Mono block and twinblock mandibular advancement devices in the treatment of obstructive sleep apnea

Aim: Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea syndrome (OSAS). There is conflicting evidence of how different MAD designs may affect OSAS outcomes in certain patients. This study aimed to assess and compare the effectiveness of two different MADs in treating OSAS, based on subjective and objective measurements. Material and Method: A randomised crossover design trial was carried out on 38 patients with OSAS. A monoblock and a twinblock MAD were tested in each patient. Changes in objective outcomes (apnea-hypopnea index (AHI), total sleep time (TST), oxygen desaturation index >4% (ODI4%), total duration of oxygen saturation with less than 90% (SpO2<90%), total arousal index (TAI) and sleep efficiency) were assessed by polysomnography, changes in subjective outcomes by the Sleep Apnea Quality of Life Index (SAQLI) and Epworth Sleepiness Scale (ESS). Results: Both MADs proved to be effective in improving several objective parameters from baseline, but when compared there was a significant difference in favor of the monoblock in terms of improving AHI, ODI 4% and total duration with SpO2<90% (p=0.032; 0.046 and 0.043, respectively). Both MADs were efficacious in improving patients' SAQLI score and ESS score (all p<0.05), but no significant difference was observed between the two MADs. Discussion: Use of the monoblock MAD should be considered when patients with OSAS choose MAD treatment, as it was more efficient in improving objective OSAS parameters compared to twinblock MAD.