Effectiveness of Mandibular Advancement Device for Obstructive Sleep Apnea in Chronic Spinal Cord Injury

Objectives: To determine the effectiveness of a mandibular advancement device (MAD) in individuals with spinal cord injury (SCI) who suffer from obstructive sleep apnea (OSA) syndrome, and to identify potential predictive factors of response to MAD. Methods: Forty individuals (34 men and 6 women) with an apnea-hypopnea index (AHI) of more than 15 were included in the MAD uncontrolled clinical trial. The outcomes were evaluated through polygraphic examination before therapy and after 1 and 6 months. Subjective daytime sleepiness (Epworth Sleepiness Scale [ESS]) and quality of life (WHOQOL-BREF) were assessed at baseline and after 6 months. Throughout the study, side effects were continuously monitored. Results: Thirty-five individuals completed the study. The mean AHI decreased from 35.7 ± 15.6 to 18.5 ± 10.6 at 6 months (P < .0001). ESS improved from 9.3 ± 5.2 to 6.8 ± 3.5 (P = .0001), while no significant change was observed in WHOQOL-BREF scores. Participants with severe (AHI >30) OSA had shorter time since injury and higher body mass index (BMI) than those with moderate OSA (AHI 15-30). According to the criterion for treatment success of at least 50% improvement in AHI, MADs were effective in 48.6% of participants. Younger age and lower WHOQOL-BREF scores were the only factors significantly associated with treatment success. Conclusion: MADs appear to be an effective treatment for both moderate and severe OSA in people with SCI. They may be a suitable alternative for individuals who decline or are unable to tolerate continuous positive airway pressure therapy.