Mandibular advancement splint titration in obstructive sleep apnoea.

Area of Science:

• Sleep Medicine
• Dental Sleep Medicine
• Respiratory Medicine

Background:

• Mandibular advancement splints (MAS) are used to treat obstructive sleep apnea (OSA).
• Titratable MAS may offer better patient tolerance, but optimal adjustment protocols require investigation.
• This study investigates two adjustment methods for titratable MAS in OSA patients.

Purpose of the Study:

• To evaluate the effectiveness of a titratable MAS in patients with moderate OSA (AHI 10-40/h) and BMI < 35 kg/m².
• To compare subjective self-adjustment versus objective adjustment based on polysomnography (PSG) feedback.
• To assess changes in apnea-hypopnoea index (AHI) and OSA symptoms.

Main Methods:

• Twenty-eight patients with symptomatic OSA were randomized to self-adjustment or PSG-guided adjustment.
• The MAS was initially set at 70% maximal protrusion.
• Outcomes (AHI, OSA symptoms) were compared at baseline and after 6 weeks.

Main Results:

• Overall, 71% of patients showed improved or resolved OSA (AHI < 5/h or >50% reduction).
• Objective adjustment (with PSG feedback) led to higher reported nightly device use (91% vs. 63%).
• Both adjustment methods yielded similar significant improvements in AHI and symptoms; PSG feedback did not further reduce AHI after 3 weeks.

Conclusions:

• Titratable MAS effectively improved or resolved OSA in a majority of selected patients.
• While PSG-based feedback increased device use, it did not offer superior clinical outcomes compared to self-adjustment.
• A follow-up sleep study is recommended to confirm MAS efficacy.