Do Mandibular Advancement Devices Influence Patients' Snoring and Obstructive Sleep Apnea? A Cone-Beam Computed Tomography Analysis of the Upper Airway Volume
Abstract
Purpose The upper airway volume is central to the development and treatment of snoring and obstructive sleep apnea, and mandibular advancement devices (MADs) have increasingly been used as an effective alternative to continuous positive airway pressure for these 2 conditions. We investigated the changes in breathing patterns and upper airway volume parameters measured on cone-beam computed tomography (CBCT) scans of patients with and without the use of custom-made MADs.Materials and methods We performed a prospective study at the Department of Oral and Maxillofacial Surgery, Odense University Hospital, on consecutively treated patients. CBCT scans were performed with and without the MAD to measure the changes in the upper airway volume. The patients underwent diagnostic cardiorespiratory monitoring before and after 3 months of MAD therapy. Measurements with and without MAD were compared using Student's t test and the Wilcoxon signed rank test, and mixed-model analyses were performed adjusting for sleep apnea severity, type 2 diabetes, body mass index, gender, and age.Results A total of 44 patients (31 men and 13 women, age 50 ± 13 years, body mass index 31 ± 5.6 kg/m(2)) completed the trial. MAD therapy was associated with an increase in the total upper airway volume from 22.9 ± 8.7 cm(3) before treatment to 26.7 ± 10.7 cm(3) after treatment (P < .001). MAD therapy reduced the apnea-hypopnea index (AHI) from 15.8 ± 17.4 events/hour before treatment to 6.2 ± 9.8 events/hour after treatment (P < .001).Conclusion The results of the present study indicate that MAD therapy appears to produce significant changes in the upper airway volume that correlate with a decrease in the AHI.
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Studies incorporating polysomnography alongside structural assessment to evaluate functional outcomes of mandibular advancement in children are more limited in number.
“In contrast, studies incorporating polysomnography alongside structural assessment to evaluate functional outcomes of mandibular advancement in children are more limited in number [20–22, 42–45]”
From Long-Term Changes Following Orthopedic Mandibular Advancement Therapy in Pediatric Obstructive Sleep Apnea: a 7-Year Follow-up Study (2026) · cites this paper as [22]
Cites
The Occurrence of Sleep-Disordered Breathing among Middle-Aged Adults
Young, T., Palta, M., Dempsey, J., Skatrud, J., Weber, S., & Badr, S. (1993) · New England Journal of Medicine · doi:10.1056/nejm199304293281704 · Cited by 10,183 · cited 1× · see citing works
“Furthermore, snoring is the primary symptom of obstructive sleep apnea (OSA), present in 4 % of males and 2 % of females and, unfortunately, often overlooked [2-5].”
BackgroundMarin, J. M., Carrizo, S. J., Vicente, E., & Agusti, A. G. (2005) · The Lancet · doi:10.1016/s0140-6736(05)71141-7 · Cited by 4,678 · see citing works
Epidemiology of Obstructive Sleep Apnea: A Population Health Perspective
Young, T., Peppard, P. E., & Gottlieb, D. J. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.2109080 · Cited by 4,244 · see citing works
(1992) · PubMed · Cited by 3,804 · see citing works
Sleep-disordered Breathing and Cardiovascular Disease
SHAHAR, E., WHITNEY, C. W., REDLINE, S., LEE, E. T., NEWMAN, A. B., JAVIER NIETO, F., O'CONNOR, G. T., BOLAND, L. L., SCHWARTZ, J. E., & SAMET, J. M. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.1.2001008 · Cited by 2,901 · see citing works
Prevalence of Sleep-disordered Breathing in Women
BIXLER, E. O., VGONTZAS, A. N., LIN, H.-M., TEN HAVE, T., REIN, J., VELA-BUENO, A., & KALES, A. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.3.9911064 · Cited by 1,598 · see citing works
Sleep Apnea and Cardiovascular Disease
Somers, V. K., White, D. P., Amin, R. S., Abraham, W. T., Costa, F., Culebras, A., Daniels, S. R., Floras, J. S., Hunt, C. E., Olson, L. J., et al. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.05.002 · Cited by 1,510 · see citing works
Goldberger, J. J., Cain, M. E., Hohnloser, S. H., Kadish, A. H., Knight, B. P., Lauer, M. S., Maron, B. J., Page, R. L., Passman, R. S., Siscovick, D., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.189375 · Cited by 1,450 · see citing works
Sleep Apnea and Cardiovascular Disease
Somers, V. K., White, D. P., Amin, R. S., Abraham, W. T., Costa, F., Culebras, A., Daniels, S. R., Floras, J. S., Hunt, C. E., Olson, L. J., et al. (2008) · Circulation · doi:10.1161/circulationaha.107.189420 · Cited by 1,301 · see citing works
Comparative dosimetry of dental CBCT devices and 64-slice CT for oral and maxillofacial radiology
Ludlow, J. B., & Ivanović, M. (2008) · Oral Surgery Oral Medicine Oral Pathology Oral Radiology and Endodontology · doi:10.1016/j.tripleo.2008.03.018 · Cited by 873 · see citing works
Dosimetry of 3 CBCT devices for oral and maxillofacial radiology: CB Mercuray, NewTom 3G and i-CAT
Ludlow, J. B., Davies-Ludlow, L., Brooks, S., & Howerton, W. (2006) · Dentomaxillofacial Radiology · doi:10.1259/dmfr/14340323 · Cited by 850 · see citing works
Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review
Ferguson, K. A., CARTWRIGHT, R. D., Rogers, R. R., & Schmidt-Nowara, W. W. (2006) · SLEEP · doi:10.1093/sleep/29.2.244 · Cited by 687 · see citing works
A Randomized, Controlled Study of a Mandibular Advancement Splint for Obstructive Sleep Apnea
MEHTA, A., QIAN, J., PETOCZ, P., DARENDELILER, M. A., & CISTULLI, P. A. (2001) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/ajrccm.163.6.2004213 · Cited by 514 · see citing works
Oral appliances for obstructive sleep apnoea
Lim, J., Lasserson, T. J., Fleetham, J. A., & Wright, J. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004435.pub3 · Cited by 436 · see citing works
The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea
Chan, A. S. L., Sutherland, K., Schwab, R. J., Zeng, B., Petocz, P., Lee, R. W. W., Darendeliler, M. A., & Cistulli, P. A. (2010) · Thorax · doi:10.1136/thx.2009.131094 · Cited by 356 · see citing works
Gotsopoulos, H., Kelly, J. J., & Cistulli, P. A. (2004) · Sleep · doi:10.1093/sleep/27.5.934 · Cited by 340 · see citing works
Obstructive sleep apnea is a risk factor for death in patients with stroke: a 10-year follow-up.
Sahlin, C., Sandberg, O., Gustafson, Y., Bucht, G., Carlberg, B., Stenlund, H. C., & Franklin, K. A. (2008) · PubMed · doi:10.1001/archinternmed.2007.70 · Cited by 340 · see citing works
Oral Appliance Therapy Improves Symptoms in Obstructive Sleep Apnea: A Randomized, Controlled Trial
Gotsopoulos, H., Chen, C., Qian, J., & Cistulli, P. A. (2002) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200203-208oc · Cited by 331 · see citing works
Obstructive sleep apnea as a risk factor for coronary events or cardiovascular death
Shah, N. A., Yaggi, H. K., Concato, J., & Mohsenin, V. (2010) · Sleep and Breathing · doi:10.1007/s11325-009-0298-7 · Cited by 298 · see citing works
Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy
Marklund, M., Verbraecken, J. A., & Randerath, W. J. (2011) · European Respiratory Journal · doi:10.1183/09031936.00144711 · Cited by 240 · see citing works
Ryan, C. F., Love, L. L., Peat, D., Fleetham, J. A., & Lowe, A. A. (1999) · Thorax · doi:10.1136/thx.54.11.972 · Cited by 235 · see citing works
Fairburn, S. C., Waite, P. D., Vilos, G., Harding, S. M., Bernreuter, W., Cure, J., & Cherala, S. (2007) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2005.11.119 · Cited by 231 · see citing works
Effect of Oral Appliance Therapy on Upper Airway Collapsibility in Obstructive Sleep Apnea
Ng, A. T., Gotsopoulos, H., Qian, J., & Cistulli, P. A. (2003) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.200211-1275oc · Cited by 221 · see citing works
Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances
Cistulli, P. A., Gotsopoulos, H., Marklund, M., & Lowe, A. A. (2004) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2004.04.002 · Cited by 214 · see citing works
Abramson, Z. R., Susarla, S. M., Lawler, M. E., Bouchard, C., Troulis, M. J., & Kaban, L. B. (2011) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2010.11.037 · Cited by 180 · see citing works
Aarab, G., Lobbezoo, F., Hamburger, H., & Naeije, M. (2010) · Respiration · doi:10.1159/000319595 · Cited by 171 · see citing works
Masa, J. F., Corral, J., Pereira, R., Duran-Cantolla, J., Cabello, M., Hernandez-Blasco, L., Monasterio, C., Alonso, A., Chiner, E., Rubio, M., et al. (2011) · Thorax · doi:10.1136/thx.2010.152272 · Cited by 161 · see citing works
PETRI, N., SVANHOLT, P., SOLOW, B., WILDSCHIØDTZ, G., & WINKEL, P. (2008) · Journal of Sleep Research · doi:10.1111/j.1365-2869.2008.00645.x · Cited by 152 · see citing works
Aarab, G., Lobbezoo, F., Heymans, M. W., Hamburger, H., & Naeije, M. (2011) · Respiration · doi:10.1159/000324580 · Cited by 140 · see citing works
Hasebe, D., Kobayashi, T., Hasegawa, M., Iwamoto, T., Kato, K., Izumi, N., Takata, Y., & Saito, C. (2011) · International Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.ijom.2011.01.011 · Cited by 134 · see citing works
Diagnosis of Obstructive Sleep Apnea Syndrome and Its Outcomes With Home Portable Monitoring
de Oliveira, A. C. T., Martinez, D., Vasconcelos, L. F. T., Cadaval Gonçalves, S., do Carmo Lenz, M., Costa Fuchs, S., Gus, M., de Abreu-Silva, E. O., Beltrami Moreira, L., & Danni Fuchs, F. (2009) · Chest · doi:10.1378/chest.08-1859 · Cited by 129 · see citing works
Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity
Tsuiki, S., Lowe, A. A., Almeida, F. R., Kawahata, N., & Fleetham, J. A. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00094304 · Cited by 106 · see citing works
Kim, K., Ruprecht, A., Wang, G., Lee, J. B., Dawson, D. V., & Vannier, M. W. (2004) · Forensic Science International · doi:10.1016/j.forsciint.2004.11.004 · Cited by 105 · see citing works
Dattilo, D. J., & Drooger, S. A. (2004) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2003.03.002 · Cited by 104 · cited 1× · see citing works
“OSA represents a disease of increasing relevance to oral and maxillofacial surgeons, mainly due to the well-known effect of surgical maxillamandibular advancement on OSA [26-28].”
BackgroundTsuiki, S., Lowe, A. A., Almeida, F. R., & Fleetham, J. A. (2004) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2003.05.006 · Cited by 94 · see citing works
Susarla, S. M., Abramson, Z. R., Dodson, T. B., & Kaban, L. B. (2010) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2010.06.196 · Cited by 93 · see citing works
Schendel, S. A., Powell, N. B., & Jacobson, R. L. (2011) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2010.11.010 · Cited by 90 · see citing works
Johal, A., Gill, G., Ferman, A., & McLaughlin, K. (2006) · Clinical Physiology and Functional Imaging · doi:10.1111/j.1475-097x.2007.00714.x · Cited by 87 · see citing works
Masa, J. F., Corral‐Peñafiel, J., Pereira, R., Durán‐Cantolla, J., Cabello, M., Blasco, L., Monasterio, C., Alonso, A., Chiner, E., Zamorano, J. L., et al. (2011) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201103-0428oc · Cited by 87 · see citing works
The influence of orthognathic surgery on ventilation during sleep
Foltán, R., Hoffmannová, J., Pavlíková, G., Hanzelka, T., Klíma, K., Horká, E., Adámek, S., & Šedý, J. (2010) · International Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.ijom.2010.10.006 · Cited by 78 · see citing works
Laboratory versus Portable Sleep Studies: A Meta‐Analysis
Ghegan, M. D., Angelos, P. C., Stonebraker, A. C., & Gillespie, M. B. (2006) · The Laryngoscope · doi:10.1097/01.mlg.0000214866.32050.2e · Cited by 74 · see citing works
Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea
Sam, K., Lam, B., Ooi, C. G. C., Cooke, M. E., & Ip, M. (2005) · Respiratory Medicine · doi:10.1016/j.rmed.2005.08.019 · Cited by 58 · see citing works
Zhao, X., Liu, Y., & Gao, Y. (2008) · American Journal of Orthodontics and Dentofacial Orthopedics · doi:10.1016/j.ajodo.2006.06.024 · Cited by 46 · see citing works
Kurtulmuş, H., Cotert, S., Bilgen, C., On, A. Y., & Boyacıoğlu, H. (2009) · PubMed · Cited by 36 · see citing works
Dose-dependent effects of mandibular protrusion on genioglossus activity in sleep apnoea
Almeida, F. R., Tsuiki, S., Hattori, Y., Takei, Y., Inoue, Y., & Lowe, A. A. (2010) · European Respiratory Journal · doi:10.1183/09031936.00194809 · Cited by 32 · see citing works
Oksenberg, A. (2013) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2013.08.003 · Cited by 22 · see citing works
Kaur, A., Chand, P., Singh, R. D., Siddhartha, R., Tripathi, A., Tripathi, S., Singh, R., & Mishra, A. (2012) · PubMed · Cited by 18 · see citing works
What are the health risks of untreated snoring without obstructive sleep apnea?
Chang, J. L., & Kezirian, E. J. (2013) · The Laryngoscope · doi:10.1002/lary.23670 · Cited by 11 · see citing works
Flagged first, then by citations
1 of the 50 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Accuracy of MDCT and CBCT in three-dimensional evaluation of the oropharynx morphology
Chen, H., van Eijnatten, M. A. J. M., Aarab, G., Forouzanfar, T., de Lange, J., van der Stelt, P. F., Lobbezoo, F., & Wolff, J. (2017) · European Journal of Orthodontics · doi:10.1093/ejo/cjx030 · Cited by 40 · see citing works
Petri, N. E., Christensen, I. J., Svanholt, P., Sonnesen, L., Wildschiødtz, G., & Berg, S. (2018) · Sleep Medicine · doi:10.1016/j.sleep.2018.09.033 · Cited by 30 · see citing works
Marco‐Pitarch, R., García‐Selva, M., Puertas, F. J., Algarra, J. M., Fernández‐Julián, E., & Font, A. F. (2018) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-018-4978-4 · Cited by 22 · see citing works
Chen, H., Aarab, G., Lobbezoo, F., de Lange, J., van der Stelt, P. F., Darendeliler, M. A., Cistulli, P. A., Sutherland, K., & Dalci, O. (2018) · European Journal of Orthodontics · doi:10.1093/ejo/cjy085 · Cited by 21 · see citing works
Changes in Upper Airway Volume Following Orthognathic Surgery
Marcussen, L. N., Stokbro, K., Aagaard, E., Torkov, P., & Thygesen, T. (2016) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000003206 · Cited by 18 · see citing works
Self-citationDontsos, V. K., Chatzigianni, A., Papadopoulos, M. A. A. P., Nena, E., & Steiropoulos, P. (2020) · European Journal of Orthodontics · doi:10.1093/ejo/cjaa035 · Cited by 18 · see citing works
Surgical Correction of Maxillofacial Skeletal Deformities
Cottrell, D. A., Farrell, B. B., Ferrer-Nuin, L., & Ratner, S. (2017) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2017.04.025 · Cited by 11 · see citing works
Haskell, B. S., Voor, M. J., & Roberts, A. M. (2020) · Journal of Clinical Sleep Medicine · doi:10.5664/jcsm.9018 · Cited by 10 · see citing works
Özer, T., Selçuk, A., Yılmaz, Z., Voyvoda, N., Çam, İ., Özel, H. E., Özdoğan, F., Esen, E., Genç, G., & Genç, S. (2018) · British Journal of Radiology · doi:10.1259/bjr.20170322 · Cited by 10 · see citing works
Garcia, G. J. M., Wolf, J. J., Campbell, D. A., Bailey, R. S., Sparapani, R., Welzig, C. M., & Woodson, B. T. (2023) · Physiological Reports · doi:10.14814/phy2.15558 · Cited by 6 · see citing works
Selçuk, A., Özer, T., Esen, E., Özdoğan, F., Özel, H. E., Yüce, T., Caliskan, S. K., Daşlı, S., Bilal, N., Genç, G., et al. (2017) · European Archives of Oto-Rhino-Laryngology · doi:10.1007/s00405-016-4448-9 · Cited by 4 · see citing works
Aydil, S. K., Kiyan, E., Ersu, R., Kilicoglu, H., Sayar, G., & Capan, E. (2026) · Clinical Oral Investigations · doi:10.1007/s00784-026-06926-4 · Cited by 2 · see citing works
“In contrast, studies incorporating polysomnography alongside structural assessment to evaluate functional outcomes of mandibular advancement in children are more limited in number [20–22 , 42– 45].”
Verma, A., & Jain, S. (2023) · Journal of College of Physicians And Surgeons Pakistan · doi:10.29271/jcpsp.2023.10.1194 · Cited by 2 · see citing works
Banari, A. S., Datana, S., Agarwal, S., Chopra, S. S., & Roy, I. (2023) · Journal of Contemporary Orthodontics · doi:10.18231/j.jco.2023.036 · Cited by 2 · see citing works
ผลของการปรบสกรขยายในสวนลอกของเครองมอยนขากรรไกรลางชนดปรบไดแบบใหม : การทดสอบจำลองแรงดง
อุมา, อ., วิเชียรเนตร, ส., & ชลิดาพงศ์, เ. (2017) · doi:10.58837/chula.the.2017.868
Surgical Correction of Maxillofacial Skeletal Deformities
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- Authors
- Marcussen, L., Henriksen, J. E., & Thygesen, T.
- Affiliations
- Odense University Hospital (DK)
- Corresponding author
- Marcussen, Lillian
- Venue
- Journal of Oral and Maxillofacial Surgery
- Publisher
- Elsevier BV
- Published
- 2015-09
- Volume
- 73
- Issue
- 9
- Pages
- 1816-1826
- ISSN
- 0278-2391 (ISSN-L)
- OpenAlex
- W1897619743
- Cited by
- 17
- References
- 50
- Citations by year
- 2026: 2 · 2023: 4 · 2020: 2 · 2018: 4 · 2017: 4 · 2016: 1
- FWCI
- 2.21
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Oral and Maxillofacial Surgery (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Obstructive Sleep Apnea Research
- Health Sciences › Health Professions › Complementary and Manual Therapy › Temporomandibular Joint Disorders
- Health Sciences › Dentistry › Orthodontics › Orthodontics and Dentofacial Orthopedics
- Keywords
- mandibular advancement device, obstructive sleep apnea, snoring, upper airway volume, apnea-hypopnea index, cone-beam computed tomography, breathing pattern, apnea severity
- MeSH terms
- Humans, Lung Volume Measurements, Prospective Studies, Snoring, Mandibular Advancement, Sleep Apnea, Obstructive, Cone-Beam Computed Tomography
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