Illara Moore

Date of Award

4-2013

Document Type

Independent Study

Degree Name

Master of Science (MS)

Abstract

Obstructive sleep apnea (OSA) is prevalent throughout the United States and worldwide, and is associated with cardiovascular, pulmonary, and metabolic complications. Despite the strong evidence confining its clinical sequelae, significant barriers to clinical diagnosis and treatment of OSA exist, including under-diagnosis by medical providers and poor patient compliance with CPAP therapy-the current treatment of choice

The purpose of this project was to review the literature of mandibular advancement devices (MADs) as an efficacious alternative treatment for OSA. Randomized controlled trials demonstrate that CPAP is superior in reducing the Apnea-Hypopnea Index, but MADs show a similar impact on daytime sleepiness and quality of life. Patients preferred MADs to both CPAP and surgical intervention. Authors suggest that a higher compliance with MADs likely translates into a similar adjusted AHL While no design was superior, efficacy was improved with custom fitting and mandibular protrusion. MADs titrated through the process of an overnight sleep study were equally efficacious to CPAP in moderate to severe OSA. Adjustable, titratable MADs are more successful in women, less severe disease (lower baseline AHI), lower BMl, and those who have a supine-dependent component to their OSA. Side effects are minimal and transitory. Compared with CPAP and no treatment, MADs are a cost-effective therapy in moderate OSA, but data is inconclusive

Additional research on larger samples of subjects is recommended in which: a) the MAD is customized and titrated during a polysomnography in a very similar approach to fitting CPAP via an overnight sleep study, b) exclusive investigation is conducted on a specific titrntable device, and c) subjects are controlled for severity categories of OSA

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