Étude comparative à court terme d’orthèses d’avancée mandibulaire titrable vs. active dans le traitement du syndrome d’apnées obstructives du sommeil chez l’adulte.

Introduction: Obstructive sleep apnea syndrome (OSAS) is a common public health issue. Management with continuous positive airway pressure (CPAP) is the gold standard, but many people are unable to cope with it or refuse it. So, titratable mandibular advancement devices (MADs) are gaining in popularity, because they provide real long-term solutions. The myofunctional approach, which involves lingual exercises, is an additional measure that could improve OSAS management. To this end, we have observed the association of these two elements by creating an active MAD (AMAD). Indeed, actively repositioning the mandible in the advanced position may well mitigate some of the adverse effects of conventional MADs. Objectives: To compare the efficacy of AMADs in a routine care environment with conventional titratable MADs in adult patients with severe OSAS who do not want or do not tolerate CPAP therapy. The evaluation will focus on the overall response rate, which includes changes in apnea-hypopnea index (AHI) and compliance. Methodology: 18 participants completed the entire study, 8 in the MAD group and 10 in the AMAD group. After completing a series of questionnaires, they were asked to undergo a dental and temporomandibular joint (TMJ) examination, and their first polysomnography (PSG). They all received the treatment. After the patients had used it for at least 3 months, another series of questionnaires was completed, and another clinical examination and a second PSG were carried out. Results: AHI (p <0.001), time spent with SpO2>90 (p = 0.002), desaturation index (p = 0.004) and number of micro-arousals (p = 0.007) significantly decreased in both groups, with no significant difference between groups. The overall results of the questionnaires showed a significant improvement between the beginning and the end of the study for both groups with no significant difference between the groups for drowsiness, fatigue, normal activities and sleep quality variables. However, a much higher salivation rate was reported with the AMAD, as well as longer wake times during sleep periods and a tendency for the device to be worn for less time during the night. It was also observed that sleep quality does not normalize as much as with conventional MADs. Subjectively, patients in the AMAD group reported fewer TMJ clicks (p = 0.05) and fewer occlusion changes (p = 0.05) in the short term, compared to the MAD group. Finally, there were no significant differences between the groups in the overall response rate (p = 0.64). Conclusion: AMAD is an equipotent treatment option, based on sleep indexes, when compared to conventional titratable MADs. While AMADs produce subjectively less TMJ clicking and occlusal changes in the short term, it is essential to conduct a large-scale study to confirm whether the tendencies to not sleep as well and to use AMADs for shorter periods than MADs can be explained.

Keyphrases: Obstructive sleep apnea syndrome, Mandibular advancement device,, Active mandibular advancement device