Titratable mandibular repositioner appliances for obstructive sleep apnea syndrome: are they an option?

Mandibular repositioning appliances (tMRAs) designed with a titratable mechanism are effective to treat obstructive sleep apnea syndrome (OSAS) but are not widely used, although many studies have proven their value. The aim of the present study was to evaluate the efficacy of tMRAs in the treatment of OSAS on the criteria of the American Academy of Sleep Medicine (AASM; apnea/hypopnea index [AHI] < 5). Three hundred consecutive patients with a polysomnographic diagnosis of OSAS were referred for treatment with tMRAs between 2000 and 2003. Thirty-eight patients were excluded, and 262 concluded the titration protocol with tMRA that lasted 4 months. After titration, the patients were referred for a medical reassessment, and 83 patients (70 men) participated in the new polysomnographic exam with tMRA in place to access tMRA's efficacy. The mean pre- and post-treatment AHI were 26 +/- 17.7 and 4.8 +/- 5.3 events per hour, respectively (p < 0.00005). Fifty-three (62.6%) of the 83 patients were treated successfully (AHI < 5). Twenty-three patients had severe OSAS, and 12 of them (52.1%) were treated successfully (AHI < 5). Forty patients had moderate OSAS, and 26 of them (65%) were treated successfully. Twenty patients had mild OSAS, and 15 (75%) were successfully treated. Even when applying more rigid criteria such as those of the AASM, the expressive success rate obtained with the treatment of different degrees of OSAS indicates that tMRAs are an additional valuable option even for cases of severe apnea in which the patient does not tolerate continuous positive airway pressure or cannot afford this treatment, a fact quite common in Brazil and other developing countries.