Efficiency of mandibular advancement devices in the treatment of light sleep apnea

Abstract

Introduction: The study has proposed a preliminary assessment of the effectiveness of using mandibular advancement devices to treat sleep apnea, snoring and mild ronchopathy. Materials and methods: The study was designed to perform a preliminary assessment of the efficiency of the use of mandible advancement devices for treating light snoring (ronchopathy) and sleep apnea. In order to perform this study we investigated 21 patients that came to the Pneumophtysiology Clinic in Iasi between 2006-2008, of whom 15 were men and 6 were women aged between 31-52 years, (average age 41.5 years), for night breathing problems. The patients experienced day fatigue, focusing difficulties, apnea reported by their family, night saliva loss and snoring. The exclusion criteria were chronic heart failure, diabetes and severe OSA suspicions. All the patients were subjected to OSA investigations by means of sleep respiratory polygraphy in order to diagnose a possible sleep apnea and to determine the type of adequate treatment for each patient. Depending on the AHI, the patients were classified either as suffering from a light OSA (AHI = 5-15/ hour), or as not suffering from OSA at all (AHI<5/hour) but only ronhopathy, the latter being sent to the Gnato-Prosthetics Clinic Iasi for dental investigations. The oral devices used were Somnoguard, Somnofit and individualized guards. We monitored to the efficiency of these devices in light OSA and ronhopathy and the patients compliance to them. Discussions: Somnoguard system trays system was first used to treat mild AOS. It is easy to apply, is compact, but mandibular advancement is limited, they are standardized by the manufacturer. Somnofit system is an improved version, trays are paired, mandibular advancement is done using elastic orthodontic and is much higher compared Somnoguard. We used this system as an alternative to Somnoguard and in patients with low overbite accentuated overjet. Individual devices have emerged as a solution designed by our team to treat AOS through oral devices. The first attempts were rigid trays for bruxism solidarity that generate excessive forces on the teeth and ATM. Conclusions: Mandibular advancement devices may be used in patients with mild desaturation in O2 , low daytime sleepiness, low frequency of apnea, intolerance to nasal positive pressure ventilation (CPAP) and those who refuse surgery. Oral appliances are a good solution to treat snoring and mild AOS. Individual guards were well tolerated, adapt better than systems Somnofit / Somnoguard, are more “comfortable” and their price is lower than that of the precast. Interdisciplinary approach is needed for investigation and treatment by these devices.