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Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea
M Marklund1, M Persson, K A Franklin
1Department of Orthodontics, Umeå University, Sweden.
Study Objective:
To evaluate the effect of a mandibular advancement device in patients with supine-dependent sleep apnea and patients with non-supine-dependent sleep apnea.
Design:
Prospective study.
Setting:
Department of Respiratory Medicine, University Hospital, Umeå, Sweden.
Patients:
Twenty-six patients with obstructive sleep apnea.
Intervention:
Individually fabricated and adjusted mandibular advancement devices.
Measurements:
Overnight polysomnographic sleep recordings with and without the device. Supine-dependent sleep apnea was defined when the supine apnea-hypopnea index was > or = 10, together with a lateral apnea-hypopnea index of < 10. Non-supine-dependent sleep apnea was considered when the lateral apnea-hypopnea index was > or = 10.
Results:
In 12 patients with supine-dependent sleep apnea, the device reduced the supine apnea-hypopnea index from a median of 41 (range, 16 to 70) to 5.9 (range, 0.0 to 15) (p < 0.01). In 14 patients with non-supine-dependent sleep apnea, the treatment reduced the supine apnea-hypopnea index from 44 (range, 1.8 to 73) to 21 (range, 6.3 to 60) (p < 0.05) and the lateral apnea-hypopnea index from 21 (range, 12 to 70) to 4.5 (range, 0.0 to 31) (p < 0.01). The odds ratio for a successful apnea reduction to an apnea-hypopnea index of < 10 in both the supine and the lateral positions was 30 for supine-dependent sleep apnea adjusted for age, obesity, mandibular advancement, and mandibular opening (p < 0.01).
Conclusion:
Successful apnea reduction with a mandibular advancement device is highly related to supine-dependent sleep apnea.