDA recognizes intraoral appliances as an alternative to CPAP treatment of nonobstructive snoring and mild OSAS.21 These ASDA guidelines are grade C recommendations supported by level V evidence.21 Numerous devices are presently available that differ widely in terms of material, freedom of mandibular movement, amount and rigidity of dental coverage, amount of mandibular advancement, and bite opening.678910111213141516171819202229 Despite the predominantly positive results, only a few

References (34)

  • BondemarkL

    Does 2 years’ nocturnal treatment with a mandibular advancement splint in adult patients with snoring and OSAS cause a change in the posture of the mandible

    Am J Orthod Dentofacial Orthop

    (1999)
  • PepinJL et al.

    Effective compliance during the first 3 months of continuous positive airway pressure: a European prospective study of 121 patients

    Am J Respir Crit Care Med

    (1999)
  • CartwrightRD et al.

    The effects of a nonsurgical treatment for obstructive sleep apnea

    JAMA

    (1982)
  • BernsteinAK et al.

    The effects of mandibular repositioning on obstructive sleep apnea

    Cranio

    (1988)
  • BlochKE et al.

    A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment

    Am J Respir Crit Care Med

    (2000)
  • Scho¨nhoferB et al.

    Immediate intraoral adaptation of mandibular advancing appliances of thermoplastic material for the treatment of obstructive sleep apnea

    Respiration

    (2000)
  • HenkeKG et al.

    An oral elastic mandibular advancement device for obstructive sleep apnea

    Am J Respir Crit Care Med

    (2000)
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