Mandibular advancement devices as an alternative to conventional treatment with CPAP in selected patients: A health intervention analysis

Introduction Mandibular Advancement Devices (MAD) are the only A grade recommended treatment alternative for Obstructive Sleep Apnea in mild to moderate disease and in patients intolerant to Positive Airway Pressure treatment (PAP). Public Health Insurance covers all expenses of MAD manufacture and maintenance in our community since mid 2010 in selected patients. We estimate a direct cost reduction of up to 50% related to PAP conventional treatment (also fully covered by our insurance system). We analyze the results of our first 18 months of treatment with MAD within the Public Health Insurance Coverage Protocol. Materials and methods We prospectively analyzed patients treated with MAD at our Department since the beginning of the Public Health Insurance Coverage Protocol and until September 2012. Patients fulfilling financing criteria were included in the study protocol. Treatment was considered effective if Apnea Hipopnea Index (AHI) wearing MAD lowered below 10 and partially effective in cases with at least a 50% reduction in AHI. Results 58 out of 66 patients had finished the protocol at the time of analysis. 57.6% were treated with MAD as a first line treatment and 41.4% as a second line treatment (60% of the latter had failed to adhere to PAP therapy). MAD treatment was effective in 65% of patients, partially effective in an additional 7.5% and showed no difference in 27.5% – three of them actually worsened their AHI – AHI was significantly reduced in both first ( p  = 0,004) and second ( p  = 0,001) line treatments. Treatment success was not significantly related to any of the patients’ morphologic, anatomic or polisomnographic features. 16.6% of patients suffered some sort of side effect. Only 10% of these caused treatment cessation, and temporomandibular joint pain was the most common cause. Conclusion MAD treatment is a valid alternative to PAP treatment in selected patients and in those intolerant to PAP therapy. No clinical measurement predicted treatment success in our case series, prompting post-intervention sleep study to confirm its efficacy. Acknowledgement Sleep Unit Team.