Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome

Objective: To compare three different oral appliances: a mandibular advancement device (Snoreguard), a tongue retaining device, and a soft palate lift, for treatment of severe obstructive sleep apnea syndrome (OSAS). Background: Oral appliances are therapeutic options for patients with OSAS. Methods: Eight patients with a mean apnea hypopnea index (AHI) of 72.1 (SD +/- 39.9) were studied. Polysomnographic measures during each of the treatment nights were compared to baseline. Results: Eight out of 8 patients completed the mandibular advancement device (MAD) night; 5/8 tolerated the tongue retaining device (TRD); only 2/8 could sleep with the soft palate lift (SPL) in place. Improvement using the MAD reached significance: overall AHI (mean +/- SD) decreased from 72.1 +/- 39.9 at baseline to 35.5 +/- 39.4 with the appliance in place (P < 0.02). There was a non-significant increase in slow wave sleep (SWS) from 9.6% +/- 8.7 to 14.4% +/- 10.5 with the MAD in place. In five responders, the mean AHI decreased from 60.0 +/- 36.6 to 9.0 +/- 4.8; all were subjectively improved, using the MAD at 1 year follow-up. However, three non-responders had persistence of AHI >40. With the TRD, AHI decreased from 50.3 +/- 18.9 at baseline to 43.5 +/- 32.5 (ns). The SPL was not effective with an AHI at baseline of 52.4 +/- 8.0, and 47.3 +/- 31.0 with the device in place (ns), and not well tolerated. Conclusions: A mandibular advancement device is an effective treatment alternative in some patients with severe OSAS. In comparison, the tongue retaining device and the soft palate lift do not achieve satisfactory results. (C) 2000 Elsevier Science B.V. All rights reserved.