Mandibular advancement splints for sleep apnoea

Key Points

• Mandibular advancement splints can be successfully used in the treatment of patients with sleep-related breathing disorders.

• Patients presenting with obstructive sleep apnoea can have a wide range of disease severity, which may not be indicative of treatment outcome.

• Follow-up sleep studies are required.

Abstract

Objectives This study assessed the effectiveness of a mandibular advancement splint (MAS) in subjects with sleep-related breathing disorders using both objective and subjective outcome measures.

Design The study was carried out as a retrospective analysis.

Setting The study was conducted within the Sleep Studies Unit at the Queen Victoria Hospital, East Grinstead, between May 1997 and March 2000.

Subjects and methods Twenty subjects with obstructive sleep apnoea (OSA) and six with non-apnoeic snoring, diagnosed by overnight polysomnography, were fitted with a monobloc appliance between May 1997 and March 2000.

Main outcome measures The subjects were analysed for changes in the respiratory disturbance index (RDI) and Epworth Sleepiness Scale (ESS) scores. In addition each subject completed an outcome questionnaire following fitting of the appliance.

Results Variability in response measured by the change in the respiratory disturbance index was found with no correlation to the baseline recording. Although median RDI values improved in both groups, significantly so in the obstructive sleep apnoea group (p<0.05), seven subjects exhibited an increased RDI score following mandibular advancement splint therapy. The median Epworth Sleepiness Scale scores decreased in both the OSA group and the non-apnoeic snorers although not significantly. Twenty-one of the 26 subjects completed the outcome questionnaire revealing an 81% reduction in snoring. Side-effects were generally transient and minor. Eighty-six per cent of the subjects' partners reported better quality of sleep as a result of MAS therapy.

Conclusions The monobloc appliance significantly improved the Respiratory Disturbance Index in the obstructive sleep apnoea group. Some subjects had increased RDI scores following splint therapy. This supports the need for an objective assessment in the follow-up of patients treated with mandibular advancement splints.

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