Effect of mandibular advancement device in the treatment of obstructive sleep apnea

Background Obstructive sleep apnea (OSA) is a situation of repetitive and interrupted collapse of the upper airways (UAs) during sleep. The physiopathology of OSA is multifactorial. Provided that continuous positive airway pressure is the gold standard for treatment of OSA, the American Academy of Sleep Medicine in 2015 stated that mandibular advancement device (MAD) was indicated as a first-line therapy for mild OSA and a second-line therapy for moderate to severe OSA with lower BMI. Aim This study is aimed to evaluate the MAD success rate in patient with OSA and to assess improvement in sleep quality. Patients and methods This was a prospective one-group pretest-post-test quasiexperimental study carried out on 30 patients with OSA admitted to the sleep center at Chest Medicine Department of Mansoura University Hospitals through the period from February 2019 to January 2021. All patients had thorough clinical examination. The clinical assessment was scored according to the following questionnaires: the Epworth Sleepiness Scale, the Berlin questionnaire, the STOP-Bang questionnaire, and the Pittsburgh sleep quality index. Patients also had polysomnography, drug-induced sleep endoscopy, and dental volumetric computerized tomography (CT) scan. All patients were treated by MAD, and then patients began home adjustment as patients were instructed to advance the device 0.5 mm each night as tolerated. After two weeks, patients repeated PSG and CBCT to assess airway volume and airway area after treatment of OSA by the MAD. Results A total of 30 patients with OSA were included, comprising 14 males and 16 females, with a mean age of 42.9 +/- 7.0 years. The types of UA obstruction were detected by both drug-induced sleep endoscopy (DISE) and dental volumetric cone-beam CT (CBCT). A total of 30 patients were studied and showed that multiple-level obstruction was the most frequent type of UA obstruction detected by both dental volumetric CBCT and DISE, representing 53.3 and 60%, respectively. Regarding polysomnographic data of the studied patients before and after treatment by MAD, there is very high significant improvement of apnea-hypopnea index among the studied patients whose were treated by MAD. Conclusion MAD has a high success rate in treatment of OSA and improves sleep quality. DISE and CBCT can be useful tools for assessing the success of MAD in the treatment of OSA.