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MAD Appliance

Rocío Marco Pitarch, Marina Selva García, Javier Puertas Cuesta, Jaime Marco Algarra, Enrique Fernández Julian, Antonio Fons Font
PURPOSE: This study aimed to determine the effectiveness of a mandibular advancement device in a sample of obstructive sleep apnea syndrome patients by the evaluation of respiratory and neurophysiologic parameters and clinical symptoms. Second, the influence of certain predictor factors related with the patient and the intraoral device, were considered in the final response with this treatment option. METHODS: Forty-one patients constituted the final sample. Outcomes were measured using polysomnography, Epworth sleepiness scale and an analogue visual snoring scale, before treatment and once the device was properly titrated...
April 20, 2018: European Archives of Oto-rhino-laryngology
Sylvan S Mintz, Reka Kovacs
PURPOSE: In 2005, the American Academy of Sleep Medicine stated, "Oral appliances are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA) who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP." However, this recommendation is based upon variable results from only six studies with more than 100 participants. These studies have assessed the effectiveness of mandibular advancement devices (MADs) in specific groups (military populations, academic institutions, or hospital settings) with no large study conducted in a fee-for-service private practice where the majority of patients receive MADs for OSA...
May 2018: Sleep & Breathing, Schlaf & Atmung
Shadi Basyuni, Michal Barabas, Tim Quinnell
Continuous positive airway pressure (CPAP) remains the gold standard treatment for obstructive sleep apnoea hypopnoea syndrome (OSAHS). However, the high efficacy of CPAP is offset by intolerance and poor compliance, which can undermine effectiveness. This means that alternatives to CPAP are also necessary. In recent years, oral appliances have emerged as the leading alternative to CPAP. There is now a strong body of evidence supporting their use in OSAHS and clinical guidelines now recommend their use in mild OSAHS and in more severe cases when CPAP fails...
January 2018: Journal of Thoracic Disease
Enrique Fernández-Julián, Tomás Pérez-Carbonell, Rocío Marco, Verónica Pellicer, Enrique Rodriguez-Borja, Jaime Marco
OBJECTIVE/HYPOTHESIS: To investigate outcomes including efficacy, quality of life, and levels of inflammatory markers of a mandibular advancement device (MAD) for moderate-to-severe obstructive sleep apnea (OSA). STUDY DESIGN: Case-control study. METHODS: Patients with apnea-hypopnea index (AHI) ≥ 15/hr who only accepted MAD therapy (study group) or who refused any treatment (control group) were recruited. At baseline and at 6 months, polysomnography, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), C-reactive protein (CRP), interleukin 1β, interleukin 6, and tumor necrosis factor α (TNF-α) were assessed in both groups...
November 20, 2017: Laryngoscope
Martha Schwartz, Luis Acosta, Yuan-Lung Hung, Mariela Padilla, Reyes Enciso
The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias...
November 11, 2017: Sleep & Breathing, Schlaf & Atmung
K Gjerde, S Lehmann, I F Naterstad, M E Berge, A Johansson
The aim of this study was to test whether digitally registered use of a mandibular advancement device (MAD) by a built-in thermal sensor was reliable compared to a self-reported diary of MAD use. Eighty consecutive patients referred to a specialist outpatient sleep medicine clinic (HUS) were recruited. Patients of both genders, aged from 25 to 70 years with a diagnosis of mild, moderate or severe, were included. All participants signed a written informed consent when they received the MAD. For the purpose of this reliability study, we found it sufficient to include the first 30 nights of MAD use in the reliability analysis...
February 2018: Journal of Oral Rehabilitation
Luciana B M Godoy, Luciana Palombini, Dalva Poyares, Cibele Dal-Fabbro, Thaís Moura Guimarães, Priscila Calixto Klichouvicz, Sergio Tufik, Sonia Maria Togeiro
Objectives: To evaluate the long-term effects of an oral appliance on clinical symptoms, respiratory sleep parameters, sleep quality, and sustained attention in patients with upper airway resistance syndrome (UARS) were compared with placebo. Methods: This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time...
December 1, 2017: Sleep
M Nikolopoulou, A Byraki, J Ahlberg, M W Heymans, H L Hamburger, J De Lange, F Lobbezoo, G Aarab
Obstructive sleep apnoea syndrome (OSAS) is associated with several sleep disorders and sleep-related problems. Therefore, the aim of this study was to compare the effects of a mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) on self-reported symptoms of common sleep disorders and sleep-related problems in mild and moderate OSAS patients. In this randomised placebo-controlled trial, sixty-four OSAS patients (52·0 ± 9·6 years) were randomly assigned to an MAD, nCPAP or an intra-oral placebo appliance in a parallel design...
June 2017: Journal of Oral Rehabilitation
Giulio Alessandri-Bonetti, Vincenzo D'Antò, Chiara Stipa, Roberto Rongo, Serena Incerti-Parenti, Ambrosina Michelotti
Objectives: To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients. Methods: Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test...
October 1, 2017: European Journal of Orthodontics
De-hong Li, Xiang-hong Yang, Jing Zhou, Ling-peng Zhang, Wen Shu
PURPOSE: To investigate the efficacy and mechanism of mandibular advancement device (MAD) treatment on obstructive sleep apnea syndrome (OSAS) patients. METHODS: Eighty OSAS patients treated with a mandibular protraction appliance were included in the study. Three-dimensional reconstruction technique was used as to measure the changes of upper airway structure and volume before and after MAD treatment. The data was analyzed using SPSS 17.0 software package. RESULTS: The anatomic structure and the reinforcement of soft tissue's collapse in the upper airway changed after application of MAD in OSAS patients; velopharyngeal and laryngopharynx configuration was significantly increased (P<0...
April 2016: Shanghai Kou Qiang Yi Xue, Shanghai Journal of Stomatology
E De Corso, G Bastanza, G Della Marca, C Grippaudo, G Rizzotto, M R Marchese, A Fiorita, B Sergi, D Meucci, W Di Nardo, G Paludetti, E Scarano
Nowadays oral appliance therapy is recognised as an effective therapy for many patients with primary snoring and mild to moderate obstructive sleep apnoea (OSA), as well as those with more severe OSA who cannot tolerate positive airway pressure (PAP) therapies. For this reason, it is important to focus on objective criteria to indicate which subjects may benefit from treatment with a mandibular advancement device (MAD). Various anthropometric and polysomnographic predictors have been described in the literature, whereas there are still controversies about the role of drug-induced sleep endoscopy (DISE) and advancement bimanual manoeuvre as predictor factors of treatment outcome by oral device...
December 2015: Acta Otorhinolaryngologica Italica
David S P Heidsieck, Maurits H T de Ruiter, Jan de Lange
PURPOSE: A high prevalence of obstructive sleep apnea (OSA) is seen in edentulous individuals. Treatment options for edentulous OSA patients however are limited with continuous positive airway pressure therapy (CPAP) remaining the current therapy of choice. As CPAP is associated with high non-adherence rates and oral appliance therapy requiring sufficient dentition, there is a clinical need for effective treatment strategies aimed at edentulous OSA patients. The purpose of this study was to present a thorough overview of the literature regarding (1) the effects of nocturnal denture wearing on OSA, (2) the outcomes of oral appliance therapy, and (3) surgical treatment in edentulous OSA patients...
March 2016: Sleep & Breathing, Schlaf & Atmung
Thais Moura Guimarães, Sâmia Colen, Paulo Afonso Cunali, Rowdley Rossi, Cibele Dal-Fabbro, Otávio Ferraz, Sergio Tufik, Lia Bittencourt
Treatment with a mandibular advancement device (MAD) is recommended for mild obstructive sleep apnea (OSA), primary snoring and as a secondary option for Continuous Positive Airway Pressure, because it has better adherence and acceptance. However, edentulous patients do not have supports to hold the MAD. This study aimed to present a possible to OSA treatment with MAD in over complete upper and partial lower dentures. The patient, a 38-year-old female with mild OSA, was treated with a MAD. The respiratory parameter, such as apnea-hypopnea index, arousal index and oxyhemoglobin saturation was improved after treatment...
April 2015: Sleep Science
Punit Kumar Singh, Habib A Alvi, Balendra Pratap Singh, Raghuwar D Singh, Surya Kant, Sunit Jurel, Kamleshwar Singh, Deeksha Arya, Abhishek Dubey
STATEMENT OF PROBLEM: Sleep bruxism (SB) is an oral condition that is associated with tooth wear, orofacial pain, and interference with sleep. The most recommended management technique is the use of an occlusal splint. Although the mandibular advancement device (MAD) has shown good results, few well-designed randomized controlled trials are available with which to compare these treatment options. Therefore, an evaluation of the effect of these 2 appliances on SB is needed. PURPOSE: The purpose of this study was to evaluate the effect of a MAD and a maxillary occlusal splint (MOS) on the sleep quality and SB activity of participants with SB...
September 2015: Journal of Prosthetic Dentistry
Rosario Marchese-Ragona, Daniele Manfredini, Marta Mion, Andrea Vianello, Alberto Staffieri, Luca Guarda-Nardini
OBJECTIVES: To assess the effectiveness of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnea syndrome (OSAS) over a long-term follow-up in patients non-compliant with continuous positive airway pressure (CPAP) and to identify potential predictive factors of response to MADs. METHODS: Fifteen OSAS patients were enrolled. Apnea-hypopnea index (AHI) and daytime sleepiness were assessed at baseline and at the end of follow-up. Potential baseline predictors of treatment effectiveness were assessed...
October 2014: Cranio: the Journal of Craniomandibular Practice
Timothy G Quinnell, Abigail L Clutterbuck-James
PURPOSE OF REVIEW: Although mandibular advancement devices (MADs) provide an alternative to continuous positive airway pressure (CPAP) therapy in obstructive sleep apnea (OSA), their effectiveness and role remain unclear. Several recent studies and an updated meta-analysis have attempted to address these uncertainties. This review examines their contribution to the existing evidence and discusses the future priorities for MAD research. RECENT FINDINGS: Recent work has examined the impact of MAD design on clinical and cost-effectiveness in milder disease...
November 2014: Current Opinion in Pulmonary Medicine
Deeksha Arya, Saumyendra Vikram Singh, Arvind Tripathi, Surya Kant Tripathi
STATEMENT OF PROBLEM: The continuous positive airway pressure (CPAP) device yields optimum results in treating mild to moderate obstructive sleep apnea (OSA). However it may be bulky, noisy, and difficult to sleep with for the patient. Mandibular advancement devices (MAD) have shown better compliance but at the expense of lesser efficiency. PURPOSE: The purpose of this study was to evaluate the patient's posttreatment subjective perception of the effectiveness of 2 common treatments of OSA...
November 2014: Journal of Prosthetic Dentistry
David Young, Nancy Collop
This article focuses on the treatment of obstructive sleep apnea (OSA), using the most recent available data. The first choice of treatment for patients with moderate or severe obstructive sleep apnea is continuous positive airway pressure (CPAP), which was first described in 1981 (Sullivan et al. Lancet 1(8225):862-5, 1981) and works by splinting the airway open to facilitate proper airflow. For patients with mild OSA, other treatments may be considered including positional therapy, weight loss, or oral appliances...
August 2014: Current Treatment Options in Neurology
Steffanie K B Veldhuis, Michiel H J Doff, Boudewijn Stegenga, Jellie A Nieuwenhuis, Peter J Wijkstra
BACKGROUND: From the moment the respiratory muscle groups are affected in amyotrophic lateral sclerosis (ALS), respiratory complications will be the major cause of morbidity and mortality. Untreated respiratory muscle impairment leads to respiratory insufficiency and additionally to difficulties in airway secretion clearance. Non-invasive ventilation (NIV) is the first choice in treating respiratory insufficiency in ALS as it improves sleep-related symptoms, quality of life and life expectancy...
March 2015: Sleep & Breathing, Schlaf & Atmung
Emilie Garreau, Thomas Wojcik, Julie Bouscaillou, Joël Ferri, Gwenaël Raoul
INTRODUCTION: Currently, positive airway pressure is the gold standard treatment of obstructive sleep apnea (OSA). Unfortunely, adherence rates are poor. Alternative therapies are mandibular advancement device (MAD) and maxillomandibular advancement (MMA). PATIENTS: This retrospective study compared both treatment effectiveness on patients with moderate and severe OSA from January 2005 to September 2012, and carried out predictive factor of effectiveness. We defined therapeutic success as an apnea hypopnea index (AHI) less than 15 per hour and at least a 50% reduction of the initial index...
June 2014: L' Orthodontie Française
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