HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) All Versions of this Article: 34/4/914    most recent 09031936.00148208v1 Alert me when this article is cited Alert me if a correction is posted Permissions Request Permissions Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Gagnadoux, F. Articles by Racineux, J. L. PubMed PubMed Citation Articles by Gagnadoux, F. Articles by Racineux, J. L.

Titrated mandibular advancement versus positive airway pressure for sleep apnoea

¹ Département de Pneumologie, CHU, and ³ Unité de Statistiques, BioMathématiques et Informatique, CHU, Angers, ² Service de Pneumologie and ⁴ Service d’ORL, Hôpital Saint-Antoine, Paris, France.

CORRESPONDENCE: F. Gagnadoux, Département de Pneumologie, CHU, Angers, France. E-mail: frgagnadoux{at}chu-angers.fr

Keywords: Continuous positive airway pressure, mandibular advancement, obstructive sleep apnoea, titration, treatment

Received: September 29, 2008
Accepted February 18, 2009

The aim of this study was to compare mandibular advancement device (MAd) therapy and continuous positive airway pressure (CPAP) for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) after one-night polysomnographic (PSG) titration of both treatments.

59 OSAHS patients (apnoea/hypopnoea index (AHI): 34±13 events·h^–1; Epworth scale: 10.6±4.5) were included in a crossover trial of 8 weeks of MAd and 8 weeks of CPAP after effective titration. Outcome measurements included home sleep study, sleepiness, health-related quality of life (HRQoL), cognitive tests, side-effects, compliance and preference.

The median (interquartile range) AHI was 2 (1–8) events·h^–1 with CPAP and 6 (3–14) events·h^–1 with MAd (p<0.001). Positive and negative predictive values of MAd titration PSG for treatment success were 85% and 45%, respectively. Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL. The reported compliance was higher for MAd (p<0.001) with >70% of patients preferring this treatment.

These results support titrated MAd as an effective therapy in moderately sleepy and overweight OSAHS patients. Although less effective than CPAP, successfully titrated MAd was very effective at reducing the AHI and was associated with a higher reported compliance. Both treatments improved functional outcomes to a similar degree. One-night titration of MAd had a low negative predictive value for treatment success.