Effectiveness of Mandibular Advancement Device for Obstructive Sleep Apnea in Chronic Spinal Cord Injury

To determine the effectiveness of a mandibular advancement device (MAD) in individuals with spinal cord injury (SCI) who suffer from obstructive sleep apnea (OSA) syndrome, and to identify potential predictive factors of response to MAD.

Forty individuals (34 men and 6 women) with an apnea-hypopnea index (AHI) of more than 15 were included in the MAD uncontrolled clinical trial. The outcomes were evaluated through polygraphic examination before therapy and after 1 and 6 months. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) and quality of life (WHOQOL-BREF) were assessed at baseline and after 6 months. Throughout the study, side effects were continuously monitored.

Thirty-five individuals completed the study. The mean AHI decreased from 35.7 ± 15.6 to 18.5 ± 10.6 at 6 months (P < .0001). ESS improved from 9.3 ± 5.2 to 6.8 ± 3.5 (P = .0001), while no significant change was observed in WHOQOL-BREF scores. Participants with severe (AHI >30) OSA had shorter time since injury and higher body mass index (BMI) than those with moderate OSA (AHI 15-30). According to the criterion for treatment success of at least 50% improvement in AHI, MADs were effective in 48.6% of participants. Younger age and lower WHOQOL-BREF scores were the only factors significantly associated with treatment success.

MADs appear to be an effective treatment for both moderate and severe OSA in people with SCI. They may be a suitable alternative for individuals who decline or are unable to tolerate continuous positive airway pressure therapy.