Comparison of Three Mandibular Advancement Device Designs in the Management of Obstructive Sleep Apnea: A Retrospective Study

Study Objectives: To evaluate the efficacy of three mandibular advancement device (MAD) designs in terms of apnea-hypopnea index (AHI), minimum blood oxygen saturation (min SpO 2 ), and Epworth Sleepiness Scale (ESS) between pretreatment and posttreatment sleep studies for the management of obstructive sleep apnea (OSA). The protrusive range at the time of the second sleep study was correlated with the effectiveness of MAD designs. Methods: Retrospective data from 49 patients with OSA referred to the Orofacial Pain Clinic at University of Kentucky (March 2016- March 2021) treated with MAD, with a post-treatment sleep study, were included. Treatment success was defined as 50% improvement in AHI, or as 50% improvement with residual AHI < 10/h. Results: Posttreatment AHI improved with Herbst and SomnoDent-Classic ( P =.003 and P =.000, respectively). Posttreatment ESS score improved with Herbst, SomnoDent-Classic, and D-SAD designs ( P =.004, P = .000, and P =.018, respectively). No differences were found between the three MADs in terms of change in AHI, min SpO 2 , and ESS (all P >.050). Treatment success was achieved in 59.18% and 48.97%, according to the criteria, with no difference between the appliances and no correlation with the range of protrusion. Conclusion: The three MADs were efficacious in improving AHI and ESS, but not min SpO2, in patients with OSA, with no differences between MAD designs. Because some patients showed a worsening in AHI, a posttreatment sleep study is of great importance. Clinical Implications: MAD should be selected on an individual basis, according to patient preference and trained dentist recommendation, as the design did not affect the effectiveness in terms of AHI improvement. Comparison of three mandibular advancement device designs in the management of sleep A retrospective study.