CC BY-NC-ND 4.0 · Sleep Sci 2024; 17(01): e55-e63
DOI: 10.1055/s-0043-1776752
Original Article

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients

Floriana Pintucci
1   Dentistry, Private Practice, Ferrara, Italy
Francesca Cremonini
2   Department of Orthodontics, University of Ferrara, Ferrara, Italy
Giulia Romagnolo
2   Department of Orthodontics, University of Ferrara, Ferrara, Italy
Gianluca Giorgio Marrano
3   Department of Otolaryngology, Morgagni-Pierantoni Hospital, Forlì, Italy
Francesca Barbanti
3   Department of Otolaryngology, Morgagni-Pierantoni Hospital, Forlì, Italy
Giorgio Alfredo Spedicato
4   Statistics Department, Bicocca University, Milano, Italy
Claudio Vicini
5   Department of Otolaryngology, University of Bologna, Bologna, Italy
6   School of Orthodontics, University of Ferrara, Ferrara, Italy
› Author Affiliations
Funding The author(s) received no financial support for the research.


Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success.

Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs.

Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance.

Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

Publication History

Received: 07 June 2022

Accepted: 18 May 2023

Article published online:
20 February 2024

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