A mandibular advancement device for the treatment of obstructive sleep apnea: long-term use and tolerance

Long-term efficacy and compliance with mandibular advancement devices (MAD) in the treatment of obstructive sleep apnea syndrome (OSAS) are under-studied. Our objective was to conduct a long-term assessment of the OPM4J device, measuring symptoms, compliance rate, and adverse effects in a cohort of consecutive patients treated with OPM4J for an average period of nearly three years. Out of 140 patients aged 62 ± 10 years with body mass index (BMI) 27 ± 4 kg/m(2) and initial apnea-hypopnea index (AHI) 27 ± 16, complete reversal of OSAS was achieved in 65%. A total of 76% reported regular MAD use, with 24% stopping treatment and half of those 24% falling back on continuous positive airway pressure (CPAP). Patients with lower residual AHI or residual Epworth scores at month 3 were more likely to continue treatment (P < 0.007 and P < 0.02). Reasons for discontinuing treatment included tooth pain, persistent snoring or fatigue, loss or breakage of the device, and the cost of replacing it. OPM4J reduced OSAS symptoms in the long-term. Regular use was reported in 76% of patients. Adverse effects were common but minor. Half of non-users were lost to follow-up and probably remain without treatment.