Non-CPAP therapies in obstructive sleep apnea: mandibular advancement device therapy.

Keywords: Continuous positive airway pressure, CPAP, obstructive sleep apnea, OSA, sleep disorder, sleep disordered breathing, apnea hypopnea index, AHI, snoring, mandibular advancement device, and oral appliance.

Are you experiencing symptoms of obstructive sleep apnea (OSA)? Or have you been diagnosed with OSA, but are having trouble using the continuous positive airway pressure (CPAP) device? Many people suffer from OSA and are given a CPAP to use at home during sleep. Although the CPAP is very effective, successfully diminishing the apnea hypopnea index (AHI), it can be intolerable to some patients. An oral sleep appliance can be an effective alternative to the CPAP or to use in conjunction with the CPAP. Dr. Stan Farrell has extensive training in sleep medicine and is a member of the American Academy of Dental Sleep Medicine, making him one of the best qualified doctors to treat sleep apnea with an oral appliance. If you are experiencing symptoms of OSA and have not been properly diagnosed, Dr. Stan Farrell uses the latest technology in home sleep testing equipment and diagnostic imaging. At AZTMJ, Dr. Stan Farrell can complete a thorough examination to determine if you are a good candidate for an oral appliance. Please visit us at or call us at 480-945-3692 to schedule your initial consultation today.

Marklund M1, Verbraecken J, Randerath W.

Abstract: Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report. Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA. In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.