Respiratory Treatment and Prevention (Advances in Experimental Medicine and Biology)

5 compared therapeutic efficacy of different
types of MAA with controls or placebo (Quinnell
et al. 2014 ; Petri et al. 2008 ; Blanco et al. 2005 ;
Gotsopoulos et al. 2002 ; Mehta et al. 2001 ).
The papers that contain a description of base-
line characteristics indicated the beginning of
treatment in moderate and severe cases of OSA.
The AHI value after application of both
CPAP and MAA decreases to the level of mild
OSA (Doff et al. 2013 ; Aarab et al. 2011 ;
Gagnadoux et al.. 2009 ; Hoekema et al. 2008 ;
Lam et al. 2007 ; Engelman et al. 2002 ; Tan
et al. 2002 ). However, AHI value after CPAP
application is significantly lower than that after
MAA application (Phillips et al. 2013 ; Barnes
et al. 2004 ; Randerath et al. 2002 ). In the study

of Aarab et al. ( 2011 ), the difference in AHI

index between baseline and CPAP treatment is

down to more than 20 while that between base-

line and MAA treatment is 15 episodes per hour

of sleep. Likewise, excessive daytime sleepiness

appreciably decreased after both CPAP and

MAA, with no significant difference between

the two therapeutic modes.

All clinical trials perused in the present

review indicate an improvement after treatment

with both CPAP and MAA. However, if the

treatment efficacy goal is set the AHI5 apneic

episodes per hour of sleep, then MAA usually

fails to reach that cut-off level and thus should

not rather be recommended as the first line treat-

ment for OSA patients (Engelman et al. 2002 ).

Table 2 Epworth Sleepness Scale (ESS) or excessive daytime sleepiness (EDS) score after the use of different modes
of treatment in obstructive sleep apnea (OSA) patients in randomized clinical trials

Study Baseline CPAP MAA Placebo

Aarab et al. ( 2011 )

EDS

Oral

appliance:12.0
5.7

CPAP: 11.0
4.4

Δ5.2
4.6ʌ Δ4.7
4.5 –

Barnes et al. ( 2004 )

ESS

10.7
0.4 9.2
0.4*{ 9.2
0.4*{ 10.2
0.4

Doff et al. ( 2013 )

ESS

Oral appliance: 13
 6

CPAP: 14
 6

5 (2–9)ns(1-yr follow-up)

5 (1–8)#(2-yr follow-up)

5 (3–8)ns(1-yr follow-up)

4 (1–8)#(2-yr follow-up)

Engelman et.al

( 2002 )

ESS

14 
 48 
 5 ʌ 12 
5–

Hoekema

et al. (2008)

(PSG evaluation)

Oral appliance:

12.5
5.6

CPAP: 14.2
5.6

6.9
5.5ns 5.9
4.8ns –

Gagnadoux

et al. (2009)

ESS

10.6
4.5 8.2
3.9* 7.7
4.0* –

Lam et al. ( 2007 )

ESS

Oral appliance:

20.0
1.7

CPAP: 23.8
1.9

2.8
11.0* 10.6
1.7* –

Phillips et al. ( 2013 )

ESS

9.1
4.2 7.5
0.4§ 7.2
0.4§ –

Tan et al. ( 2002 )

ESS

13.4
4.6 8.1
4.1* 9.0
5.1* –

Data are means
SD, values with additives in parenthesis are medians and interquartile ranges;ΔEDS downward
difference between baseline and treatment result, CPAP continuous positive airway pressure, MAA mandibular
advancement appliance
*p<0.001vs. baseline
{p<0.001vs. placebo
§p<0.01vs. baseline
#p<0.05vs.baseline
ʌp<0.001vs. MAA
nsnon-significant

Mandibular Advancement Appliance for Obstructive Sleep Apnea Treatment 67