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Mandibular Advancement Splint Therapy.

Anna M Mohammadieh1,2,3, Kate Sutherland4,5,6, Andrew S L Chan4,6

  • 1Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia. amoh2259@uni.sydney.edu.au.

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|October 10, 2022
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Summary
This summary is machine-generated.

Mandibular advancement splints (MAS) offer an alternative to CPAP for sleep apnea, showing similar health outcomes despite lower AHI reduction. Patient adherence and tolerability are key benefits, though predicting MAS response remains a challenge.

Keywords:
Apnoea-hypopnoea indexMAS customisationMAS titrationMandibular advancementOSA therapy

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Area of Science:

  • Sleep Medicine
  • Dental Sleep Medicine
  • Respiratory Medicine

Background:

  • Mandibular advancement splint (MAS) therapy is a primary alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA).
  • MAS devices function by advancing the mandible to increase airway caliber and reduce collapsibility.
  • While less effective than CPAP in reducing the apnea-hypopnea index (AHI), MAS therapy demonstrates comparable neurobehavioral and cardiovascular health outcomes, potentially due to better patient adherence and tolerability.

Purpose of the Study:

  • To review the efficacy and limitations of MAS therapy for obstructive sleep apnea.
  • To highlight the variability in patient response to MAS and the lack of predictive tools.
  • To discuss the clinical barriers, side effects, and recommended patient-centered management of MAS therapy.

Main Methods:

  • Review of current literature on Mandibular Advancement Splint (MAS) therapy for obstructive sleep apnea (OSA).
  • Comparison of MAS efficacy and patient outcomes against Continuous Positive Airway Pressure (CPAP) therapy.
  • Analysis of factors influencing MAS tolerability, adherence, and potential side effects.

Main Results:

  • MAS therapy is a viable alternative to CPAP for OSA, showing comparable benefits in neurobehavioral and cardiovascular health outcomes.
  • Patient adherence and tolerability are often higher with MAS compared to CPAP, despite a potentially smaller reduction in AHI.
  • Predictive tools for MAS response are currently lacking, representing a significant clinical barrier to its wider adoption.

Conclusions:

  • MAS therapy offers significant benefits for OSA patients, particularly those intolerant to CPAP, but response variability necessitates further research into predictive markers.
  • Custom-made MAS devices, while effective, may pose accessibility and financial challenges.
  • A multidisciplinary, patient-centered approach is recommended for managing MAS therapy, considering potential side effects like temporomandibular joint dysfunction and occlusal changes.