Use of a mandibular advancement device in patients with congestive heart failure and sleep apnoea.

OBJECTIVE: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year.

SUBJECTS: Twenty-five patients aged 66 +/- 8 years (mean +/- SD) met the inclusion criteria and were included in the study.

DESIGN: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months, and 1 year after intervention.

RESULTS: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 +/- 12.1 to 11.8 +/- 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by 10 patients. Dental complications were observed in two patients. Sixty-four per cent of the patients were still using the MAD at the 1-year follow-up.

CONCLUSIONS: Both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.