Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults

  • Cauby Maia Chaves Junior
  • Cibele Dal Fabbro
  • Marco Antonio Cardoso Machado
  • Veralice Meireles Sales de Bruin
  • Pedro Felipe Carvalhedo de Bruin
  • Marcela Lima Gurgel
  • Sonia Maria Guimarães Pereira Torgeiro
  • Lucia Cevidanes
  • Fernanda Louise Martinho Haddad
  • Lia Bittencourt

Abstract

ABSTRACT


Introduction: This article is based on Clinical Guidelines for obstructive sleep apnoea (OSA) established by a taskforce coordinated by the Brazilian Sleep Association.


Objective: The aim of this article is to evaluate the available scientific evidence regarding the efficacy, adherence and safety of using mandibular advancement devices (MAD) as a therapeutic course for treating obstructive sleep apnoea in adult patients.


Method: Active searches were performed in the PubMed/MEDLINE, EMBASE, Scielo/LILACS and Cochrane Library databases.  Methodological aspects were used to rank the levels of evidence according to the criteria of the Centre for Evidence-Based Medicine at Oxford.


Results: Mandibular advancement devices offer the best results for patients with primary snoring, upper airway resistance syndrome and mild or moderate OSA (Levels of Evidence I and II).  Patients seem to exhibit greater adherence to oral appliances (MAD) than to continuous positive airway pressure (CPAP) devices, although the latter are more effective in controlling OSA (Level of Evidence I).  The long-term side effects most observed after the use of MADs are related to changes in the mandibular and dental positions (Levels of Evidence I and II).


 


Conclusion: MAD constitute a therapeutic alternative for OSA and promote favourable results with good efficacy and adherence to treatment.  Side effects can arise in the short, medium or long term.  Patients must be informed about the possible occurrence of these adverse effects, and the orthodontist must be able to manage any side effects that occur due to the use of these devices.

References

1. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Medicine Reviews. 2016; 1(12).
2. Schipper MH, Jellema K, Thomassen BJW, Alvarez-Estevez D, Verbraecken J, Rijsman RM. Stroke and other cardiovascular events in patients with obstructive sleep apnea and the effect of continuous positive airway pressure. J Neurol. 2017 May 26.
3. Zamarron C, Garcia Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systematic disease. Current evidence. Eur J Int Med. 2008;19(6):390-8.
4. Guilleminault C, Stoohs R, Clerk A, Cetel M, Maistros P. A cause of excessive daytime sleepiness.The upper airway resistance syndrome. Chest. 1993;104(3):781-7.
5. Pépin JL, Guillot M,Tamisier R, Lévy P.The Upper Airway Resistance Syndrome Respiration. 2012;83(6):559-66.
6. American Academy of Sleep Medicine. ICSD-3 - International classification of sleep disorders, 3nd ed.: Diagnostic and coding manual. Westchester, IL: American Academy of Sleep Medicine; 2014.
7. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, l Malhotra A, Patil SP, et al. (Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine). Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med. 2009;5(3):263-76.
8. Kushida CA, Littner MR, Morgenthaler T, Alessi CA, Bailey D, Coleman J Jr, et al. Practice parameters for the indications for polysomnography and related procedures: an update for 2005. Sleep. 2005;28(4):499-521.
9. Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, Bruehlmann S, Charkhandeh S, Jahromi SAZ. A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy. J Clin Sleep Med. 2017; May 11.
10. Lim J,LassersonTJ,Fleetham J,Wright J.Oral appliances for obstructive sleep apnoea.Cochrane Database Syst Rev.2006;(1):CD004435.
11. Ahrens A, McGrath C, Hägg U. A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod. 2011;33(3):318-24.
12. Li W, Xiao L, Hu J.The comparison of CPAP and oral appliances in treatment of patients with OSA: a systematic review and meta- analysis. Respir Care. 2013;58(7):1184-95.
13. Aarab G, Lobbezoo F, Heymans MW, Hamburger HL Naeije M. Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respiration 2011;82(2):162–8.
14. Wilhelmsson B,Tegelberg A,Walker-Engström ML, Ringqvist M,Andersson L, Krekmanov L, et al.A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol. 1999;119(4):503-9.
15. Bloch KE, Iseli A, Zhang JN, Xie X, Kaplan V, Stockeli PW, et al. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med. 2000;162(1):246–51.
16. Gauthier L, Laberge L, Beaudry M, Laforte M, Rompré PH, Lavigne GJ. Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study. Sleep Med. 2009;10(3):329-36.
17. Eveloff SE, Rosenberg CL, Carlisle CC, Millman RP. Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med. 1994;149:905-9.
18. Mayer G, Meier-Ewert K. Cephalometric predictors for orthopaedic mandibular advancement in obstructive sleep apnoea. Eur J Orthod. 1995;17:35-43.
19. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med. 2001;163(6):1457-61.
20. Mostafiz W, Dalci O, Sutherland K, Malhotra A, Srinivasan V, Darendeliler MA, et al. Influence of oral and craniofacial dimensions on mandibular advancement splint treatment outcome in patients with obstructive sleep apnea. Chest. 2011;139(6):1331-9.
21. Yoshida K. Effect on blood pressure of oral appliance therapy for sleep apnea syndrome. Int J Prosthodont. 2006;19(1):61–6. Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. Sleep.2001;24(5):538-44.
22. Chung JW, Enciso R, Levendowski DJ, MorganTD,Westbrook PR, Clark GT.Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2010;109(5):724-31.
23. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest. 2004;125(4):1270–8.
24. Naismith SL, Winter VR, Hickie IB, Cistulli PA. Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med. 2005;1(4):374-80.
25. Gagnadoux F, Fleury B,Vielle B, Pételle B, Meslier N, N’Guyen XL, et al.Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J. 2009;34(4):914-20.
26. Andrén A, Sjöquist M, Tegelberg A. Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance - a three year follow-up. J Oral Rehabil. 2009;36(10):719-25.
27. Itzhaki S, Dorchin H, Clark G, Lavie L, Lavie P, Pillar G.The effects of 1-year treatment with a Herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest. 2007;131(3):740-9.
28. Coruzzi P, Gualerzi M, Bernkopf E, Brambilla L, Brambilla V, Broia V, et al. Autonomic cardiac modulation in obstructive sleep apnea: effect of an oral jaw-positioning appliance. Chest. 2006;130(5):1362-8.
29. Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev. 2006 Jul 19;(3):CD001106.
30. Ferguson KA.The role of oral appliance therapy in the treatment of obstructive sleep apnea. Clin Chest Med. 2003;24(2):355-64.
31. Almeida FR, Lowe AA,Tsuiki S, Otsuka R,Wong M, Fastlicht S, et al. Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005;1(2):143-52.
32. Lowe AA, Sjöholm TT, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE.Treatment, airway and compliance effects of a titratable oral appliance. Sleep 2000;23(Suppl. 4):S172–S178.
33. Vanderveken OM, Dieltjens M,Wouters K, De Backer WA,Van de Heyning PH, Braem MJ. Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing.Thorax. 2013;68(1):91-6.
34. Vanderveken OM, Devolder A, Marklund M, Boudewyns AN, Braem MJ, Okkerse W, et al. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med. 2008;178(2):197-202.
35. Pitsis AJ, Darendeliler MA, Gotsopoulos H, Petocz P, Cistulli PA. Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med. 2002;166(6):860-4.
36. Rose E, Staats R, Virchow C, Jonas IE. A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod. 2002;24:191-8.
37. Doff MH, Hoekema A, Pruim GJ, Huddleston Slater JJ, Stegenga B. Long-term oral-appliance therapy in obstructive sleep apnea: a cephalometric study of craniofacial changes. J Dent. 2010;38(12):1010-8.
38. Doff MH,Veldhuis SK, Hoekema A, Slater JJ,Wijkstra PJ, de Bont LG, et al. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects. Clin Oral Investig. 2012;16(3):689-97.
Published
2017-08-09
How to Cite
CHAVES JUNIOR, Cauby Maia et al. Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults. International Archives of Medicine, [S.l.], v. 10, aug. 2017. ISSN 1755-7682. Available at: <http://imedicalsociety.org/ojs/index.php/iam/article/view/2647>. Date accessed: 23 aug. 2017. doi: https://doi.org/10.3823/2502.
Section
Dental Medicine