Abstract 1 of 2 
American Journal of Respiratory and Critical Care Medicine Vol 166. pp. 743-748, (2002)© 2002 American Thoracic Society
Oral Appliance Therapy Improves Symptoms in Obstructive Sleep ApneaA Randomized, Controlled TrialDepartment of Respiratory Medicine, Centre for Sleep Disorders and Respiratory Failure, St. George Hospital, University of New South Wales, Kogarah, Australia Correspondence and requests for reprints should be addressed to Dr. Peter A. Cistulli, Department of Respiratory Medicine, Centre for Sleep Disorders and Respiratory Failure, St. George Hospital, University of New South Wales, Kogarah 2217, NSW, Australia. E-mail: p.cistulli{at}unsw.edu.au The aim of this study was to evaluate the effect of a mandibular advancement splint (MAS) on daytime sleepiness and a range of other symptoms in obstructive sleep apnea (OSA). Using a randomized crossover design, patients received 4 weeks of treatment with MAS and a control device (inactive oral appliance), with an intervening 1-week washout. At the end of each treatment period, patients were reassessed by questionnaire, polysomnography, and multiple sleep latency test. Fifty-nine men and 14 women with a mean (± SD) age of 48 ± 11 years and proven OSA experienced a significantly improved mean (± SEM) sleep latency on the multiple sleep latency test (10.3 ± 0.5 versus 9.1 ± 0.5 minutes, p = 0.01) and Epworth sleepiness scale score (7 ± 1 versus 9 ± 1, p < 0.0001) with the MAS compared with the control device after 4 weeks. The proportion of patients with normal subjective sleepiness was significantly higher with the MAS than with the control device (82 versus 62%, p < 0.01), but this was not so for objective sleepiness (48 versus 34%, p = 0.08). Other OSA symptoms were controlled in significantly more patients with the MAS than with the control device. MAS therapy improves a range of symptoms associated with OSA.
Key Words: sleep apnea • obstructive • orthodontic appliances
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Abstract 2 of 2
American Journal of Respiratory and Critical Care Medicine Vol 168. pp. 238-241, (2003)© 2003 American Thoracic Society
Effect of Oral Appliance Therapy on Upper Airway Collapsibility in Obstructive Sleep ApneaDepartment of Respiratory and Sleep Medicine, St. George Hospital, University of New South Wales, Sydney, Australia Correspondence and requests for reprints should be addressed to Peter Cistulli, M.D., Ph.D., Department of Respiratory Medicine, St. George Hospital, Belgrave Street, Kogarah, NSW 2217, Australia. E-mail: p.cistulli{at}unsw.edu.au Oral appliance therapy is emerging as an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea (OSA). However, its precise mechanisms of action are yet to be defined. We examined the effect of a mandibular advancement splint (MAS) on upper airway collapsibility during sleep in OSA. Ten patients with proven OSA had a custom-made MAS incrementally adjusted during an acclimatization period until the maximum comfortable limit of mandibular advancement was reached. Polysomnography with the splint was then performed. After a 1-week washout period, upper airway closing pressures during sleep (with and without MAS) were determined. Significant improvements with MAS therapy were seen in the apnea/hypopnea index (25.0 ± 3.1 vs. 13.2 ± 4.5/hour, p < 0.03) and upper airway closing pressure in Stage 2 sleep (–1.6 ± 0.4 vs. –3.9 ± 0.6 cm H2O, p < 0.01) and in slow wave sleep (–2.5 ± 0.7 vs. –4.7 ± 0.6 cm H2O, p < 0.02) compared with no therapy. These preliminary data indicate that MAS therapy is associated with improved upper airway collapsibility during sleep. The mediators of this effect remain to be determined.
Key Words: mandibular advancement splint • obstructive sleep apnea • upper airway collapsibility
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