Evaluation of Variable Mandibular Advancement Appliance for Treatment of Snoring and Sleep Apnea*
(Chest. 1999;1 16:1511-1518.) @ 1999 American College of Chest Physicians
JEFFREY PANCER, DDS; SALEM AL-FAIFI, MD; MOHAMED AL-FAIFI, MD AND VICTOR HOFFSTEIN, PhD, MD, FCCP
* From the Department of Medicine, Respiratory Division, St. Michael's Hospital, University of Toronto, Ontario, Canada.
Correspondence to: Victor Hoffstein, PhD, MD, FCCP, St. Michael's Hospital, 30 Bond St, Toronto, Ontario, Canada M 5 B I W8; e-mail: email@example.com
Objective: To evaluate an adjustable mandibular positioning appliance for treatment of snoring and sleep apnea.
Methods: One hundred thirty-four patients with baseline apnea/hypopnea index (AHI) of 37 ± 28 events/h (mean ± SD) received the appliance. The efficacy of the appliance was assessed by the following investigations, performed at baseline and with the appliance: polysomnography, Epworth sleepiness scale, bedpartners' assessment of snoring severity, patients' assessment of side effects, and overall satisfaction.
Results: Thirteen patients were lost to follow-up. Additional 46 patients had no follow-up polysomnography, but answered the questionnaires. A total of 75 patients had polysomnography at baseline and with the appliance. We found a significant reduction in AHI from 44 ± 28 events/h to 1 2 ± 1 5 events/h (p < 0.0005) and a reduction in the arousal index from 37 ± 27 events/h to 1 6 ± 1 3 events/h (p < 0.05). Epworth scores fell from II ± 5 to 7 ± 3 (p < 0.0005). Bedpartners' assessment revealed marked improvement in snoring. For example, at baseline 96% of patients were judged to snore loudly "often" or "always" by their bedpartners, whereas only 2% were judged so while using dental appliance. The most frequent side effect was teeth discomfort, present "sometimes" or often" in up to 32% of patients. Follow-up clinical assessment in 1 21 patients conducted on the average 350 days after the insertion of the appliance revealed that 86% of patients continued to use the appliance nightly; 60% were very satisfied with the appliance, 27% were moderately satisfied, 11% were moderately dissatisfied, and 2% were very dissatisfied.
Conclusion: We conclude that the adjustable mandibular positioning appliance is an effective treatment alternative for some patients with snoring and sleep apnoea.