Mandibular advancement splints (MAS) are a type of oral appliance used to treat obstructive sleep apnoea. These devices work to stabilise and/or advance the lower jaw position and in doing so the device may prevent the upper airway collapse during sleep. This therapy can be quite effective for patients with mild to moderate severity of OSA. Upper airway resistance syndrome (UARS) is a mild form of OSA, which may also be treatable with MAS therapy. Godoy et al recently had a randomised placebo-controlled trial accepted for publication. The trial looks to evaluate the long term effects of an oral appliance (MAS) on clinical symptoms, respiratory sleep parameters, sleep quality and sustained attention in patients with Upper Airway Resistance Syndrome (UARS) compared with placebo.
Methods: This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes of Sleep Questionnaire (FOSQ), the Beck Anxiety and Depression Inventories, underwent full-night polysomnography, Multiple Sleep Latency Test (MSLT) and Psychomotor Vigilance Test (PVT). Evaluations were performed before and after 1.5 years of treatment.
Results: RDI, number of respiratory effort related arousal (RERA), percentage of total sleep time with flow limitation and arousal index significantly decreased after 1.5 years of mandibular advancement device treatment. PSQI total score improved, severity of depression symptoms decreased and mean reaction time in the PVT, based on the first measurement taken at 8a.m. significantly decreased (p = 0.03) at the end of the protocol.
Conclusion: Mandibular advancement device was effective in decreasing respiratory events in UARS patients. 1.5-years of oral appliance therapy for UARS also improved sleep quality and sustained attention, and decreased the severity of depression symptoms.
Reference:
Luciana B M Godoy, Luciana Palombini, Dalva Poyares, Cibele Dal-Fabbro, Thaís Moura Guimarães, Priscila Calixto Klichouvicz, Sergio Tufik, Sonia Maria Togeiro; Long-Term Oral Appliance Therapy Improves Daytime Function and Mood in Upper Airway Resistance Syndrome Patients, Sleep, Volume 40, Issue 12, 1 December 2017, zsx175, https://doi.org/10.1093/sleep/zsx175
