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Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Marie Marklund, Johan Verbraecken, Winfried Randerath
European Respiratory Journal 2012 39: 1241-1247; DOI: 10.1183/09031936.00144711
Marie Marklund
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  • For correspondence: Marie.Marklund@odont.umu.se
Johan Verbraecken
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Winfried Randerath
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Abstract

Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.

Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.

In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

  • Mandibular advancement device
  • mandibular advancement splint
  • mandibular repositioning appliance
  • oral appliance
  • sleep apnoea

Footnotes

  • This article has supplementary material available from www.erj.ersjournals.com

  • Statement of Interest

    None declared.

  • Received August 22, 2011.
  • Accepted November 1, 2011.
  • ©ERS 2012
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Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy
Marie Marklund, Johan Verbraecken, Winfried Randerath
European Respiratory Journal May 2012, 39 (5) 1241-1247; DOI: 10.1183/09031936.00144711

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Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy
Marie Marklund, Johan Verbraecken, Winfried Randerath
European Respiratory Journal May 2012, 39 (5) 1241-1247; DOI: 10.1183/09031936.00144711
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  • Article
    • Abstract
    • SEARCH CRITERIA
    • DESCRIPTION OF THE INCLUDED STUDIES
    • EFFECTS ON OSA
    • EFFECTS ON SYMPTOMS AND QUALITY OF LIFE
    • EFFECTS ON CARDIOVASCULAR HEALTH
    • DEFINITION OF TREATMENT SUCCESS
    • PREDICTION OF TREATMENT SUCCESS
    • MANDIBULAR POSITIONING
    • DEVICE DESIGN
    • SIDE-EFFECTS, PREFERENCE AND COMPLIANCE
    • LONG-TERM EFFICACY
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