Treatment Outcome of Mandibular Advancement Device in Obstructive Sleep Apnea Patients- Polysomnographic and Cephalometric analyses

수면무호흡증 환자에서 수면다원검사와 두부규격방사선사진을 이용한 하악전방이동장치의 치료효과에 관한 연구

  • Chung, Jin-Woo (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University) ;
  • Kim, Ebee (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University) ;
  • Kim, Sung-Hun (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University)
  • 김성헌 (서울대학교 치의학대학원 구강내과진단학교실) ;
  • 김이비 (서울대학교 치의학대학원 구강내과진단학교실) ;
  • 정진우 (서울대학교 치의학대학원 구강내과진단학교실)
  • Received : 2013.03.18
  • Accepted : 2013.04.15
  • Published : 2013.06.30


Objecives : The purpose of the study was to evaluate treatment outcome of mandibular advancement device(MAD) in obstructive sleep apnea (OSA) patients using full night polysomnography and cephalometry. Methods : Twenty-seven OSA patients were confirmed by full night, lab-attended polysomnography. Cephalometric examinations were conducted to obtain SNA, ANB, $AH{\bot}MP$, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, and HAS. Mandibular advancement devices (MADs) were fabricated and delivered for all subjects. After acclimation period of MAD, the second polysomnographic examinations were conducted in the same manner. Polysomnographic variables were compared between before and after MAD placement. Also, correlation coefficients were calculated between apnea-hypopnea index (AHI) and each item of cephalometric parameters. Results : There were significant improvements in total AHI, lowest $SpO_2$, and total arousal index after MAD therapy. Also, there were significant improvements in NREM $SpO_2$ and NREM AHI, but not in REM $SpO_2$ and REM AHI with MAD. Stratifying the sleep stage, there were significant decrease in stage I and significant increases in stage II and REM, but change in stage III was not significant. SNA and SOAS were significantly correlated with total AHI and NAS was significantly correlated with supine AHI. ANB was significantly associate with the effect of MAD. Conclusions : MAD is an effective treatment in OSA patients comparing polysomnographic variables before and after treatment. Cephalometric examination can be useful to evaluate OSA patients and predict treatment outcome of MAD.


  1. Chae KY. Physiology of sleep. Korean J Pediatr 2007;50:711-7.
  2. Hoffstein V, Viner S, Mateika S, Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Rspir Dis 1992;145:841-5.
  3. Riolfe I, Olson LG, Saunders NA. Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. Am Rev Respir Dis 1991; 144:1130-3.
  4. Miljeteig H, Mateika S, Haight JS. Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1994;150:1286-90.
  5. Wilhelmsson B, Tegelberg A, Walker-Engstrom ML, Ringqvist M, Andersson L, Krekmanov L, Ringqvist IA. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol 1999;119:503-9.
  6. Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibulat positioning devices on patients with obstructive sleep apnea. Chest 1996;109:1477-83.
  7. 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 apnea. Thorax 1997;52: 362-8.
  8. Aber WR, Block AJ, Hellard DW, Webb WB. Consistency of respiratory measurements from night to night during the sleep of elderly men. Chest 1989;96:747-51.
  9. Chediak AD, Acevedo-Crespo JC, Seiden DJ, Kim HH, Kiel MH. Night variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. Sleep 1996;19:589-92.
  10. Keenan SP, Anderson B, Wiggs B, Ryan CF, Fleetham JA. The predictive accuracy of home oximetry in patients with suspective obstructive sleep apnea. Sleep 1993;16:133-4.
  11. Manser RL, Rochford P, Naughton MT, et al. Measurement variability in sleep disorders medicine: the Victorian experience. Intern Med J 2002;32: 386-93.
  12. Littner M. Polysomnography in the diagnosis of the obstructive sleep apnea-hypopnea syndrome: where do we draw the line? Chest 2000;118:286-8.
  13. Meyer TJ, Eveloff SE, Kline LR, Millman RP. One negative polysomnogram does not exclude obstructive sleep apnea. Chest 1993;103:756-60.
  14. Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep 2005;28:499-519.
  15. Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995;18:501-10.
  16. Clark GT, Arand D, Chung E, Tong D. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Rev Respir Dis 1993;147:624-9.
  17. 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;113:707-13.
  18. Mehta A, Qian J, Petocz P, Daredeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 2001;163:1457-61.
  19. Tsuiki S, Lowe AA, Almeida FR, Kawahata N, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir J 2004;23:263-8.
  20. 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;109:724-31.
  21. Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. 2001 Aug1;24(5):538-544.
  22. Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathingclinical and polysomnographic features. Chest 2005;128:3350-7.
  23. Umemoto G, Yoshimura C, Aoyagi N, Toyoshima H, Matsumoto T, Watanabe K, Maki H, Kikuta T. Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea. Oral Science Int 2012;9:49-54.
  24. Choi JK, Choi JM, Ahn HJ. Cephalometric characteristics and their relationship to Respiratory Disturbance Indices in snorer and patients with Obstructive Sleep Apnea. Korean J Oral Med 2001; 26: 369-76.
  25. Chang ET, Shiao GM. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med 2008;9:403-10.
  26. Liu Y, Lowe AA, Fleetham JA, Park Y-C. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2001;120:639-47.
  27. Sforza E, Bacon W, Weiss T, et al. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161: 347-52.