Management of Obstructive Sleep Apnea in an Edentulous Lower Jaw Patient with a Mandibular Advancement Device

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed. 1. Introduction Obstructive sleep apnea (OSA) is a common, chronic disorder of sleep and breathing that causes disability from pathologic sleepiness and respiratory and cardiovascular complications. The most common complaints are loud snoring and disrupted sleep. Of the many oral appliances designed for use in the treatment of OSA, mandibular advancement devices (MAD) have been the most intensely researched [1–5]. Although oral appliances can be used in a wide range of patients with OSA, they have several contraindications, one of which is the insufficient number of teeth in maxillary and mandibular arches. A tooth is considered particularly important in obtaining retention and stability of the mandibular advancement device. Edentulism itself in turn contributes to the worsening of OSA and reduces the number of available treatment options. However, a search of the literature reveals only a few reports describing the treatment of edentulous patients with OSA using MAD [2–5]. The purpose of this case presentation is to report the use and results of a modified MAD as complete denture in an edentulous lower jaw patient with OSA. 2. Case Report A 63-year-old woman was referred from the Council of the Sleep Related Breathing Disorders of Ataturk Chest Diseases and Chest Surgery Education and Research Hospital with a history and diagnosis of intrusive snoring and mild OSA. All participants underwent a full-night polysomnogram (PSG), using the compumedics voyager digital imaging 44-channel E-series system. Sleep stages as well as respiratory parameters were scored according to the standard criteria of American Academy of Sleep Medicine [6]. The patient was examined at the Department of Prosthodontics, Faculty