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.