Mandibular advancement devices in the treatment of obstructive sleep apnoea


Randomized controlled trials have previously  addressed the efficacy of mandibular advancement devices (MADs) in the treatment of obstructive sleep apnoea (OSA).  The control used in these studies is usually nasal continuous positive airway pressure (nCPAP). It is frequently found to be superior to MAD therapy. In most of these studies nCPAP was titrated objectively but not MAD.  To enable an unbiased comparison between both treatment modalities, the MAD should be titrated objectively as well.

The aim of the present study was to compare the treatment effects of a titrated MAD with those of nCPAP and an intra-oral placebo device.

Sixty-four mild/moderate patients with obstructive sleep apnoea (aged 52.0 +/- 9.6 years) were randomly assigned to three parallel groups: MAD, nCPAP and placebo device.  Two polysomnographic recordings were obtained for all patients: one before treatment and one after approximately 6 months of treatment.

They found:-

  • A significant change in the apnoea-hypopnoea index (Delta AHI)  between  the three therapy groups (ANCOVA; p = 0.000).
  • No differences in the DeltaAHI were found between the MAD and nCPAP therapy (p = 0.092),
  • AHI changes in the MAD and nCPAP therapy groups were significantly larger than those in the placebo group (p = 0.000 and 0.002, respectively).

They concluded:-

There is no clinically relevant difference between MAD and nCPAP in the treatment of mild/moderate OSA when both treatment modalities are titrated objectively.

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(5):411-9. Epub 2010 Oct 20. PubMed PMID: 20962502.

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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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