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Mandibular Advancement Devices in 630 Men and Women With Obstructive Sleep Apnea and Snoring^*

Tolerability and Predictors of Treatment Success

^* From the Department of Orthodontics (Dr. Marklund), Umeå University; and the Departments of Public Health and Clinical Medicine, Epidemiology (Dr. Stenlund), and Respiratory Medicine (Dr. Franklin), University Hospital, Umeå, Sweden.

Correspondence to: Marie Marklund, DDS, PhD, Department of Orthodontics, Umeå University SE-901 87 Umeå, Sweden; e-mail: Marie.Marklund{at}odont.umu.se

Study objective: To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep apnea.

Design: Prospective study.

Setting: Departments of Respiratory Medicine and Orthodontics, Umeå University.

Patients: Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000, were followed up. They had a mean apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42).

Measurements: Interviews, questionnaires, and overnight sleep apnea recordings. Patients with an apnea-hypopnea index of 10 in the supine and/or lateral position were considered to have obstructive sleep apnea. A lateral apnea-hypopnea index of < 10, together with a supine apnea-hypopnea index of 10, defined supine-dependent sleep apneas.

Results: One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p = 0.01). In the women, the odds ratios for treatment success were 12 for mild sleep apnea (p = 0.04), and 0.1 for complaints of nasal obstruction (p = 0.03). In the men, the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas (p < 0.001), 2.5 for mild sleep apnea (p = 0.04), 1.3 for each millimeter of mandibular advancement (p = 0.03), and 0.8 for each kilogram of weight increase (p = 0.001).

Conclusions: The mandibular advancement device is recommended for women with sleep apnea, for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10, and for snorers without sleep apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device.

Key Words: activator appliances • mandibular advancement • nasal obstruction • sex • sleep apnea syndromes • supine position

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