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Mandibular Advancement Devices for Treating Snoring and Obstructive Sleep Apnea

  • Byun, Jin-Seok (Department of Oral Medicine, School of Dentistry, Kyungpook National University) ;
  • Jung, Jae-Kwang (Department of Oral Medicine, School of Dentistry, Kyungpook National University)
  • 투고 : 2014.03.04
  • 심사 : 2014.03.31
  • 발행 : 2014.06.30

초록

Many therapeutic modalities including continuous positive airway pressure, surgery, and oral appliances are used to treat patients with sleep-disordered breathing. However, there are no definitive treatment modalities for individual patients due to various causes of sleep-disordered breathing. Clinicians should have select best options for individual patients and it is quite challenging process. Oral appliances attracted clinical attention for its convenience and safety. Several designs of oral appliances are introduces such as soft palate lifter, tongue retaining device, and various appliances which aimed to mandibular advancement. Among these oral appliances, mandibular advancement devices (MADs) are considered the most excellent based on their effectiveness and patient tolerance. Although MADs are not guarantee dramatic outcome and less consistent than continuous positive airway pressure, they offer several advantages over continuous positive airway pressure and surgical methods, including non-invasiveness, silence, portability, and tolerability, simplicity. Therefore, general dental practitioner who had passed sleep dental curriculum or coursework can treat the patients with sleep problems. This article reviews the history, clinical indications, suggested mechanism of actions, various positive effects and several side effects, factors predicting a favorable outcome, determining amounts of mandibular advancement, compliance and long-term efficacy of MADs use.

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참고문헌

  1. Guilleminault C, Tilkian A, Dement WC. The sleep apnea syndromes. Annu Rev Med 1976;27:465-484. https://doi.org/10.1146/annurev.me.27.020176.002341
  2. White DP. Sleep apnea. Proc Am Thorac Soc 2006;3:124-128. https://doi.org/10.1513/pats.200510-116JH
  3. Dasheiff RM, Finn R. Clinical foundation for efficient treatment of obstructive sleep apnea. J Oral Maxillofac Surg 2009;67:2171-2182. https://doi.org/10.1016/j.joms.2009.04.071
  4. Harding SM. Complications and consequences of obstructive sleep apnea. Curr Opin Pulm Med 2000;6:485-489. https://doi.org/10.1097/00063198-200011000-00004
  5. Teran-Santos J, Jimenez-Gomez A, Cordero-Guevara J. The association between sleep apnea and the risk of traffic accidents. Cooperative Group Burgos-Santander. N Engl J Med 1999;340:847-851. https://doi.org/10.1056/NEJM199903183401104
  6. Morgenthaler TI, Kapen S, Lee-Chiong T, et al; Standards of Practice Committee; American Academy of Sleep Medicine. Practice parameters for the medical therapy of obstructive sleep apnea. Sleep 2006;29:1031-1035.
  7. Epstein LJ, Kristo D, Strollo PJ Jr, et al; Adult Obstructive Sleep Apnea Task Force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and longterm care of obstructive sleep apnea in adults. J Clin Sleep Med 2009;5:263-276.
  8. Strauss AM. Oral devices for the management of snoring and obstructive sleep apnea. In: Fairbanks DNF, Fujita R, eds. Snoring and obstructive sleep apnea. 2nd ed. New York: Raven Press Ltd.;1994. pp. 229-241.
  9. Clark GT. Mandibular advancement devices and sleep disordered breathing. Sleep Med Rev 1998;2:163-174. https://doi.org/10.1016/S1087-0792(98)90019-3
  10. Lowe AA, Sjöholm TT, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE. Treatment, airway and compliance effects of a titratable oral appliance. Sleep 2000;23(Suppl 4):S172-S178.
  11. Robin P. Glossoptosis due to atresia and hypotrophy of the mandible. Arch Pediatr Adolesc Med 1934;48:541-547. https://doi.org/10.1001/archpedi.1934.01960160063005
  12. Soll BA, George PT. Treatment of obstructive sleep apnea with a nocturnal airway-patency appliance. N Engl J Med 1985;313:386-387. https://doi.org/10.1056/NEJM198508083130612
  13. Meier-Ewert K, Brosig B. Treatment of sleep apnea by prosthetic mandibular advancement. In: Peter JH, Podszus T, von Wichert P, eds. Sleep related disorders and internal diseases. Heidelberg: Springer Verlag GmbH; 1987. pp. 341-345.
  14. Cartwright RD, Samelson CF. The effects of a nonsurgical treatment for obstructive sleep apnea. The tongue-retaining device. JAMA 1982;248:705-709. https://doi.org/10.1001/jama.1982.03330060045032
  15. Paskow H, Paskow S. Dentistry's role in treating sleep apnea and snoring. N J Med 1991;88:815-817.
  16. Barthlen GM, Brown LK, Wiland MR, Sadeh JS, Patwari J, Zimmerman M. Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome. Sleep Med 2000;1:299-305. https://doi.org/10.1016/S1389-9457(00)00030-7
  17. Marklund M, Franklin KA. Dental appliances in the treatment of snoring. A comparison between an activator, a soft-palate lifter, and a mouth-shield. Swed Dent J 1996;20:183-188.
  18. Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA. Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep 2009;32:648-653.
  19. Kushida CA, Morgenthaler TI, Littner MR, et al; American Academy of Sleep. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 2006;29:240-243.
  20. Lee CH, Mo JH, Choi IJ, et al. The mandibular advancement device and patient selection in the treatment of obstructive sleep apnea. Arch Otolaryngol Head Neck Surg 2009;135:439-444. https://doi.org/10.1001/archoto.2009.31
  21. Borel JC, Gakwaya S, Masse JF, Melo-Silva CA, Series F. Impact of CPAP interface and mandibular advancement device on upper airway mechanical properties assessed with phrenic nerve stimulation in sleep apnea patients. Respir Physiol Neurobiol 2012;183:170-176. https://doi.org/10.1016/j.resp.2012.06.018
  22. Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest 1999;116:1511-1518. https://doi.org/10.1378/chest.116.6.1511
  23. Marklund M, Franklin KA, Sahlin C, Lundgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 1998;113:707-713. https://doi.org/10.1378/chest.113.3.707
  24. Millman RP, Rosenberg CL, Carlisle CC, Kramer NR, Kahn DM, Bonitati AE. The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty. Chest 1998;113:992-996. https://doi.org/10.1378/chest.113.4.992
  25. Mayer G, Meier-Ewert K. Cephalometric predictors for orthopaeendothedic mandibular advancement in obstructive sleep apnoea. Eur J Orthod 1995;17:35-43. https://doi.org/10.1093/ejo/17.1.35
  26. L'Estrange PR, Battagel JM, Harkness B, Spratley MH, Nolan PJ, Jorgensen GI. A method of studying adaptive changes of the oropharynx to variation in mandibular position in patients with obstructive sleep apnoea. J Oral Rehabil 1996;23:699-711. https://doi.org/10.1046/j.1365-2842.1996.00416.x
  27. Sam K, Lam B, Ooi CG, Cooke M, Ip MS. Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea. Respir Med 2006;100:897-902. https://doi.org/10.1016/j.rmed.2005.08.019
  28. Kurtulmus H, Cotert S, Bilgen C, On AY, Boyacioglu H. The effect of a mandibular advancement splint on electromyographic activity of the submental and masseter muscles in patients with obstructive sleep apnea. Int J Prosthodont 2009;22:586-593.
  29. Almeida FR, Tsuiki S, Hattori Y, Takei Y, Inoue Y, Lowe AA. Dose-dependent effects of mandibular protrusion on genioglossus activity in sleep apnoea. Eur Respir J 2011;37:209-212. https://doi.org/10.1183/09031936.00194809
  30. Chan AS, Lee RW, Srinivasan VK, Darendeliler MA, Grunstein RR, Cistulli PA. Nasopharyngoscopic evaluation of oral appliance therapy for obstructive sleep apnoea. Eur Respir J 2010;35:836-842. https://doi.org/10.1183/09031936.00077409
  31. Choi JK, Hur YK, Lee JM, Clark GT. Effects of mandibular advancement on upper airway dimension and collapsibility in patients with obstructive sleep apnea using dynamic upper airway imaging during sleep. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:712-719. https://doi.org/10.1016/j.tripleo.2009.11.034
  32. Ng AT, Qian J, Cistulli PA. Oropharyngeal collapse predicts treatment response with oral appliance therapy in obstructive sleep apnea. Sleep 2006;29:666-671.
  33. Hoffstein V. Review of oral appliances for treatment of sleepdisordered breathing. Sleep Breath 2007;11:1-22. https://doi.org/10.1007/s11325-006-0084-8
  34. Marklund M, Verbraecken J, Randerath W. Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J 2012;39:1241-1247. https://doi.org/10.1183/09031936.00144711
  35. Gotsopoulos H, Chen C, Qian J, Cistulli PA. Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. Am J Respir Crit Care Med 2002;166:743-748. https://doi.org/10.1164/rccm.200203-208OC
  36. Holley AB, Lettieri CJ, Shah AA. Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest 2011;140:1511-1516. https://doi.org/10.1378/chest.10-2851
  37. Naismith SL, Winter VR, Hickie IB, Cistulli PA. Effect of oral appliance therapy on neurobehavioral functioning in obstructive sleep apnea: a randomized controlled trial. J Clin Sleep Med 2005;1:374-380.
  38. Maguire J, Steele JG, Gibson GJ, Wilson JA, Steen N, McCracken GI. Randomised cross-over study of oral appliances for snoring. Clin Otolaryngol 2010;35:204-209. https://doi.org/10.1111/j.1749-4486.2010.02126.x
  39. Lam B, Sam K, Mok WY, et al. Randomised study of three nonsurgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354-359. https://doi.org/10.1136/thx.2006.063644
  40. Engleman HM, McDonald JP, Graham D, et al. Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med 2002;166:855-859. https://doi.org/10.1164/rccm.2109023
  41. Gagnadoux F, Fleury B, Vielle B, et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J 2009;34:914-920. https://doi.org/10.1183/09031936.00148208
  42. Barnes M, McEvoy RD, Banks S, et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 2004;170:656-664. https://doi.org/10.1164/rccm.200311-1571OC
  43. Hoekema A, Stegenga B, Bakker M, et al. Simulated driving in obstructive sleep apnoea-hypopnoea; effects of oral appliances and continuous positive airway pressure. Sleep Breath 2007;11:129-138. https://doi.org/10.1007/s11325-006-0093-7
  44. George PT. A modified functional appliance for treatment of obstructive sleep apnea. J Clin Orthod 1987;21:171-175.
  45. Cartwright R, Venkatesan TK, Caldarelli D, Diaz F. Treatments for snoring: a comparison of somnoplasty and an oral appliance. Laryngoscope 2000;110:1680-1683. https://doi.org/10.1097/00005537-200010000-00020
  46. Schonhofer B, Stoohs RA, Rager H, Wenzel M, Wenzel G, Kohler D. A new tongue advancement technique for sleep-disordered breathing: side effects and efficacy. Am J Respir Crit Care Med 1997;155:732-738. https://doi.org/10.1164/ajrccm.155.2.9032220
  47. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 2001;163:1457-1461. https://doi.org/10.1164/ajrccm.163.6.2004213
  48. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest 1996;109:1269-1275. https://doi.org/10.1378/chest.109.5.1269
  49. Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration 2011;81:411-419. https://doi.org/10.1159/000319595
  50. Biggs SN, Vlahandonis A, Anderson V, et al. Long-term changes in neurocognition and behavior following treatment of sleep disordered breathing in school-aged children. Sleep 2014;37:77-84.
  51. Kennedy JD, Blunden S, Hirte C, et al. Reduced neurocognition in children who snore. Pediatr Pulmonol 2004;37:330-337. https://doi.org/10.1002/ppul.10453
  52. Walker-Engström ML, Wilhelmsson B, Tegelberg A, Dimenas E, Ringqvist I. Quality of life assessment of treatment with dental appliance or UPPP in patients with mild to moderate obstructive sleep apnoea. A prospective randomized 1-year follow-up study. J Sleep Res 2000;9:303-308. https://doi.org/10.1046/j.1365-2869.2000.00210.x
  53. Gotsopoulos H, Kelly JJ, Cistulli PA. Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep 2004;27:934-941.
  54. Lam B, Sam K, Lam JC, Lai AY, Lam CL, Ip MS. The efficacy of oral appliances in the treatment of severe obstructive sleep apnea. Sleep Breath 2011;15:195-201. https://doi.org/10.1007/s11325-011-0496-y
  55. Gauthier L, Laberge L, Beaudry M, Laforte M, Rompré PH, Lavigne GJ. Efficacy of two mandibular advancement appliances in the management of snoring and mild-moderate sleep apnea: a cross-over randomized study. Sleep Med 2009;10:329-336. https://doi.org/10.1016/j.sleep.2008.03.011
  56. Trzepizur W, Gagnadoux F, Abraham P, et al. Microvascular endothelial function in obstructive sleep apnea: Impact of continuous positive airway pressure and mandibular advancement. Sleep Med 2009;10:746-752. https://doi.org/10.1016/j.sleep.2008.06.013
  57. Itzhaki S, Dorchin H, Clark G, Lavie L, Lavie P, Pillar G. The effects of 1-year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest 2007;131:740-749. https://doi.org/10.1378/chest.06-0965
  58. Anandam A, Patil M, Akinnusi M, Jaoude P, El-Solh AA. Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study. Respirology 2013;18:1184-1190. https://doi.org/10.1111/resp.12140
  59. Liu Y, Park YC, Lowe AA, Fleetham JA. Supine cephalometric analyses of an adjustable oral appliance used in the treatment of obstructive sleep apnea. Sleep Breath 2000;4:59-66. https://doi.org/10.1007/BF03045025
  60. Liu Y, Lowe AA, Fleetham JA, Park YC. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2001;120:639-647. https://doi.org/10.1067/mod.2001.118782
  61. Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH, Meinesz AF, de Bont LG. Obstructive sleep apnea therapy. J Dent Res 2008;87:882-887. https://doi.org/10.1177/154405910808700917
  62. Chung JW, Enciso R, Levendowski DJ, Morgan TD, Westbrook PR, Clark GT. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:724-731. https://doi.org/10.1016/j.tripleo.2009.11.031
  63. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 2004;125:1270-1278. https://doi.org/10.1378/chest.125.4.1270
  64. Ferguson KA, Ono T, Lowe AA, al-Majed S, Love LL, Fleetham JA. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax 1997;52:362-368. https://doi.org/10.1136/thx.52.4.362
  65. Battagel JM, Johal A, L'Estrange PR, Croft CB, Kotecha B. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod 1999;21:363-376. https://doi.org/10.1093/ejo/21.4.363
  66. Popovic RM, White DP. Influence of gender on waking genioglossal electromyogram and upper airway resistance. Am J Respir Crit Care Med 1995;152:725-731. https://doi.org/10.1164/ajrccm.152.2.7633734
  67. Collop NA. The significance of sleep-disordered breathing and obstructive sleep apnea in the elderly. Chest 1997;112:867-868. https://doi.org/10.1378/chest.112.4.867
  68. Sanner BM, Heise M, Knoben B, et al. MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome. Eur Respir J 2002;20:143-150. https://doi.org/10.1183/09031936.02.00268902
  69. Almeida FR, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis. Am J Orthod Dentofacial Orthop 2006;129:205-213. https://doi.org/10.1016/j.ajodo.2005.04.034
  70. Marklund M. Predictors of long-term orthodontic side effects from mandibular advancement devices in patients with snoring and obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2006;129:214-221. https://doi.org/10.1016/j.ajodo.2005.10.004
  71. de Almeida FR, Bittencourt LR, de Almeida CI, Tsuiki S, Lowe AA, Tufik S. Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance. Sleep 2002;25:507-513.
  72. Pliska BT, Almeida F. Effectiveness and outcome of oral appliance therapy. Dent Clin North Am 2012;56:433-444. https://doi.org/10.1016/j.cden.2012.02.003
  73. Pitsis AJ, Darendeliler MA, Gotsopoulos H, Petocz P, Cistulli PA. Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 2002;166:860-864. https://doi.org/10.1164/rccm.200204-342OC
  74. Nikolopoulou M, Naeije M, Aarab G, Hamburger HL, Visscher CM, Lobbezoo F. The effect of raising the bite without mandibular protrusion on obstructive sleep apnoea. J Oral Rehabil 2011;38:643-647. https://doi.org/10.1111/j.1365-2842.2011.02221.x
  75. Kato J, Isono S, Tanaka A, et al. Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest 2000;117:1065-1072. https://doi.org/10.1378/chest.117.4.1065
  76. Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea. Clin Oral Investig 2010;14:339-345. https://doi.org/10.1007/s00784-009-0298-9
  77. Tegelberg A, Walker-Engstrom ML, Vestling O, Wilhelmsson B. Two different degrees of mandibular advancement with a dental appliance in treatment of patients with mild to moderate obstructive sleep apnea. Acta Odontol Scand 2003;61:356-362. https://doi.org/10.1080/00016350310007130
  78. Ahrens A, McGrath C, Hagg U. A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod 2011;33:318-324. https://doi.org/10.1093/ejo/cjq079
  79. Battagel JM, Kotecha B. Dental side-effects of mandibular advancement splint wear in patients who snore. Clin Otolaryngol 2005;30:149-156. https://doi.org/10.1111/j.1365-2273.2004.00944.x
  80. Marklund M, Sahlin C, Stenlund H, Persson M, Franklin KA. Mandibular advancement device in patients with obstructive sleep apnea: long-term effects on apnea and sleep. Chest 2001;120:162-169. https://doi.org/10.1378/chest.120.1.162
  81. Lee WH, Wee JH, Lee CH, et al. Comparison between mono-bloc and bi-bloc mandibular advancement devices for obstructive sleep apnea. Eur Arch Otorhinolaryngol 2013;270:2909-2913. https://doi.org/10.1007/s00405-013-2417-0
  82. Rose E, Staats R, Virchow C, Jonas IE. A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod 2002;24:191-198. https://doi.org/10.1093/ejo/24.2.191
  83. Ghazal A, Sorichter S, Jonas I, Rose EC. A randomized prospective long-term study of two oral appliances for sleep apnoea treatment. J Sleep Res 2009;18:321-328. https://doi.org/10.1111/j.1365-2869.2009.00738.x
  84. Vanderveken OM, Devolder A, Marklund M, et al. Comparison of a custom-made and a thermoplastic oral appliance for the treatment of mild sleep apnea. Am J Respir Crit Care Med 2008;178:197-202. https://doi.org/10.1164/rccm.200701-114OC
  85. Tan YK, L'Estrange PR, Luo YM, et al. Mandibular advancement splints and continuous positive airway pressure in patients with obstructive sleep apnoea: a randomized cross-over trial. Eur J Orthod 2002;24:239-249. https://doi.org/10.1093/ejo/24.3.239
  86. Almeida FR, Henrich N, Marra C, et al. Patient preferences and experiences of CPAP and oral appliances for the treatment of obstructive sleep apnea: a qualitative analysis. Sleep Breath 2013;17:659-666. https://doi.org/10.1007/s11325-012-0739-6
  87. Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006;(1):CD001106.

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