Comparison of titrable thermoplastic versus custom-made mandibular advancement device for the treatment of obstructive sleep apnoea. (October 2017)

• Record Type: Journal Article
• Authors: Gagnadoux, Frédéric; Nguyen, Xuan-Lan; Le Vaillant, Marc; Priou, Pascaline; Meslier, Nicole; Eberlein, Audrey; Kun-Darbois, Jean-Daniel; Chaufton, Cyril; Villiers, Bruno; Levy, Maguy; Trzépizur, Wojciech; Launois, Sandrine
• Is Part Of: Respiratory medicine. Volume 131(2017)
• Page Start: 35
• Page End: 42
• Publication Date: 2017-10
• Subjects: Obstructive sleep apnoea -- Mandibular advancement device -- Thermoplastic oral appliance -- Custom-made oral appliance; AHI apnoea-hypopnoea index -- AI apnoea index -- BMI body mass index -- CPAP continuous positive airway pressure -- ESS Epworth Sleepiness Scale -- MAD mandibular advancement device -- ODI oxygen desaturation index -- SF36 Outcomes Study 36-item Short-Form -- SDB sleep-disordered breathing -- T90 sleep time with SaO2 <90% -- VAS visual analogue scale (VAS); Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2017.08.004
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Backgound and objectives: The disadvantages of custom-made mandibular advancement devices (MAD) for obstructive sleep apnoea (OSA) therapy are the cost and delay required to manufacture the device. This study aimed to evaluate the efficacy of a titrable, thermoplastic MAD compared to a custom-made MAD for OSA therapy. Methods: In this prospective nonrandomized study, 158 patients with OSA from two French sleep centers were treated for 6 months with a titrable thermoplastic MAD (n = 86) or a custom-made MAD (n = 72). The primary outcome was the change in sleep-disordered breathing (SDB) severity. Results: After adjustment for baseline values, age, body mass index and study site, no significant intergroup differences were observed between thermoplastic and custom-made MAD for the outcome of apnoea, hypopnoea and oxygen desaturation indices. No between treatment differences were observed for the outcome of subjective sleepiness, symptoms of snoring and fatigue, depressive symptoms, and quality of life. Thermoplastic MAD therapy was associated with higher side effects scores for tooth pain (p &lt; 0.0001) and self-reported occlusal changes (p = 0.0069). Mean (SD) reported compliance was lower in the thermoplastic MAD group than in the custom-made MAD group (6.4 [0.2] vs 7.1 [0.1] h/night; p = 0.035). Conclusions: This study demonstrates the efficacy of a titrable thermoplastic MAD in reducing SDB and related symptoms in patients with mild to severe OSA. Reported compliance at 6 months was high despite more dental discomfort than with custom-made MAD. Highlights: The use custom-made devices is recommended for mandibular advancement therapy of OSA. Custom-made devices are expensive and a delay is required to manufacture the device. A titrable thermoplastic device was effective in reducing OSA severity and symptoms. 6-month adherence was high despite more dental discomfort than with a custom-made device. A trial with a titrable thermoplastic device could be of interest prior to custome-made device.