Sleep Breath DOI 10.1007/s11325-014-0987-8
Treatment of elderly patients with snoring and obstructive sleep apnea using a mandibular advancement device Marie Marklund & Karl A. Franklin
Received: 25 March 2014 / Accepted: 19 April 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Introduction The simplicity of oral appliance therapy in the treatment of adult patients with snoring and obstructive sleep apnea (OSA) has resulted in a worldwide interest for this treatment modality. Mandibular advancement devices (MADs) that hold the lower jaw forward during sleep are mainly indicated for patients with milder OSA and those with CPAP intolerance. There has been minor attention on age when suggesting treatment alternatives for patients with OSA. Some studies indicate that there is a weak negative relationship between treatment success from MADs and higher age, but no studies have stratified their samples with respect to age. Objective The present aim was to compare the effects and side effects from MADs between an elderly group of patients (>65 years of age) and a younger age group that were extracted from two of our previous studies. Results The results showed no difference between the elderly and the younger patients in success rate or the degree of bite changes from MAD treatment. Conclusion These findings indicate that MADs represent an alternative to CPAP irrespective of the age of the patient.
The studies were conducted at the Department of Orthodontics, Umeå University, Sweden, in collaboration with the Department of Respiratory Medicine, Umeå University. The studies were supported by grants from the Swedish Heart-Lung Foundation and the Swedish Dental Society.
Keywords Sleep apnea . Geriatric . Mandibular advancement device
Introduction Mandibular advancement devices (MADs) are recognized as the primary non-CPAP therapy today . Their efficacy in the treatment of snoring and obstructive sleep apnea (OSA) is supported by an increasing number of RCTs and a large number of observational studies [2–5]. MADs are therefore more and more used in adults worldwide. The mean age of patients who were included in these studies varied between 44–57 years, with a minimum of 20 years and a maximum of 75 years of age [4, 6, 7]. The effect of age on the treatment outcome has been reported in a few of these studies and shows a relationship between higher age and a lower efficacy of the device [8, 9]. The influence of age was weak, however, when controlled for other predictors, such as mild sleep apnea, supine-dependent sleep apneas, female gender, weight increase, mandibular advancement, or the presence of larger mandibular tori [9, 10]. Increasing general health concerns and often impaired oral health with age makes the oldest age group of particular interest for further analysis. No study has stratified their data with respect to age. We here present sub-analyses from two of our previous studies including comparisons between the elderly patients and the younger ones [9, 11].
M. Marklund (*) Department of Orthodontics, Umeå University, 901 87 Umeå, Sweden e-mail: [email protected]
K. A. Franklin Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden e-mail: [email protected]
In the first study of 630 patients evaluating the efficacy of MADs and predictors of success, 56 patients were over 65 years of age (Fig. 1) . Forty-five of these 56 patients (80 %) continued treatment at a 1-year follow-up. This was
≤ 65 yrs N=574 (107 women)
> 65 yrs N=56 (15 women)
70 60 AHI
Continued N=426 (74%) Died=2 Moved=8 DisconƟnued=138
Re -evaluated with MAD N=243
Continued N=45 (80%) Died=0 Moved=1 DisconƟnued=10
Re -evaluated with MAD N=34
20 10 0
AHI with MAD
Fig. 2 Baseline AHI and AHI with MAD in patients >65 years of age 
over jet, decreased 1.0 mm in the older group and 0.7 mm in the younger group (p=0.24) during the first 5 years of MAD treatment. This is comparable to what has been found in other studies .
Fig. 1 Flow chart of included patients 
Limitations similar to the younger patients, where 426 patients out of 574 (74 %) continued treatment. Two hundred and forty-three younger patients and 34 older patients were re-evaluated with the device in situ. MAD reduced AHI to a similar degree in the older and younger age groups (p