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Oral Appliance Therapy Improves Symptoms in Obstructive Sleep Apnea

A Randomized, Controlled Trial

Department of Respiratory Medicine, Centre for Sleep Disorders and Respiratory Failure, St. George Hospital, University of New South Wales, Kogarah, Australia

Correspondence and requests for reprints should be addressed to Dr. Peter A. Cistulli, Department of Respiratory Medicine, Centre for Sleep Disorders and Respiratory Failure, St. George Hospital, University of New South Wales, Kogarah 2217, NSW, Australia. E-mail: p.cistulli{at}unsw.edu.au

The aim of this study was to evaluate the effect of a mandibular advancement splint (MAS) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea (OSA). Using a randomized crossover design, patients received 4 weeks of treatment with MAS and a control device (inactive oral appliance), with an intervening 1-week washout. At the end of each treatment period, patients were reassessed by questionnaire, polysomnography, and multiple sleep latency test. Fifty-nine men and 14 women with a mean (± SD) age of 48 ± 11 years and proven OSA experienced a significantly improved mean (± SEM) sleep latency on the multiple sleep latency test (10.3 ± 0.5 versus 9.1 ± 0.5 minutes, p = 0.01) and Epworth sleepiness scale score (7 ± 1 versus 9 ± 1, p < 0.0001) with the MAS compared with the control device after 4 weeks. The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device (82 versus 62%, p < 0.01), but this was not so for objective sleepiness (48 versus 34%, p = 0.08). Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device. MAS therapy improves a range of symptoms associated with OSA.

Key Words: sleep apnea • obstructive • orthodontic appliances

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