Health Problem: Obstructive sleep apnea (OSA) is a chronic disorder that is characterized by repeated starting and stopping of breathing during sleep. Patients with OSA typically exhibit loud snoring followed by periods of silence and then snorting, choking, or gasping upon continuation of breathing. This often leads to fragmented sleep and daytime sleepiness. The estimated prevalence of moderate-to-severe OSA is 10% of men and 3% of women younger than 50 years of age and 17% of men and 9% of women older than 50 years of age.

Technology Description: Mandibular advancement devices (MADs) are the most common type of oral appliance used for the treatment of OSA. The aim of MADs is to reduce or relieve upper airway obstruction and snoring by modifying the position of the mandible, tongue, and other oropharyngeal structures.

Controversy: There is a large body of evidence supporting the use of MAD for mild-to-moderate OSA. However, the effectiveness of MAD can be difficult to predict and the optimal level of design sophistication is being debated. The design and sophistication of MADs vary widely and include the adjustability, extent of customization, 1- or 2-piece design, and the materials used. In addition, more evidence on the long-term side effects of MAD is needed.

Key Questions:

  • Does MAD improve clinical outcomes compared with other treatments for OSA, such as continuous positive airway pressure (CPAP)?
  • Is MAD safe?
  • Have definitive patient selection criteria been established for MAD?

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