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Mandibular advancement device (MAD) treatment for moderate to severe obstructive sleep apnea (OSA)


Obstructive sleep apnea (OSA) is a highly prevalent sleep-related breathing disorder characterized by periods of recurrent cessation of breathing caused by partial or complete collapse of the upper airway. Mandibular advancement device (MAD) represents a well-tolerated treatment for selected patients with OSA. MAD reduces upper airway collapsibility, often in a dose-dependent manner, by increasing the pharyngeal dimensions upon protrusion of the lower jaw. The apnea hypopnea index (AHI) has been found to be a weaker predictor to identify MAD treatment responders and patients with moderate to severe OSA might also have a good outcome.


To describe three cases of moderate to severe OSA treated with MAD presenting improvement of clinical complaints and AHI.


We describe three patients being followed-up in the Otolaryngology or Neurophysiology Laboratory, complaining excessive daytime sleepiness, snoring, fatigue and other clinical symptoms, diagnosed with OSA, as follow: Case 1: 42-year-old male patient, presenting in 2012 an apnea hypopnea index (AIH) 57.5 events/hour, submitted to otolaryngology surgeries with no improvement of symptoms and AHI 53.3 events/hour. Case 2: 45-year-old male patient, presenting in 2010 an AIH 18.4 events/hour, after two otolaryngology surgeries (2010 and 2011) presented an AHI 23.7 events/hour. Case 3: 55-year-old male patient, presenting AHI 25 events/hour had no adherence to CPAP treatment due to limited economic condition. All patients were referred to Dentistry Division of the Hospital for MAD treatment for OSA and submitted to clinical and radiological evaluation. The installed model was one-piece, allowing 70% retrusion and protrusion and its efficiency were determined with a new polysomnography.


All patients reported improvement in clinical complaints after MAD use and there was a significant improvement in AHI observed in subsequent polysomnography. Case 1: AHI 1.1 event/hour, case 2: AHI 7,3 events/hour and case 3: AHI 11.8 events/hour.


Advanced ways to interpret sleep apnea recordings will allow the identification of various phenotypes of sleep apnea patients and provide a more promising way forward to find patients who respond to OSA treatment in different ways. MAD therapy alone is sufficient in a quarter of severe OSA patients.


Sleep Apnea, Obstructive; Mandibular Advancement; Therapeutics.


Área Clínica


HC-FMUSP - Sao Paulo - Brasil


Rita Cássia Bonatto Vilarim, Andrea Cecilia Toscanini, Sumatra Melo da Costa Pereira Jales, Cássio Batista Lacerda, Daniel Guilherme Suzuki Borges, Gilberto Guanaes Formigoni, Michel B Cahali, Rosa Hasan, José Tadeu Tesseroli Siqueira