Treatment Emergent Central Sleep Apnea Evaluation in Patients Treated with Mandibular Advancement Device

The aim of the present cohort study was to evaluate the possible occurrence of central sleep apnea (CSA) in patients with obstructive sleep apnea (OSA) after treatment with a mandibular advancement device (MAD). In this case, 56 patients with OSA treated with MAD were enrolled. Inclusion criteria were age over 20 years, body mass index (BMI) less than 34 kg/m2, diagnosis of OSA confirmed by polysomnography (PSG), and MAD therapy for OSA. Exclusion criteria were smoking, medications for neurological disorders or a history of cervical head injury, and comorbidities (arrhythmias, congenital heart disease, stroke, heart failure or lung disease). Apnea-Hypopnea Index (AHI), Oxygen Desaturation Index (ODI), Obstructive Sleep Apnea (OSA), Central Sleep Apnea (CSA) and Mixed Apnea were extracted from the PSGs before (T0) and after three months of treatment (T1). Paired-sample t-tests and the Wilcoxon Signature Rank test were performed to evaluate differences in PSG indices at T1 and T0. OSA, CSA, AHI, ODI showed a noticeable reduction after MAD therapy, but a limited number of patients showed a dramatic increase in TCSA. The presence of TECSA in the course of MAD treatment is a condition that should be taken into consideration when needing to treat an OSA patient.