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

Abstract

Introduction: Mandibular advancement devices (MADs) are a treatment option for obstructive sleep apnea/hypopnea syndrome (OSAHS); however, the ideal patient selection criteria continue to be refined.

Objectives: To determine the overall efficacy of a custom titratable MAD in treating a subset of OSAHS patients. A secondary objective was to determine predictive factors affecting treatment outcome for MAD therapy.

Methods: Retrospective analysis of a single otolaryngologist's (DCU) experience in 86 patients with Friedman Stages 2 to 4 treated with a MAD (Thornton Adjustable Positioner) at an academic medical center.

Results: Therapeutic success as measured by type 3 home apnea test (HSAT) before and after proper MAD titration was defined as a 50% reduction in initial AHI or reduction of AHI to a mild severity below 15 events/hour. The 50% AHI reduction rate after MAD titration was 64% and the overall success rate inclusive of patients with reduction below 15 events/hour was 72.1%. MAD therapy significantly reduced the mean AHI (-10.4 ± 12.6), P < .001) and improved the minimum oxygen saturation (1.88 ± 5.79, P = .003). Significant reduction of OSAHS severity was seen across all treatment groups regardless of initial OSAHS severity: mild (55.9%), moderate (85%), severe (75%; P < .001 for all 3 groups). High BMI, advanced age, concentric velopharyngeal collapse pattern, prior pharyngeal surgery, and male sex were not statistically significant predictors of ineffectiveness.

Conclusions: MAD therapy for OSAHS in patients with Friedman Stages 2 to 4 is an effective treatment in 72% of cases and should be considered as an initial treatment option within this subset of patients, inclusive of those with initially severe, moderate, and mild OSAHS.

Keywords: apnea hypopnea index; intraoral device; mandibular advancement device; obstructive sleep apnea; oral appliance.