Predictors of Long-Term Withdrawal to Mandibular Advancement Device Treatment in Obstructive Sleep Apnea Syndrome

Abstract

The mandibular advancement device (MAD) is an important part of the treatment of obstructive sleep apnea syndrome (OSA). The objective of our study was to evaluate the compliance of MAD in the short, medium and long term and the predictive factors of withdrawal. Among the 78 patients using MAD for OSA treatment, we successfully contacted by phone 64 patients (73% men, age 53 ± 10 years old, body mass index 25,6 kg/m2 ± 2,86) 3,9 years (1,9-4,9) after MAD placement. Among the 64 patients, 35 of them (55%) were still carriers of their MAD. The higher risk of withdrawal in the 29 patients (45%) who abandoned their MAD was observed during the first eight months of treatment and was mainly due for 8 patients (28%) to pain in the temporomandibular joint. Maxillomandibular dysmorphosis appears as the only predictor of abandonment. In conclusion, the MAD provides an effective and sustained solution in the treatment of mild to moderate OSA with good long-term compliance, except in case of maxillo-mandibular dysmorphosis. A close follow up during the first months could improve treatment compliance.