Therapeutic Effect of Mandibular Advancement Device in Sleep-Related Breathing Disorders

J Korean Neurol Assoc > Volume 25(4); 2007 > Article

Journal of the Korean Neurological Association 2007;25(4): 500-507.

수면호흡장애에서 하악전진기구의 치료 효과

김수경, 김대영 김영남 이지현 조재욱 주은연 김영호a 홍승봉

성균관대학교 의과대학, 삼성서울병원 신경과학교실, 수면장애클리닉, 치과진료부 교정과a

Therapeutic Effect of Mandibular Advancement Device in Sleep-Related Breathing Disorders

Soo-Kyoung Kim

Department of Neurology, Sleep Disorders Clinic, Department of Orthodontics, The Institute of Oral Health & Sciencea, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Abstract

Background: The Mandibular advancement device (MAD) was known to be one of the effective treatments for the broad spectrum of sleep related breathing disorders. The aim of the present study was to evaluate the therapeutic effects and the determinants of success or failure of MAD in patients with sleep-related breathing disorders (SRBD).
Methods: We enrolled 20 patients with SRBD confirmed by overnight polysomnography. All patients were fitted with temporary MAD. Apnea-hypopnea index (AHI) and risk index (RI) were measured by a portable respiratory- monitoring device (MESAM Ⅳ) before and after temporary MAD use.
Results: Overall, MAD significantly reduced AHI (18.9±11.6/hr to 13.8±11.9/hr, p=0.029), but Epworth sleepiness scale was not improved (10.9±3.9 to 9.8±3.9, p=0.086). More than 50% of reduction in AHI was observed in 6 patients (30%, 6/20). When subjects were divided into patients who were satisfied with the temporary MAD and decided to keep wearing permanent MAD during the night (good response, GR, N=12) and patients who refuse to wear permanent MAD because they could not get accustomed to the temporary MAD (poor response, PR, N=8), There were no differences in age, body mass index, and pre-treatment AHI during the overnight polysomnography between both groups. There were significant reductions in AHI, and ESS were observed in GR, not in PR. Seven patients in GR group decided to apply the permanent MAD (two-piece Herbst type).
Conclusions: These findings suggested that having good response to MAD determined the improvement of SRBD and daytime sleepiness. However, it is uncertain whether other factors affected the patients’ compliance to MAD.KeyWords:Sleep-related breathing disorder, Oral appliance, Mandibular advancement device, Apnea-hypopnea index, Risk index