Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives

Sofie Wilkens Knappe, Liselotte Sonnesen Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Abstract: The purpose of this article is to review 1) mandibular advancement device (MAD) – in...

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Autores principales:	Knappe SW, Sonnesen L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Sleep disordered breathing mandibular advancement treatment treatment outcome Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
Acceso en línea:	https://doaj.org/article/dcb0c53bb5c9442a9e5c2dfa70501544
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spelling	oai:doaj.org-article:dcb0c53bb5c9442a9e5c2dfa705015442021-12-02T01:54:45ZMandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives1179-1608https://doaj.org/article/dcb0c53bb5c9442a9e5c2dfa705015442018-02-01T00:00:00Zhttps://www.dovepress.com/mandibular-positioning-techniques-to-improve-sleep-quality-in-patients-peer-reviewed-article-NSShttps://doaj.org/toc/1179-1608Sofie Wilkens Knappe, Liselotte Sonnesen Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Abstract: The purpose of this article is to review 1) mandibular advancement device (MAD) – indication, treatment success, and side effects; 2) maxillomandibular advancement (MMA) surgery of the jaws – indication, treatment success, and side effects; and 3) current perspectives. Both MAD and MMA are administered to increase the upper airway volume and reduce the collapsibility of the upper airway. MAD is noninvasive and is indicated as a first-stage treatment in adult patients with mild-to-moderate obstructive sleep apnea (OSA) and in patients with severe OSA unable to adhere to continuous positive airway pressure (CPAP). MAD remains inferior to CPAP in reducing the apnea–hypopnea index (AHI) with a treatment success ranging between 24% and 72%. However, patient compliance to MAD is greater, and with regard to subjective sleepiness and health outcomes, MAD and CPAP have been found to be similarly effective. Short-term side effects of MAD are minor and often transient. Long-term side effects primarily appear as changes in the dental occlusion related to decreases in overjet and overbite. MMA is efficacious but highly invasive and indicated as a second-stage treatment in patients with moderate-to-severe OSA, with prior failure to other treatment modalities or with craniofacial abnormalities. The surgical success and cure rates are found to be 86.0% and 43.2%, respectively. Side effects may appear as postsurgical complications such as temporary facial paresthesia and compromised facial esthetics. However, most patients report satisfaction with their postsurgical appearance. Both treatment modalities require experienced clinicians and multidisciplinary approaches in order to efficaciously treat OSA patients. Some researchers do propose possible predictors of treatment success, but clear patient selection criteria and clinical predictive values for treatment success are still needed in both treatment modalities. Keywords: sleep-disordered breathing, mandibular advancement treatment, treatment outcomeKnappe SWSonnesen LDove Medical PressarticleSleep disordered breathingmandibular advancement treatmenttreatment outcomePsychiatryRC435-571Neurophysiology and neuropsychologyQP351-495ENNature and Science of Sleep, Vol Volume 10, Pp 65-72 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Sleep disordered breathing mandibular advancement treatment treatment outcome Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495
spellingShingle	Sleep disordered breathing mandibular advancement treatment treatment outcome Psychiatry RC435-571 Neurophysiology and neuropsychology QP351-495 Knappe SW Sonnesen L Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
description	Sofie Wilkens Knappe, Liselotte Sonnesen Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark Abstract: The purpose of this article is to review 1) mandibular advancement device (MAD) – indication, treatment success, and side effects; 2) maxillomandibular advancement (MMA) surgery of the jaws – indication, treatment success, and side effects; and 3) current perspectives. Both MAD and MMA are administered to increase the upper airway volume and reduce the collapsibility of the upper airway. MAD is noninvasive and is indicated as a first-stage treatment in adult patients with mild-to-moderate obstructive sleep apnea (OSA) and in patients with severe OSA unable to adhere to continuous positive airway pressure (CPAP). MAD remains inferior to CPAP in reducing the apnea–hypopnea index (AHI) with a treatment success ranging between 24% and 72%. However, patient compliance to MAD is greater, and with regard to subjective sleepiness and health outcomes, MAD and CPAP have been found to be similarly effective. Short-term side effects of MAD are minor and often transient. Long-term side effects primarily appear as changes in the dental occlusion related to decreases in overjet and overbite. MMA is efficacious but highly invasive and indicated as a second-stage treatment in patients with moderate-to-severe OSA, with prior failure to other treatment modalities or with craniofacial abnormalities. The surgical success and cure rates are found to be 86.0% and 43.2%, respectively. Side effects may appear as postsurgical complications such as temporary facial paresthesia and compromised facial esthetics. However, most patients report satisfaction with their postsurgical appearance. Both treatment modalities require experienced clinicians and multidisciplinary approaches in order to efficaciously treat OSA patients. Some researchers do propose possible predictors of treatment success, but clear patient selection criteria and clinical predictive values for treatment success are still needed in both treatment modalities. Keywords: sleep-disordered breathing, mandibular advancement treatment, treatment outcome
format	article
author	Knappe SW Sonnesen L
author_facet	Knappe SW Sonnesen L
author_sort	Knappe SW
title	Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
title_short	Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
title_full	Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
title_fullStr	Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
title_full_unstemmed	Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
title_sort	mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/dcb0c53bb5c9442a9e5c2dfa70501544
work_keys_str_mv	AT knappesw mandibularpositioningtechniquestoimprovesleepqualityinpatientswithobstructivesleepapneacurrentperspectives AT sonnesenl mandibularpositioningtechniquestoimprovesleepqualityinpatientswithobstructivesleepapneacurrentperspectives
_version_	1718402807263920128

Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives

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