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Anette Fransson

A Mandibular Protruding Device in
Obstructive Sleep Apnea and Snoring

AKADEMISK AVHANDLING
som för avläggande av Odontologie Doktorsexamen kommer att offentligen försvaras i föreläsningssal 3, Odontologiska kliniken, Göteborg, Fredagen den 12 december 2003, kl. 9.00 av Anette Fransson, Leg. tandläkare

ABSTRACT
A mandibular protruding device in obstructive sleep apnea and snoring.
Anette Fransson, 2003.

Department of Stomatognathic Physiology, Faculty of Odontology, The Sahlgrenska Academy at Göteborg University, Box 450, SE-405 30 Göteborg, Sweden.

The overall purpose behind treatment in sleep-breathing disorders is to ease breathing and thereby reduce the risk of morbidity. The mandibular protruding device (MPD) is one method of treating both obstructive sleep apnea (OSA) and snoring. The aims of the studies were to study MPD users after 2 years and evaluate the following aspects of the MPD: subjective and objective effects on sleep, influences on airway passages and hard tissues, and the incidence and types of adverse events of the masticatory system including temporomandibular disorders. Further aims were to evaluate the impact of body posture and the effects of the MPD on pharyngeal width and to validate two methods for measuring mandibular protrusion and MPD advancement.

MATERIALS AND METHODS: Seventy-seven subjects with OSA or snorers without OSA, were admitted to the study after a medical examination, which included a somnographic registration. The patients completed questionnaires regarding sleep quality and symptoms from the masticatory system, and underwent a clinical jaw function examination, were given an MPD, and were subjected to lateral cephalometric examination. Two follow-ups, 6 months and 2 years after MPD treatment were conducted. The study population comprised 65 patients at the 2-year follow-up.

RESULTS: At the 2-year follow-up, a significant reduction of the subjective complaints was noted by 90% of the MPD users. In the objective evaluation, the oxygen desaturation index (ODI) of the OSA group (n=39) decreased significantly from a mean of 14.7 to 3.1 and the mean arterial oxygen saturation (SaO2) increased significantly from 78% to 89%. The snorers maintained their initial values. In the total group, MPD treatment significantly increased most pharyngeal measures and lifted the hyoid bone. The pharyngeal area decreased significantly—by more than 50%—when the patient was supine, and the velum area increased significantly. At the 2-year follow-up, on upright cephalogram without MPD, the pharyngeal area had significantly increased and the velum area had significantly decreased. The mandible was posteriorly rotated (P<0.01) as well as the lower incisors were proclined (P<0.05). Mandibular advancement and vertical opening with an MPD, as measured with a ruler, compared well with measurements taken from a cephalogram. At the 2-year follow-up significant changes in the mean mandibular range of protrusion (+0.6 mm), overjet (-0.5 mm), and overbite (-0.8 mm) were registered. Nine of the 65 patients had developed a lateral open bite, and 2 were aware of the change. The reported frequency of headache was significantly reduced. At the 2-year follow-up there was a significant reduction in pain during mandibular movements.

CONCLUSIONS: MPD treatment significantly reduced subjective complaints of sleep disturbances and significantly reduced ODI values among OSA patients. A high MPD compliance rate after 2 years (84%) indicated a well-tolerated treatment and a low rate of side effects were noted. The key factor in OSA and snoring is the obstruction of pharynx. The MPD treatment significantly increased the pharyngeal passages and significantly reduced the size of velum and thereby facilitated the breathing.

Key words: adverse events, clinical trial, daytime tiredness, lateral cephalogram, mandibular protruding device, obstructive sleep apnea, oral appliance, posture, prospective study, questionnaires, snoring, somnography, temporomandibular disorders

ISBN: 91-628-5901-3
ISSN 0348-6672

Avhandlingen är av sammanläggningstyp och baseras på följande arbeten:

I. Fransson AMC, Svenson BAH, Isacsson G. The effect of posture and a mandibular protruding device on pharyngeal dimensions: a cephalometric study.

Sleep and Breathing 2002; 6:55–68

II. Fransson AMC, Tegelberg Å, Svenson BAH, Wenneberg B, Isacsson G. Validation of measurements of mandibular protrusion in the treatment of obstructive sleep apnoea and snoring with a mandibular protruding device.

European Journal of Orthodontics 2003; 25:377–383

III. Fransson AMC, Tegelberg Å, Svenson BAH, Lennartsson B, Isacsson G. Influence of mandibular protruding device on airway passages and dentofacial characteristics in obstructive sleep apnea and snoring.

American Journal of Orthodontics and Dentofacial Orthopedics 2002; 122:371–379

IV. Fransson AMC, Tegelberg Å, Leissner L, Wenneberg B, Isacsson G. Effects of a mandibular protruding device on the sleep of patients with obstructive sleep apnea and snoring problems: A 2-year follow-up.

Sleep and Breathing 2003; 7:131–142 (In press)

V. Fransson AMC, Tegelberg Å, Johansson A, Wenneberg B. Influence on the masticatory system in treatment of obstructive sleep apnea and snoring with a mandibular protruding device. A 2-year follow-up.

Accepted for publication in American Journal of Orthodontics and Dentofacial Orthopedics

Fakultetsopponent: Docent Lars Bondemark, Tandvårdshögskolan, Malmö Högskola, Malmö

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