MANDIBULAR ADVANCEMENT SPLINT - AN APPLIANCE TO TREAT SNORING AND OBSTRUCTIVE SLEEP-APNEA

Snoring and obstructive sleep apnea (OSA) are related to narrowing of the upper airway. A mandibular advancement splint (MAS) could improve both conditions by increasing oropharyngeal and hypopharyngeal dimensi ons. The effects of a MAS on snoring and OSA was evaluated 3.5 +/- 2.1 (mean +/- SD) mo after issue in 57 subjects with habitual loud snorin g, 39 of whom had an apnea-hypopnea index (AHI) greater than or equal to 10. Assessment was by questionnaire (all subjects) and polysomnogra phy (51 subjects, 47 male) including measurement of sound intensity. U se of the MAS was randomized to first or second half of study. Snores were scored where inspiratory noise was greater than 5 dB above backgr ound, Total sleep time, sleep efficiency, % REM sleep, and % sleep spe nt supine were similar (p > 0.05) with and without the MAS. Snores per sleep minute, corrected for time in apnea, and sound intensity of sno res (% snores greater than or equal to 50 dB) decreased with the MAS f rom 11.0 +/- 5.8 and 42.0 +/- 25.0% to 9.0 +/- 6.0 (p < 0.01) and 26.2 +/- 25.2% (p < 0.01), respectively. Using the MAS significantly impro ved OSA: AHI decreased from 32.2 +/- 28.5 to 17.5 +/- 22.7 (p < 0.01) and arousal index decreased from 31.4 +/- 20.6 to 19.0 +/- 14.6 (p < 0 .01). AHI decreased to < 20 with the MAS in 12 of 17 subjects where un treated AHI was between 20 and 60, and in 2 of 9 subjects where untrea ted AHI was > 60. Forty-five patients continued to use the MAS regular ly. We conclude that the MAS can be an acceptable and effective treatm ent of snoring and also of OSA, particularly where the AHI is < 60.