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. 2016 Nov 3;45(1):56.
doi: 10.1186/s40463-016-0167-x.

Efficacy and mechanism of mandibular advancement devices for persistent sleep apnea after surgery: a prospective study

Huiping Luo  1 , Xulan Tang  1 , Yuanping Xiong  1 , Lili Meng  1 , Hongliang Yi  2 , Shankai Yin  1
Affiliations

Efficacy and mechanism of mandibular advancement devices for persistent sleep apnea after surgery: a prospective study

Huiping Luo et al. J Otolaryngol Head Neck Surg. .

Abstract

Background: To explore the feasibility, the efficacy, and the mechanism of mandibular advancement devices (MAD) in the treatment of persistent sleep apnea after surgery.

Methods: Nineteen patients who failed uvulopalatopharyngoplasty (UPPP) or UPPP plus genioglossus advancement and hyoid myotomy (GAHM) were given a non-adjustable MAD for treatment. All patients had polysomnography (PSG) at least 6 months post-UPPP with and without the MAD. Seventeen patients had computed tomography (CT) examinations.

Results: After the application of MAD, the apnea hypopnea index (AHI) decreased significantly from 41.2 ± 13.1/h to 10.1 ± 5.6/h in the responder group. The response rate was 57.9 % (11/19). During sleep apnea/hypopnea acquired from sedated sleep, the cross-sectional area and anterior-posterior and lateral diameters of the velopharynx enlarged significantly from 4.2 ± 6.0 mm2 to 17.5 ± 15.3 mm2, 1.9 ± 2.3 mm to 6.5 ± 4.1 mm, and 1.1 ± 1.3 mm to 2.6 ± 2.1 mm, respectively (P < 0.01) in the responder group with MAD. The velopharyngeal collapsibility also decreased significantly from 83.3 ± 21.8 % to 46.5 ± 27.1 %. The glossopharyngeal collapsibility decreased from 39.8 ± 39.1 % to -22.9 ± 73.2 % (P < 0.05).

Conclusion: MAD can be an effective alternative treatment for patients with moderate and severe OSAHS after surgery. The principal mechanisms underlying the effect of MAD are expansion of the lateral diameter of the velopharynx, the enlargement of the velopharyngeal area, the reduction of velopharyngeal and glossopharyngeal collapsibility, and the stabilization of the upper airway.

Keywords: Computed tomography; Mandibular advancement devices; Persistent sleep apnea; Upper Airway; Uvulopalatopharyngoplasty.

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Figures

Fig. 1
Fig. 1
Snore Guard XT-1B (produced by Xintai Company, Peking)
Fig. 2
Fig. 2
Lateral view before wearing an MAD (a), Lateral view after wearing an MAD (b), Front view before wearing an MAD (c), Front view after wearing an MAD (d)
Fig. 3
Fig. 3
CT scan of responders under the condition of sleep apnea. Without OA in place: nasopharynx (a), velopharynx (b), glossopharynx (c), epiglotopharynx (d). With OA in place: nasopharynx (e), velopharynx (f), glossopharynx (g), epiglotopharynx (h)
See this image and copyright information in PMC

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