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About 20% of the adult population has obstructive sleep apnea (OSA), defined as apnea hypopnea index (AHI) of at least five events per hour. OSA prevalence increases from age 18 to 45 years and obesity is the most consistently documented risk factor. Untreated severe OSA is associated with a three to six times higher risk for all-cause mortality. OSA is associated with hypertension, coronary artery disease, cardiovascular disease, cardiac arrhythmias, stroke, accidents, and impaired cognitive function and quality of life.
Although a diagnosis of OSA can improve quantity of life, patients facing such a diagnosis often dread the prospect of lifelong nightly use of a continuous positive airway pressure (CPAP) device. Impact on spousal and travel considerations can be substantial.
Mandibular advancement devices (MADs) are the primary non-CPAP therapy for patients with OSA. MADs increase upper airway size and limit pharyngeal collapsibility and reduce the risk of snoring and apneas. MADs are recommended for patients with mild to moderate OSA who cannot tolerate CPAP. MADs also are an option for patients with severe sleep apnea who fail CPAP.
Marie Marklund, DDS, of Umeå University, Umeå, Sweden, and colleagues, reviewed the literature to determine the evidence base for MAD interventions. Their conclusion: For patients with mild to moderate OSA, MADS reduce apneic episodes, daytime sleepiness, and improve quality of life compared with placebo devices. In general, the reduction in overall apneic episodes is less than that achieved with traditional CPAP devices. However, emerging reports suggest that MADS are comparable to CPAP with regard to improvements in blood pressure, cardiac function, symptoms, and driving ability (Eur Respir J 2012 39:1241-7).
MADs are adjusted through titration requiring local expertise in the application and refinement of device fitting. Insurance coverage of these devices remains uncertain and requires homework on the part of the patient. MADs may be an exciting option for patients who want to travel without their CPAP devices. But for patients with mild to moderate OSA, or who have severe OSA and cannot tolerate CPAP, MADs are life-improving and life-saving devices.
Jon O. Ebbert, M.D., is a professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He declares having no conflict of interest. The opinions expressed are solely those of the author. Contact him at ebbert.jon@mayo.edu.
About 20% of the adult population has obstructive sleep apnea (OSA), defined as apnea hypopnea index (AHI) of at least five events per hour. OSA prevalence increases from age 18 to 45 years and obesity is the most consistently documented risk factor. Untreated severe OSA is associated with a three to six times higher risk for all-cause mortality. OSA is associated with hypertension, coronary artery disease, cardiovascular disease, cardiac arrhythmias, stroke, accidents, and impaired cognitive function and quality of life.
Although a diagnosis of OSA can improve quantity of life, patients facing such a diagnosis often dread the prospect of lifelong nightly use of a continuous positive airway pressure (CPAP) device. Impact on spousal and travel considerations can be substantial.
Mandibular advancement devices (MADs) are the primary non-CPAP therapy for patients with OSA. MADs increase upper airway size and limit pharyngeal collapsibility and reduce the risk of snoring and apneas. MADs are recommended for patients with mild to moderate OSA who cannot tolerate CPAP. MADs also are an option for patients with severe sleep apnea who fail CPAP.
Marie Marklund, DDS, of Umeå University, Umeå, Sweden, and colleagues, reviewed the literature to determine the evidence base for MAD interventions. Their conclusion: For patients with mild to moderate OSA, MADS reduce apneic episodes, daytime sleepiness, and improve quality of life compared with placebo devices. In general, the reduction in overall apneic episodes is less than that achieved with traditional CPAP devices. However, emerging reports suggest that MADS are comparable to CPAP with regard to improvements in blood pressure, cardiac function, symptoms, and driving ability (Eur Respir J 2012 39:1241-7).
MADs are adjusted through titration requiring local expertise in the application and refinement of device fitting. Insurance coverage of these devices remains uncertain and requires homework on the part of the patient. MADs may be an exciting option for patients who want to travel without their CPAP devices. But for patients with mild to moderate OSA, or who have severe OSA and cannot tolerate CPAP, MADs are life-improving and life-saving devices.
Jon O. Ebbert, M.D., is a professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He declares having no conflict of interest. The opinions expressed are solely those of the author. Contact him at ebbert.jon@mayo.edu.
About 20% of the adult population has obstructive sleep apnea (OSA), defined as apnea hypopnea index (AHI) of at least five events per hour. OSA prevalence increases from age 18 to 45 years and obesity is the most consistently documented risk factor. Untreated severe OSA is associated with a three to six times higher risk for all-cause mortality. OSA is associated with hypertension, coronary artery disease, cardiovascular disease, cardiac arrhythmias, stroke, accidents, and impaired cognitive function and quality of life.
Although a diagnosis of OSA can improve quantity of life, patients facing such a diagnosis often dread the prospect of lifelong nightly use of a continuous positive airway pressure (CPAP) device. Impact on spousal and travel considerations can be substantial.
Mandibular advancement devices (MADs) are the primary non-CPAP therapy for patients with OSA. MADs increase upper airway size and limit pharyngeal collapsibility and reduce the risk of snoring and apneas. MADs are recommended for patients with mild to moderate OSA who cannot tolerate CPAP. MADs also are an option for patients with severe sleep apnea who fail CPAP.
Marie Marklund, DDS, of Umeå University, Umeå, Sweden, and colleagues, reviewed the literature to determine the evidence base for MAD interventions. Their conclusion: For patients with mild to moderate OSA, MADS reduce apneic episodes, daytime sleepiness, and improve quality of life compared with placebo devices. In general, the reduction in overall apneic episodes is less than that achieved with traditional CPAP devices. However, emerging reports suggest that MADS are comparable to CPAP with regard to improvements in blood pressure, cardiac function, symptoms, and driving ability (Eur Respir J 2012 39:1241-7).
MADs are adjusted through titration requiring local expertise in the application and refinement of device fitting. Insurance coverage of these devices remains uncertain and requires homework on the part of the patient. MADs may be an exciting option for patients who want to travel without their CPAP devices. But for patients with mild to moderate OSA, or who have severe OSA and cannot tolerate CPAP, MADs are life-improving and life-saving devices.
Jon O. Ebbert, M.D., is a professor of medicine and a primary care clinician at the Mayo Clinic in Rochester, Minn. He declares having no conflict of interest. The opinions expressed are solely those of the author. Contact him at ebbert.jon@mayo.edu.