Die Anwendung von Protrusionsschienen zur Behandlung des obstruktiven Schlafapnoe-Syndroms bei erwachsenen Patienten The use of oral appliances in the treatment of obstructive sleep apnea syndrome in adult patients

Obstructive sleep apnea (OSA) is characterized by repetitive episodes of complete or partial closure of the upper airway during sleep leading to sleep fragmentation and oxygen desaturation. This sleep-related breathing disorder is associated with daytime sleepiness, impaired quality of life, poor work performance, neurocognitive decline, increased risk of motor vehicle accidents and, in the long term, an increased risk of cardio-vascular disease and mortality. Nasal continuous positive airway pressure (nCPAP) maintains a positive pressure in the upper airway through a nose mask worn during sleep and is currently the most effective treatment option for OSA patients. Nevertheless, adherence to this therapy is low. The availability of alternative treatment options is therefore of the utmost importance. Mandibular advancement devices (MADs), which hold the mandible forward with the aim of preventing collapse of the upper airway during sleep provide a less invasive, more comfortable, and less costly treatment alternative for patients with mild to moderate OSA who do not tolerate, do not respond to, or are not appropriate candidates for treatment with nCPAP. Forward repositioning of the mandible increases the upper airway volume, widens the lateral dimension of the velopharynx, it stretches tongue muscles counteracting tongue's retrolapse during sleep, and it moves the hyoid bone anteriorly and stabilizes epiglottis and soft palate preventing the posterior rotation of the jaw. The therapy with a mandibular advancement device (MAD) represents a treatment option to obtain this anterior jaw repositioning. In this article, we will review the indications, the efficacy, the role in the clinical practice and the adverse effects of MADs for the management of OSA.