In this prospective study of carefully selected non-obese subjects with moderate OSA (OAHI ≥ 15 and < 30 events/h) without concomitant overt cardiovascular–metabolic disease and without presence of other disorders (especially sleep disorders other than OSA, potentially interfering with their clinical presentation) a MAD ΔOAHI ≥ 50% was obtained in 73%, a MAD ΔOAHI ≥ 50% with OAHI < 10 in 70%, and a complete resolution of OSA (MAD OAHI < 5) in 40%. The patients also reported an overt amelioration in snoring severity and ESS (especially in the somnolent subjects at baseline), without correlation with the change in OAHI. Lower age, lower baseline OAHI, presence of non-
supine OSA, and absence of collapse on DISE with jaw thrust at velum level or at all VOTE levels were found to be statistically significant determinants of treatment success defined as reduction in OAHI, but the clinical relevance of these determinants could be questioned.
Different criteria could be used to evaluate efficacy of MAD. The most common used are (1) ≥ 50% reduction in AHI from baseline (treatment response), (2) treatment AHI < 10 events/h and > 50% reduction in AHI from baseline (treatment success), and (3) treatment success with OSA resolution AHI < 5). In the 2015 joined AASM/American Academy of Dental Sleep Medicine meta-analysis, treatment response was observed in 82%, but data on treatment success or OSA resolution were not evaluated.
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