Mandibular Advancement Device for Obstructive Sleep Apnea
Mandibular Advancement Device for Obstructive Sleep Apnea
The purpose of this study was to determine how effective a custom-made standard dental splint
 (activator) advancing the lower jaw forward is in treatment of obstructive sleep apnea, and
 further to find factors for identification of those patients likely to benefit from this
 treatment.
Obstructive sleep apnea (OSA) is far the most common sleep disordered breathing, affecting
 2-4% of the adult population. The repetitive obstructions are located in the pharyngeal
 airway, leading to sleep fragmentation and resulting in excessive daytime sleepiness with
 consequences for ability to work, road safety and quality of life. Furthermore, OSA is an
 independant riskfactor for cardiovascular disease. The treatment of choice today is
 continuous positive airway pressure (CPAP) but a main problem with CPAP is an unsatisfactory
 compliance. An alternative conservative more user-friendly treatment could be oral
 appliances, intending to increase the pharyngeal airway directly by tongue retaining devices
 or indirectly by mandibular advancing devices. Though several randomized studies on oral
 appliances have come recent years, all giving some evidence for effect on OSA, they all had
 some shortcomings, such as using crossover design, small sample sizes, under-reporting of
 methods and data and lack of blinding.

 In this study of a mandibular advancement device was used a parallel group design with an
 inactive device and no intervention as controls. Beside the effect on sleep, daytime
 sleepiness and quality of life, the study aimed to find objective factors to be used as
 predictors of the outcome.
Inclusion Criteria:

 -  AHI > 5 on polysomnography

 -  sufficient set of teeth to hold a splint

 -  written informed consent

 Exclusion Criteria:

 -  sleep apnea with severe cardiovascular disease

 -  other severe somatic or psychiatric disease

 -  periodontal disease

 -  significant occlusal dysfunction

 -  pregnant women