Mandibular Progression Tool: Advantages, Drawbacks, and Additional Details
Mandibular Advancement Devices (MADs) are becoming increasingly popular as an alternative treatment for obstructive sleep apnea (OSA), a condition that causes throat walls to close during sleep, leading to breathing interruptions.
### Effectiveness of MADs
Research indicates that MADs can significantly reduce the apnea-hypopnea index (AHI), a measure of breathing pauses per hour during sleep. Custom-made MADs have shown particularly promising results, with treatment response rates of around 64%, compared to 24% for ready-made appliances in a small trial. However, it's important to note that about one-third of patients may not experience substantial improvement with MADs.
Predicting MAD success can be aided by diagnostic tools like drug-induced sleep endoscopy (DISE), which simulates airway collapse during sleep, potentially more accurately than CT imaging.
### Benefits of MADs Compared to CPAP
MADs are user-friendly, portable, and do not require electricity or noise, making them ideal for travel or for patients who find CPAP intolerable. Besides reducing breathing interruptions, MADs may improve blood oxygen levels, daytime fatigue, blood pressure, cognitive function, mood, and overall quality of life.
### Risks and Side Effects of MADs
Short-term side effects of MADs include increased saliva production, dry mouth, gum tenderness, mild tooth discomfort, teeth grinding, and jaw joint pain or tenderness. These usually improve within weeks. Over months or years, MADs may cause changes in dental bite and tooth movement, so regular dental monitoring is essential.
### Comparison to CPAP and Other Treatments
| Aspect | MADs | CPAP | Surgery | |----------------------|---------------------------------------------------|--------------------------------------------------|-----------------------------------------------| | **Effectiveness** | Good for mild/moderate; effective custom devices | Gold standard; highly effective for all severities | Variable; usually for severe or anatomical cases | | **Compliance** | Higher compliance, easier to tolerate | Often lower due to discomfort, noise, inconvenience | Depends on invasiveness and recovery | | **Convenience** | Portable, no electricity, quiet | Requires power, tubing, machine noise | Requires hospital stay and recovery | | **Side Effects** | Oral discomfort, bite changes, jaw pain | Nasal congestion, dry mouth, facial skin irritation | Surgical risks, infection, pain | | **Use Case** | Alternative for CPAP-intolerant patients | First-line treatment for moderate/severe OSA | Reserved for selected cases or surgery candidates |
### Future Outlook
Advances in MAD design using better materials and digital customizations aim to increase comfort and effectiveness, potentially improving patient outcomes further.
It's essential to note that MADs are not suitable for people who wear dentures or have severe dental issues. The Royal Australian College of General Practitioners also identifies older adults, individuals with obesity and excess fat tissue around the neck, people with a stiff jaw, those with dental conditions, people with central sleep apnea, and certain other groups as less likely to see symptom improvement with MADs.
In addition to CPAP and MADs, other sleep apnea treatment options include surgery, weight loss, quitting smoking, limiting alcohol consumption, using allergy medications, and changing sleep position. A sleep study can confirm a diagnosis of sleep apnea, and a specialist can then provide treatment options. Some MADs are custom or semi-custom, while others are available over the counter (OTC) and are known as boil-and-bite MADs.
Common symptoms of sleep apnea, besides snoring, include feeling unusually tired during the day, waking up suddenly during the night, difficulty with focus and memory, pauses in breathing while asleep, headaches in the morning, and difficulty staying asleep. If you suspect you may have sleep apnea, it's crucial to consult a healthcare professional for a proper diagnosis and treatment options.
- The predictive power of MAD success can be enhanced with diagnostic tools like drug-induced sleep endoscopy (DISE), which provides a more accurate simulation of airway collapse during sleep compared to CT imaging.
- While MADs are effective in treating mild to moderate obstructive sleep apnea (OSA), they are not ideal for individuals with psoriatic disease or psoriatic arthritis, as the devices may aggravate existing oral conditions.
- Chronic diseases such as HIV, asthma, migraine, and chronic mental-health conditions can exacerbate the symptoms of OSA, making it essential for healthcare professionals to take these comorbidities into account when considering MADs as a treatment option.
- Preparation for using MADs may involve adjusting one's health-and-wellness lifestyle, which could involve quitting smoking or avoiding alcohol consumption, as these factors can contribute to the severity of OSA.
- Science continues to explore the potential benefits of CBD for managing snoring and improving sleep quality, although more research is needed to confirm the effectiveness of CBD in treating sleep disorders like OSA.
- MADs share some similarities with other chronic diseases treatments, such as the adjustments needed for dental appliances in managing conditions like Crohn's disease or temporomandibular joint (TMJ) disorders.
- As MAD technology evolves, new designs using advanced materials and digital customizations will aim to increase comfort and effectiveness, potentially improving outcomes for patients with a wide range of medical-conditions.
- Practitioners may recommend boil-and-bite MADs, which are over-the-counter devices, as a convenient and affordable alternative to custom-made MADs for patients with less severe OSA or those looking for an entry-level solution to manage their snoring or sleep apnea symptoms.
- To ensure long-term success with MADs, it's important to consistently monitor dental health, address any dental issues before using the device, and maintain continuous communication with a healthcare professional to manage any potential risks and side effects associated with the device.
