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Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: Outcomes and practicability
Author(s) -
Banhiran Wish,
Kittiphumwong Phantipar,
Assanasen Paraya,
Chongkolwatana Cheerasook,
Metheetrairut Choakchai
Publication year - 2014
Publication title -
the laryngoscope
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.181
H-Index - 148
eISSN - 1531-4995
pISSN - 0023-852X
DOI - 10.1002/lary.24607
Subject(s) - medicine , obstructive sleep apnea , polysomnography , oral appliance , otorhinolaryngology , epworth sleepiness scale , quality of life (healthcare) , inclusion and exclusion criteria , hypopnea , adverse effect , physical therapy , continuous positive airway pressure , sleep apnea , dentistry , apnea , surgery , nursing , alternative medicine , pathology
Objectives/Hypothesis To assess outcomes including efficacy, adverse effects, and quality of life (QOL) of an adjustable thermoplastic mandibular advancement device (AT‐MAD) fitted by an otolaryngologist for obstructive sleep apnea (OSA) treatment. Study Design Prospective, nonrandomized, before‐after study. Methods Sixty‐four adult patients (40 men and 24 women) were recruited. Inclusion criteria were OSA patients who had failed or refused treatment with continuous positive airway pressure and surgery. Exclusion criteria were insufficient teeth, active intraoral disease, and temporomandibular joint (TMJ) disorders. Outcomes were measured using polysomnography, symptom questionnaires, Epworth Sleepiness Scale (ESS), and Functional Outcomes of Sleep Questionnaire (FOSQ) before treatment and 4 to 6 months thereafter. Results Mean apnea‐hypopnea index (AHI) and ESS scores decreased from 17.7 ± 14.6 to 7.5 ± 10.9 and from 8.7 ± 4.9 to 6.5 ± 4.4, respectively, after treatment ( P < .001). Thirty‐nine patients (60.9%) achieved post‐treatment AHI of <5, with the highest success rate in those with mild OSA (75%). FOSQ global scores increased from 16.4 ± 2.8 to 17.7 ± 3.0 ( P < .05), along with most FOSQ subscale scores. Thirty‐four patients (53.1%) regularly used the device for ≥5 nights per week. Adverse effects include TMJ discomfort, dry mouth, and excessive salivation, which were largely tolerable. Only four patients withdrew from the study because of adverse effects. Conclusions This is the first study in Asians demonstrating that an AT‐MAD, if done properly, is a practical short‐term treatment of OSA, with good outcomes including improved QOL. Its advantages are its low cost and ready‐to‐use nature. However, further randomized controlled trials are required. Level of Evidence 4 Laryngoscope 124:2427–2432, 2014