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Surgery or Dental Appliance for Obstructive Sleep Apnea?



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Am Fam Physician. 2002 Jun 15;65(12):2572.

About 1 to 4 percent of middle-aged men have sleep apnea. The prevalence of this disorder increases with age up to 60 years. Patients with obstructive sleep apnea have excessive daytime sleepiness and decreased cognitive performance. In addition, they have a significant increase in overall and cardiovascular mortality. Patients with coronary artery disease and obstructive sleep apnea also have an increased risk of cardiovascular mortality. One treatment option for patients with mild to moderate sleep apnea includes uvulo-palatopharyngoplasty (UPPP). Long-term studies of patients who have undergone UPPP have shown a decrease in rates of success over time. Another option for treatment is the use of a mandibular advancement device. Short-term studies of the device have shown that it is effective in treating mild to moderate obstructive sleep apnea, but no long-term studies have been performed. Walker-Engström and associates studied the effectiveness of UPPP compared with the mandibular advancement device in the treatment of mild to moderate sleep apnea.

The trial was a randomized study of 95 patients referred for evaluation of obstructive sleep apnea. Those with mild to moderate obstructive sleep apnea were assigned to undergo either UPPP or treatment with the mandibular advancement device. Patients selected to participate were men with mild to moderate sleep apnea, defined as an apnea index (number of apnea spells per hour of sleep) of greater than 5 but less than 25. Follow-up included sleep studies performed at baseline and one year and four years after intervention. Success rate was defined as the percentage of patients with at least a 50 percent reduction in apnea index or apnea/hypopnea index.

The success rate for the mandibular advancement device was significantly better than the rate for UPPP. At four years, 63 percent of patients using the mandibular device achieved normalization of the apnea index, while only 33 percent of those who underwent UPPP had normalization of the apnea index. Compliance with the mandibular device was 62 percent at four years. Complication rates for UPPP were approximately 10 percent.

The authors conclude that the mandibular advancement device had significantly higher success and normalization rates than UPPP surgery. The success rate was compromised by the fact that the compliance rate with the mandibular advancement device was 62 percent. However, the authors state that the mandibular advancement device should be recommended for long-term treatment of patients with mild to moderate sleep apnea.

Walker-Engström ML, et al. 4-Year follow-up of treatment with dental appliance or uvulopalatopharyngoplasty in patients with obstructive sleep apnea. Chest. March 2002;121:739–46.



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