The Mandibular Advancement Devices Induce Obstructive Sleep Apnea Treatment

Haval Jalal Rasheed ^1*, Zana Qader Omer ²

Mandibular advancement devices significantly improve sleep apnea-related physiological parameters within three months, promoting better sleep quality and overall health.

Abstract

Introduction: Obstructive sleep apnea (OSA) is a prevalent breathing-related disorder characterized by intermittent airflow cessation due to upper airway narrowing or collapse. Polysomnography is the gold standard diagnostic test for sleep disorders, including sleep apnea. This study evaluates the efficacy of mandibular advancement devices, specifically the MSI, by examining changes in various physiological parameters. Methods: Twenty patients with mild to moderate OSA risk, selected from 500 patients attending Khanzad Teaching Hospital, were treated with MSI for three months with a 3mm advancement. Physiological records were obtained before and after treatment using a portable sleep study device. Results: Significant changes were observed after three months of treatment. The Apnea-Hypopnea Index (AHI)/Respiratory Event Index (REI) showed a slight reduction from 30.5 to 28 events, but this change was statistically non-significant. The Respiratory Disturbance Index (RDI) significantly decreased from 49.42 to 35.94. The Oxygen Desaturation Index (ODI) showed a significant reduction from 34.25 to 33.97. Blood oxygen levels (spO2%) improved from 77.85% to 89.7%. The pulse rate frequency (50-75 bpm) changed from 80.17 to 81.91, which was non-significant. Respiratory desaturations decreased from 162.5 to 144, obstructive apnea events reduced from 34.7 to 19.65 (approximately 15%), and hypopnea events decreased from 144.25 to 107.3. Conclusion: Statistically significant improvements were recorded in the ODI, spO2%, desaturations, and RDI, except for the AHI/REI and pulse rate, which showed non-significant differences. Mandibular advancement at a range of 0.5 mm was better tolerated by patients than 0.5 mm per week advancements.

Keywords: Obstructive Sleep Apnea, Mandibular Advancement Device, Polysomnography, Sleep Disorders, Physiological Parameters

References

Agarwal, L., & Gupta, A. (2016). Role of orthodontist in obstructive sleep apnea-an orthodontic review. J Orthod Endod, 2(3), 7.

Braebon. Available at: https://www2.braebon.com/products/medibyte (Accessed: 14 May 2024).

Braebon. Available at: https://www2.braebon.com/products/medibyte (Accessed: 29 May 2024).

Bruyneel, M., & Ninane, V. (2014). Unattended home-based polysomnography for sleep disordered breathing: current concepts and perspectives. Sleep Medicine Reviews, 18(4), 341-347.

Chattu, V. K., Manzar, M. D., Kumary, S., Burman, D., Spence, D. W., & Pandi-Perumal, S. R. (2018, December). The global problem of insufficient sleep and its serious public health implications. In Healthcare (Vol. 7, No. 1, p. 1). MDPI.

Chung, F., Yegneswaran, B., Liao, P., et al. (2008). STOP questionnaire: A tool to screen patients for obstructive sleep apnea. Anesthesiology, 108(5), 812.

DB Orthodontics. (n.d.). MSi Mandibular Snoring Inhibitor. Retrieved from https://dbortho.com/products/msi-mandibular-snoring-inhibitor.

Kim, H. S., Son, J. H., Chung, J. H., Kim, K. S., Choi, J., & Yang, J. Y. (2021). Nasal airway function after Le Fort I osteotomy with maxillary impaction: A prospective study using the Nasal Obstruction Symptom Evaluation scale. Archives of Plastic Surgery, 48(1), 61-68.

Kirsch, D. B. (2011). There and back again: a current history of sleep medicine. Chest, 139(4), 939-946.

Kulshrestha, R., Tandon, R., Kinger, S., Rohmetra, A., & Singh, R. V. (2016). Obstructive sleep apnea in orthodontics: An overview. International Journal of Orthodontic Rehabilitation, 7(3), 115.

Marbach, F., Elgizouli, M., Rech, M., Beygo, J., Erger, F., Velmans, C., ... & Kuechler, A. (2020). The adult phenotype of Schaaf-Yang syndrome. Orphanet Journal of Rare Diseases, 15, 1-11.

Mendonça, F., Mostafa, S. S., Ravelo-García, A. G., Morgado-Dias, F., & Penzel, T. (2018). Devices for home detection of obstructive sleep apnea: A review. Sleep Medicine Reviews, 41, 149-160.

MSI (Mandibular Snoring Inhibitor). (n.d.). DB Orthodontics Limited. Retrieved from https://dbortho.com/products/msi-mandibular-snoring-inhibitor.

Nagappa, M., Liao, P., Wong, J., Auckley, D., Ramachandran, S. K., Memtsoudis, S., ... & Chung, F. (2015). Validation of the STOP-Bang questionnaire as a screening tool for obstructive sleep apnea among different populations: a systematic review and meta-analysis. PloS One, 10(12), e0143697.

Nunn, C. L., Samson, D. R., & Krystal, A. D. (2016). Shining evolutionary light on human sleep and sleep disorders. Evolution, Medicine, and Public Health, 2016(1), 227-243.

Obstructive sleep apnea. The Official STOP-Bang Questionnaire Website. (n.d.). Retrieved from http://www.stopbang.ca/

Raveendran, R., & Chung, F. (2015). Ambulatory anesthesia for patients with sleep apnea. Ambulatory Anesthesia, 143-151.

Venema, J. A. U., Rosenmöller, B. R., De Vries, N., de Lange, J., Aarab, G., Lobbezoo, F., & Hoekema, A. (2021). Mandibular advancement device design: a systematic review on outcomes in obstructive sleep apnea treatment. Sleep Medicine Reviews, 60, 101557.

Zampogna, E., Bertolotti, G., Ambrosino, N., Bello, G. L., Cherubino, F., Ianni, A., ... & Giordano, A. (2021). The Maugeri daily activity profile: a tool to assess physical activity in patients with chronic obstructive pulmonary disease. Monaldi Archives for Chest Disease, 91(4).