MADs have potential advantages over CPAP (the current first-line therapy for OSA). They are less obtrusive and more portable; they make no noise, are not reliant on a power source and are often more acceptable to patients and families. However, they are not effective for every patient.
Patient acceptance of MADs is generally high. However, physiological, structural and individual patient characteristics influence response to MAD therapy. Factors associated with better treatment outcomes include:
- lower OSA severity (i.e. mild to moderate)
- female gender
- younger age
- OSA that is less pronounced when the patient sleeps on their side
- a face shape with a slightly receding jaw (retrognathic mandible).
Factors associated with poorer efficacy of MADs include:
- older age
- obesity and greater neck circumference
- increased nasal resistance
- a very stiff jaw (which impedes advancement)
- dental conditions (e.g. TMJ disease, periodontal disease, insufficient dentition to hold the device in the mouth).
Assessment for suitability may require assessment by a sleep specialist (and include a sleep study) or a dentist.