Mandibular advancement device in patients with obstructive sleep apnea - Long-term effects on apnea and sleep

Study objectives: To evaluate the long-term effects on apneas and sleep and the tolerability of a mandibular advancement device in patients with obstr uctive sleep apnea, Design: Prospective study. Setting: Department of Respiratory Medicine, University Hospital, Umea, Swe den. Patients: Thirty-three consecutively treated patients. Interventions: Individually adjusted mandibular advancement devices. Measurements and results: Polysomnographic sleep recordings on 1 night with out the device and 1 night with the device were performed after 0.7 +/- 0.5 years (mean +/- SD) and after 5.2 +/- 0.1 years from the start of treatmen t. Nineteen of the 33 patients experienced a short-term satisfactory treatm ent result with an apnea-hypopnea index of < 10 events per hour and a satis factory reduction in snoring. Fourteen patients were regarded as being insu fficiently treated with the device. Seventeen of the short-term satisfactor ily treated patients (90%) and 2 of die remaining patients continued treatm ent on a long-term basis. The apnea-hypopnea index was reduced by the devic e from 22 +/- 17 to 4.9 +/- 5.1 events per hour (p < 0.001) in these 19 lon g-term treatment patients, which did not differ from what was found at the short-term follow-up visits in these patients. Patients with their devices replaced or adjusted experienced a better long-term effect than patients st ill using their original devices (p < 0.05), Conclusions: The long-term effect and tolerability of a mandibular advancem ent device are good in patients who are recommended the treatment on the ba sis of a short-term sleep recording, provided that the device is continuous ly adjusted or replaced with a new one when needed. A short-term follow-up is valuable in the selection of patients who will benefit from long-term tr eatment with a mandibular advancement device.