Impact of a Mandibular Advancement Device on Sleep Stages and Micro-Awakenings: A Case Series Study
DOI:
https://doi.org/10.56294/saludcyt20251492Keywords:
Snoring, Sleep Apnea Obstructive, Mandibular Advancement Splints, Sleep StagesAbstract
Introduction: Snoring and obstructive sleep apnea (OSA) are prevalent sleep-related breathing disorders with significant social and medical implications. Mandibular advancement devices (MADs) are a recognized treatment option for managing snoring and mild to moderate OSA; however, their impact on sleep architecture requires further investigation. Objective: This study aimed to evaluate the effects of MAD placement on total sleep duration, sleep stage distribution, and micro-awakenings. Methods: A total of 12 participants (66.67% male, 33.33% female) underwent polysomnography before and 60 days after MAD placement. Sleep duration in different stages and the frequency of micro-awakenings were analyzed. Descriptive and inferential statistical analyses were conducted using t stutends. Results: After MAD placement, total sleep duration increased, along with prolonged stage 2 and 3 NREM sleep (p > 0.05). However, the number of micro-awakenings, particularly those associated with respiratory events and snoring, also increased significantly (p < 0.05). Conclusion: The MAD contributed to an increase in total sleep duration and deeper sleep stages, which may indicate a beneficial effect on sleep architecture.
References
1. Janszky I, Ljung R, Rohani M, Hallqvist J. Heavy snoring is a risk factor for case fatality and poor short-term prognosis after a first acute myocardial infarction. Sleep. 2008;31(6):801-7. DOI: 10.1093/sleep/31.6.801.
2. Gelardi M, Porro G, Sterlicchio B, Quaranta N, Ciprandi G, Group On Sonoring IS. Internal and external nasal dilatator in patients who snore: a comparison in clinical practice. Acta Biomed. 2019;90(2-S):10–4. DOI: 10.23750/abm.v90i2-S.8096
3. Lyons MM, Bhatt NY, Pack AI, Magalang UJ. Global burden of sleep-disordered breathing and its implications. Respirology. 2020;25(7):690-702. DOI: 10.1111/resp.13838.
4. Ma Y, Liang L, Zheng F, Shi L, Zhong B, Xie W. Association Between Sleep Duration and Cognitive Decline. JAMA Netw Open. 2020;3(9):e2013573. DOI: 10.1001/jamanetworkopen.2020.13573.
5. Ruiz AJ, Sepúlveda MA, Martínez PH, Muñoz MC, Mendoza LO, Centanaro OP, Carrasco LF, García JC. Prevalence of sleep complaints in Colombia at different altitudes. Sleep Sci. 2016;9(2):100-5. DOI: 10.1016/j.slsci.2016.05.008.
6. Cowie MR, Linz D, Redline S, Somers VK, Simonds AK. Sleep Disordered Breathing and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol. 2021;78(6):608-624. DOI: 10.1016/j.jacc.2021.05.048.
7. Janott C, Schuller B, Heiser C Acoustic information in snoring noises. HNO. 2017;65(2):107-116. German. DOI: 10.1007/s00106-016-0331-7.
8. Huang Z, Aarab G, Ravesloot MJL, de Vries N, Hilgevoord AAJ, Lobbezoo F. The Annoying Nature of Snoring Sounds Is Not Only about Intensity: A Pilot Study on Exposed Test Subjects. J Clin Med. 2023;12(7):2630. DOI: 10.3390/jcm12072630.
9. Ren D, Jiang B, Guo Z. Insomnia disorder with objective short sleep duration (ISS) phenotype and cognitive performance: a systematic review and meta-analysis. Neurol Sci. 2023;44(7):2363-2368. DOI: 10.1007/s10072-023-06692-1. E
10. Cuschieri S. The STROBE guidelines. Saudi J Anaesth. 2019 Apr;13(S1):S31-S34. DOI: 10.4103/sja.SJA_543_18.
11. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4. DOI: 10.1001/jama.2013.281053.
12. Lee JJ, Sundar KM. Evaluation and Management of Adults with Obstructive Sleep Apnea Syndrome. Lung. 2021;199(2):87-101. DOI: 10.1007/s00408-021-00426-w.
13. Chen A, Burger MS, Rietdijk-Smulders MAWJ, Smeenk FWJM. Mandibular advancement device: Effectiveness and dental side effects. A real-life study. Cranio. 2022;40(2):97-106. DOI: 10.1080/08869634.2019.1708610
14. Langaliya A, Alam MK, Hegde U, Panakaje MS, Cervino G, Minervini G. Occurrence of Temporomandibular Disorders among patients undergoing treatment for Obstructive Sleep Apnoea Syndrome (OSAS) using Mandibular Advancement Device (MAD): A Systematic Review conducted according to PRISMA guidelines and the Cochrane handbook for systematic reviews of interventions. J Oral Rehabil. 2023;50(12):1554-1563. DOI: 10.1111/joor.13574.
15. Uniken Venema JAM, Rosenmöller BRAM, de Vries N, de Lange J, Aarab G, Lobbezoo F, Hoekema A. Mandibular advancement device design: A systematic review on outcomes in obstructive sleep apnea treatment. Sleep Med Rev. 2021;60:101557. DOI: 10.1016/j.smrv.2021.101557.
16. Gjerde K, Lehmann S, Bjorvatn B, Berge M, Thuen F, Berge T, Johansson A. Partner perceptions are associated with objective sensor-measured adherence to oral appliance therapy in obstructive sleep apnea. J Sleep Res. 2022;31(2):e13462. DOI: 10.1111/jsr.13462.
17. López Soto OP, Castellanos Ruíz J, López Soto LM, López Echeverry YP, Quintero Marín YT, Cardona Londoño JW, et al. Evaluación interdisciplinaria del sistema estomatognático y de la postura en un sujeto diagnosticado con bruxismo del sueño: reporte de caso. Salud UIS. 2020; 52(2): 153-159. DOI: 10.18273/revsal.v52n2-2020009
18. Park JW, Mehta S, Fastlicht S, Lowe AA, Almeida FR. Changes in headache characteristics with oral appliance treatment for obstructive sleep apnea. Sci Rep. 2021;11(1):2568. DOI: 10.1038/s41598-021-82041-6.
19. Camañes-Gonzalvo S, Marco-Pitarch R, García-Selva M, Bellot-Arcís C, Paredes-Gallardo V, Falardo S, Feliciano A, Montiel-Company JM. Polysomnographic phenotypes: predictors of treatment response in Obstructive Sleep Apnea with Mandibular Advancement devices. Eur Arch Otorhinolaryngol. 2025;282(1):435-449. DOI: 10.1007/s00405-024-08952-y.
20. Meira E Cruz M, Soca R. Sexsomnia and REM- predominant obstructive sleep apnea effectively treated with a mandibular advancement device. Sleep Sci. 2016;9(3):140-141. DOI: 10.1016/j.slsci.2016.11.002.
21. Serdar CC, Cihan M, Yücel D, Serdar MA. Sample size, power and effect size revisited: simplified and practical approaches in pre-clinical, clinical and laboratory studies. Biochem Med (Zagreb). 2021;31(1):010502. DOI: 10.11613/BM.2021.010502.
22. Shieh G. Effect size, statistical power, and sample size for assessing interactions between categorical and continuous variables. Br J Math Stat Psychol. 2019;72(1):136-154. DOI: 10.1111/bmsp.12147
23. Xing H, Song Y, Wu X, Chang Y, Shang Y, Yu L, Dai H. Diurnal variation of cerebral blood flow in healthy humans under normal entrained conditions. J Sleep Res. 2024;33(6):e14190. DOI: 10.1111/jsr.14190.
24. Antza C, Kostopoulos G, Mostafa S, Nirantharakumar K, Tahrani A. The links between sleep duration, obesity and type 2 diabetes mellitus. J Endocrinol. 2021;252(2):125-141. DOI: 10.1530/JOE-21-0155.
25. St-Onge MP, Cherta-Murillo A, Darimont C, Mantantzis K, Martin FP, Owen L. The interrelationship between sleep, diet, and glucose metabolism. Sleep Med Rev. 2023;69:101788. DOI: 10.1016/j.smrv.2023.101788.
26. Martins FO, Conde SV. Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases. Front Physiol. 2021;12:792633. DOI: 10.3389/fphys.2021.792633.
27. Kontou TG, Roach GD, Sargent C. Mild to Moderate Sleep Restriction Does Not Affect the Cortisol Awakening Response in Healthy Adult Males. Clocks Sleep. 2022;4(4):722-734. DOI: 10.3390/clockssleep4040054
28. Guyon A, Balbo M, Morselli LL, Tasali E, Leproult R, L'Hermite-Balériaux M, Van Cauter E, Spiegel K. Adverse effects of two nights of sleep restriction on the hypothalamic-pituitary-adrenal axis in healthy men. J Clin Endocrinol Metab. 2014;99(8):2861-8. DOI: 10.1210/jc.2013-4254.
29. Liu D, Dan Y. A Motor Theory of Sleep-Wake Control: Arousal-Action Circuit. Annu Rev Neurosci. 2019;42:27-46. DOI: 10.1146/annurev-neuro-080317-061813.
30. Lai H, Huang W, Chen W, Wang D. Effectiveness of Continuous Positive Airway Pressure Versus Mandibular Advancement Device in Severe Obstructive Sleep Apnea Patients With Mandibular Retrognathia: A Prospective Clinical Trial. Ear Nose Throat J. 2022;101(9):606-615. DOI: 10.1177/0145561320969251.
31. Marco Pitarch R, Selva García M, Puertas Cuesta J, Marco Algarra J, Fernández Julian E, Fons Font A. Effectiveness of a mandibular advancement device in obstructive sleep apnea patients: a prospective clinical trial. Eur Arch Otorhinolaryngol. 2018;275(7):1903-1911. DOI: 10.1007/s00405-018-4978-4.
32. Zhiguo Z, Ruizhi T, Fan Z, Wenchao S, Maoning W. Biomechanical effects of a mandibular advancement device on the periodontal ligament: Based on different bone models. J Mech Behav Biomed Mater. 2023;144:105914. DOI: 10.1016/j.jmbbm.2023.105914.
33. Patel S, Rinchuse D, Zullo T, Wadhwa R. Long-term dental and skeletal effects of mandibular advancement devices in adults with obstructive sleep apnoea: A systematic review. Int Orthod. 2019;17(1):3-11. DOI: 10.1016/j.ortho.2019.01.004.
34. Bratton DJ, Gaisl T, Schlatzer C, Kohler M. Comparison of the effects of continuous positive airway pressure and mandibular advancement devices on sleepiness in patients with obstructive sleep apnoea: a network meta-analysis. Lancet Respir Med. 2015;3(11):869-78. DOI: 10.1016/S2213-2600(15)00416-6.
35. Trzepizur W, Cistulli PA, Glos M, Vielle B, Sutherland K, Wijkstra PJ, Hoekema A, Gagnadoux F. Health outcomes of continuous positive airway pressure versus mandibular advancement device for the treatment of severe obstructive sleep apnea: an individual participant data meta-analysis. Sleep. 2021;44(7): zsab015. DOI 10.1093/sleep/zsab015
36. Yu M, Ma Y, Han F, Gao X. Long-term efficacy of mandibular advancement devices in the treatment of adult obstructive sleep apnea: A systematic review and meta-analysis. PLoS One. 2023;18(11): e0292832. DOI: 10.1371/journal.pone.0292832.
37. Manetta IP, Ettlin D, Sanz PM, Rocha I, Meira E Cruz M. Mandibular advancement devices in obstructive sleep apnea: an updated review. Sleep Sci. 2022;15(S2):398-405. DOI: 10.5935/1984-0063.20210032.
38. Francis CE, Quinnell T. Mandibular Advancement Devices for OSA: An Alternative to CPAP? Pulm Ther. 2021;7(1):25-36. DOI: 10.1007/s41030-020-00137-2.
39. Institute for Quality and Efficiency in Health Care (IQWiG). Mandibular advancement device in mild to moderate obstructive sleep apnoea in adults: IQWiG Reports – Commission No. N18-03. Cologne (Germany): Institute for Quality and Efficiency in Health Care (IQWiG); 2020 Jun 10.
40. O'Toole S, Moazzez R, Wojewodka G, Zeki S, Jafari J, Hope K, Brand A, Hoare Z, Scott S, Doungsong K, Ezeofor V, Edwards RT, Drakatos P, Steier J. Single-centre, single-blinded, randomised, parallel group, feasibility study protocol investigating if mandibular advancement device treatment for obstructive sleep apnoea can reduce nocturnal gastro-oesophageal reflux (MAD-Reflux trial). BMJ Open. 2023 Aug 24;13(8):e076661. DOI: 10.1136/bmjopen-2023-076661.
41. Martinot JB, Le-Dong NN, Crespeigne E, Silkoff PE, Cuthbert V, Denison S, Borel JC, Pépin JL. Mandibular Movement Analysis to Assess Efficacy of Oral Appliance Therapy in OSA. Chest. 2018;154(6):1340-1347. DOI: 10.1016/j.chest.2018.08.1027.
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Copyright (c) 2025 Olga Patricia López-Soto , Juan Alberto Aristizábal-Hoyos , Héctor Fuentes-Barría , Héctor Fuentes-Barría , Cherie Flores-Fernández , Ángel Roco-Videla, Miguel Alarcón-Rivera (Author)

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