[Mandibular advancement device: a 5-year long experience in obstructive sleep apnea/hypopnea syndrome]

We assessed the effectiveness of mandibular advancement device (MAD) on 113 patients having consulted in our specialized unit for obstructive sleep apnea syndrome (OSAS), from January 2005 to January 2010.

We included all adult patients referred by pulmonologists for OSAS. The data collected were gender, age, BMI, dental occlusion, presentation of retromandibulism, apnea hypopnea index (AHI) at diagnosis, and MAD effectiveness (AHI, compliance, satisfaction, tolerance).

One hundred and thirteen patients were included, 83 men and 30 women, with an average age of 53.6 years, and average BMI of 26.9. Fifty-eight patients (55.8%) used the MAD regularly, 17 (16.4%) irregularly, and 29 (27.9%) stopped using it. Fifty-seven patients (54.8%) were very satisfied, 20 (19.2%) somewhat satisfied, and 27 (26%) not at all. The average AHI with MAD was 13.3 (±10.3) and the average improvement of AHI was 19 (±14.1). Twenty-seven patients (28.7%) were cured, 46 (48.9%) presented with an AHI decrease greater than 50%, and for 21 (22.3%) the treatment failed.

The sample of patients in this study has the same characteristics as the general apneic population. Adherence and satisfaction were satisfactory. AHI results were also good but seemed low compared to other studies. This was due to more stringent criteria for cure, more in line with the overall management. No criterion for inclusion was predictive of good tolerance and no score predictive of success could be established. However, the improvement in AHI was significantly correlated to the patient's BMI and its diagnostic AHI.