Immediate intraoral adaptation of mandibular advancing appliances of thermoplastic material for the treatment of obstructive sleep apnea

Background: In the treatment of obstructive sleep apnea (OSA), mandibular a dvancing devices (MAD) are usually individually fabricated on plaster casts of both jaws from polymethyl-methacrylate. The potential disadvantages of these devices are (1) the costs and (2) the time required to construct the device. Objective: In this study, the efficacy and feasibility of a cheap M AD consisting of thermoplastic material (SnorBan(R)), which can be directly moulded intraorally, were evaluated. Methods: In a prospective study, the effect of an MAD consisting of thermoplastic material was investigated in 2 2 consecutive patients with OSA [respiratory disturbance index (RDI) 32.6 /- 18.4/h]. Polysomnographic sleep was recorded prior to treatment and afte r 3 months of treatment with the MAD. Results: Three of the 22 patients who did not tolerate the MAD were excluded from the analysis, whereas 11 patie nts were classified as responders. In the responder group, the mean RDI dec reased from 27.6 +/- 7.3 to 7.3 +/- 2.9 (p < 0.01), correspondingly the sle ep quality and the Epworth Sleepiness Scale improved (p < 0.05). Eight pati ents proved to be non-responders without relevant changes for the measured parameters. Conclusions: In 50% (11 of 22) of the patients, the MAD improve d the OSA to a clinically relevant degree. In contrast to the majority of e stablished MAD, the MAD investigated is cheap and immediately adaptable and thus a feasible strategy to 'screen' the efficacy of this therapeutic prin ciple. Thus the construction of unnecessary MAD is avoided. Copyright (C) 2 000 S. Karger AG, Basel.