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Daytime sleepiness estimated using the Karolinska Sleepiness Scale during mandibular advancement device therapy for snoring and sleep apnea: a secondary analysis of a randomized controlled trial.

Sleep & breathing = Schlaf & Atmung·2025
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Starting Mandibular Advancement Device Therapy in Patients with Good Protrusive Capacity: A Randomized Pilot Study.

Marie Marklund1

  • 1Umea University Faculty of Medicine, Department of Odontology, Umea, Sweden.

Turkish Journal of Orthodontics
|October 2, 2023
PubMed
Summary

Starting mandibular advancement device treatment with a larger advancement (70% of maximum) led to more severe side effects in obstructive sleep apnea patients compared to a smaller, fixed advancement (4mm). This highlights the importance of initial titration for device acceptance.

Keywords:
Oral appliancesmandibular advancement devicesmandibular repositioning appliancesobstructive sleep apnoeaside-effects

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Area of Science:

  • Sleep Medicine
  • Dental Devices
  • Obstructive Sleep Apnea

Background:

  • Mandibular advancement devices (MAD) are used for obstructive sleep apnea (OSA).
  • Patient acceptance of MAD is often limited by discomfort and side effects.
  • Initial treatment parameters may influence patient adherence and outcomes.

Purpose of the Study:

  • To compare severe initial side effects between two different degrees of mandibular advancement in OSA patients.
  • To investigate the impact of initial advancement magnitude on early treatment tolerability.

Main Methods:

  • A pilot, parallel-design study randomized OSA patients with good protrusive capacity (≥8 mm) to two groups.
  • Group 1 received 70% of maximum mandibular protrusion (Adv70%); Group 2 received 4 mm fixed advancement (Adv4mm).
  • Primary outcome: severe tooth/jaw tenderness or pain (VAS ≥7) or treatment exclusion within the first week.

Main Results:

  • Four out of nine patients in the Adv70% group reported severe pain on ≥5 days, versus none in the Adv4mm group (p=0.03).
  • A significant correlation was found between the degree of advancement (in mm) and the number of days with severe side effects (r=0.64, p=0.006).
  • Minor secondary side effects like salivation issues and bite changes were reported.

Conclusions:

  • Initiating MAD treatment with a 70% mandibular advancement results in more severe initial side effects compared to a smaller, fixed advancement in OSA patients with good protrusive capacity.
  • This suggests that a less aggressive initial advancement may improve early treatment acceptance and reduce discomfort.