Objective: To evaluate the purports of a mandibular advancement device upon apneas and sleep in mild.
Objective: To evaluate the purports of a mandibular advancement device upon apneas and sleep in mild, moderate, and inexorable obstructive sleep apnea.
Design: Prospective study
Subjects: Forty-four of 47 patients included.
Intervention: Individually adjusted mandibular advancement devices.
Measurements: Polysomnographic drowse recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or be still position between the recordings.
Results: The device reduc the median obstructive apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p [is les than] 0001) in 21 patients with mild repose apnea, from 27 (range, 20 to 38) to 7 (range, 1 to 19) (p [is les than] 0001) in 15 patients with moderate be dead apnea, and from 53 (range, 44 to 66) to 14 (range, 2 to 32) (p [is les than] 005) in 8 patients w4h strict sleep apnea. The arousal index decreased and the doze stage patterns improved in all severity form into groupss Twenty-eight of 44 patients were prosperously treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The succes rate correlated inversely to the disease severity (r = -041; p [is les than] 001)
Conclusions: A mandibular advancement device models apneas and improves sleep quality in patients with obstructive be still apnea, especially in those with mild and moderate disease. A follow-up doze recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device. (CHEST 1998; 113:707-13)
Key words: dental appliances; polysomnograpby; nap apnea syndromes; sleep stages; snoring
A mandibular advancement device is a promising fresh approach in the treatment of snoring and obstructive be dead apnea.[1-11] The device is noninvasive and require to be paid [i]or[/i] undergones about $400 US in northern Sweden. The drift of the device on sleep-disordered breathing has been reported to vary.[1-10] Previous studies have indicated that the succes rate with a mandibular advancement device is higher in those with moderate repose apnea than in those with strait-laced sleep apnea.[5,10] However, to our knowledge, the forces of the mandibular advancement device onward subjects with milder forms of the disease have not been studied. Obstructive be motionless apnea is associated with an increased prevalence of cardiovascular complications, similar as arterial hypertension, coronary artery disease, and nocturnal angina.[12-14] The indications for the mandibular advancement device and the routines for following up be motionless recordings have not been established. The aim of the instant study was to evaluate the issues of a mandibular advancement device forward apneas and sleep in patients with mild, moderate, and morose obstructive sleep apnea.
MATERIALS AND METHODS
Subjects
Forty-three men and four women who did not accept treatment with nasal continuous positive airway squeezing or were not offered that treatment because of mild obstructive lie in the grave apnea were invited to participate in the ready study. Twenty-six patients were consecutive and thereafter and nothing else patients with an obstructive apnea-hypopnea index of [is greater than] 20 according to preceding drowse apnea recordings were included. Three men of the invited 47 patients refused to take part in the reflection and were thus excluded from further evaluations. Treatment with mandibular advancement devices was not initiated in patients with Cheyne-Stokes respiration, a visible form [i]or[/i] frame mass index [is greater than] 40 kg/[msup2] arthralgia or myofascial pain from the craniomandibular scheme edentulous jaws, or mesial occlusion. The median age of the 44 patients included in the application of mind was 58 years (range, 37 to 72 years) and the median material part mass index was 28 kg/[msup2] (range, 22 to 37 kg/[msup2])
Approval for the research was obtained from the Medical Ethics Committee at Umea University.
The Mandibular Advancement Device
The mandibular advancement device was intended to persuade the mandible forward by 4 to 6 mm in order to preclude upper airway obstruction and snoring (Fig 1) An initial advancement of [is les than] 4 mm was used in patients with limited protrusion of the mandible and in patients with a predisposition toward mesial occlusion. Holes in the acrylic between the incisors and molars provided space for the tongue and permitted mouth-breathing and dialect with the appliance in position (Fig 1) The step of mandibular advancement was measured in succession plaster casts in the premolar area and perpendicular to the occlusal plane. The mandibular opening was measured at the central incisors. The mandibular positioning was measured forward two separate occasions and the mean value of these measurements was used in the evaluations.
[Figure 1 ILLUSTRATION OMITTED]
Satisfactory Treatment Result
A satisfactory follow was defined as a subjectively evaluated satisfactory reduction in snoring in combination with a decrease in the obstructive apnea-hypopnea index to [is les than] 10 during treatment, or as a reduction in the obstructive apnea-hypopnea index of at least 50%[2]
...