Patient Selection for Efficacious Mandibular Advancement Device Therapy in Obstructive Sleep Apnea: An Institutional...

Area of Science:

• Otolaryngology
• Sleep Medicine
• Dental Sleep Medicine

Background:

• Mandibular advancement devices (MADs) are a recognized treatment for obstructive sleep apnea/hypopnea syndrome (OSAHS).
• Optimal patient selection for MAD therapy is still being refined.
• This study focuses on custom titratable MADs for OSAHS treatment.

Purpose of the Study:

• To evaluate the overall effectiveness of custom titratable MADs in a specific group of OSAHS patients.
• To identify factors that predict the success of MAD therapy.
• To analyze MAD efficacy in patients with Friedman Stages 2 to 4.

Main Methods:

• Retrospective analysis of 86 patients treated by a single otolaryngologist.
• Patients had Friedman Stages 2 to 4 OSAHS and were treated with a Thornton Adjustable Positioner (MAD).
• Treatment outcomes were assessed using home apnea tests (HSAT) before and after MAD titration.

Main Results:

• Overall success rate was 72.1%, defined by a 50% reduction in initial apnea-hypopnea index (AHI) or AHI below 15 events/hour.
• MAD therapy significantly reduced mean AHI (P < .001) and improved minimum oxygen saturation (P = .003).
• Significant OSAHS severity reduction occurred across mild (55.9%), moderate (85%), and severe (75%) groups.

Conclusions:

• Custom titratable MAD therapy is an effective treatment for OSAHS in patients with Friedman Stages 2-4, achieving a 72% success rate.
• MADs should be considered an initial treatment option for this patient subset, including those with mild, moderate, and severe OSAHS.
• Factors like BMI, age, velopharyngeal collapse pattern, prior surgery, and sex did not predict treatment failure.