Clinical Study Of Two Mandibular Advancement Devices In The Treatment Of Obstructive Sleep Apnea Hypopnea Syndrome

Objective The aim of this study is to evaluate the efficacy and adverse reactions of two types of Mandibular Advancement Devices(MADs),Shark-fin MAD and Silensor MAD,in the treatment of Obstructive Sleep Apnea Hypopnea Syndrome(OSAHS).The aim is to explore treatment effect and adverse reactions of the MADs and to provide a theoretical basis for the selection of clinical practice.Methods From January 2022 to November 2022,40 patients with OSAHS diagnosed by polysomnography were recruited from the Special Diagnosis Department,Stomatological Hospital Affiliated to Zhejiang Chinese Medical University.Among them,14 patients were mild,17 patients were moderate,and 9 patients were severe.They were randomly divided into two groups,wearing Shark-fin MAD and Silensor MAD.The Apnea Hypopnea Index(AHI),the lowest oxygen saturation,the average oxygen saturation,the proportion of deep sleep,the longest apnea and hypopnea time were obtained by polysomnography before and after wearing the MADs for one month and three month,meanwhile,the snoring loudness score,Epworth Sleepiness Score(ESS)and Pittsburgh Sleep Quality Index(PSQI)were scored by patients themselves through questionnaires.In addition,the snoring loudness score was also evaluated on the first day and one week of wearing.The comfort score was assessed by questionnaires at one day,one week,one month and three months after wearing the MADs.In addition,CBCT and lateral radiographs were taken before and three months after the use of MADs.The anterior,superior and posterior Spaces of the left and right joints were measured in CBCT.The tooth changes and skeletal changes were compared with the mark point and line overlap method in the lateral cephalometric measurement.The occlusal changes before and after wearing the appliance were recorded by iTero scanner.The data were entered into SPSS25.0 software and analyzed by t test.The significance level was defined asα=0.05.Results In this study,a decrease in AHI to less than 5 or a decrease of more than 50%was considered to be effective.The effective rate was 70%in the Shark-fin MAD group and 50%in the Silensor MAD group.After one month wearing the Shark-fin MAD,AHI was significantly decreased in all patients(P<0.05),and the lowest oxygen saturation was significantly increased in severe patients(P<0.05).In the Silensor MAD group,AHI in mild and moderate OSAHS patients improved significantly(P<0.05),but there was no significant difference in severe OSAHS patients(P>0.05).There were no significant differences in mean oxygen saturation,proportion of deep sleep,and the longest duration of apnea and hypopnea between the two groups before and after using the MADs(P>0.05).There was no significant difference between one month and three month of wearing MADs(P>0.05).After three months of wearing Shark-fin MAD,in addition to the significant reduction in AHI,the proportion of deep sleep was significantly increased in mild and moderate patients(P<0.05),and the longest duration of apnea and hypopnea was significantly decreased in severe patients(P<0.05).After three months of wearing Silensor MAD,the lowest oxygen saturation of mild and moderate patients increased significantly(P<0.05).The loudness of snoring was significantly decreased after one day using Shark-fin MAD(P<0.05),and further decreased after one month of using(P<0.01),while the loudness of snoring was not significantly decreased until after one month of using Silensor MAD(P<0.05).After wearing Shark-fin MAD,ESS were significantly improved after one month and three months(P<0.05),and PSQI were significantly improved after three months(P<0.05),While there was no significant difference after wearing Silensor MAD one month and three months(P>0.05).After one day and three months of wearing,the Shark-fin MAD group had a better comfort score than the Silensor MAD group(P<0.05),while there was no significant difference in the comfort score between the two groups after one week and one month of wearing(P>0.05).There was no significant difference in joints,tooth and skeletal changes between the two groups after three months of using the MADs(P>0.05).Conclusion Both of two MADs have significant objective effect in the mild and moderate OSAHS patients,for severe patients,the Shark-fin MAD has a significant objective effect,but the Silensor MAD has a poor effect.The subjective efficacy and comfort of Shark-fin MAD are better than those of Silensor MAD.Short-term use of MADs do not cause significant changes in occlusion and temporomandibular joint,and tooth changes and skeletal changes were not obvious either.