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Invited Commentary
August 2015

Mandibular Advancement Therapy for Obstructive Sleep ApneaAnswers and (More) Questions

Author Affiliations
  • 1Clinic of Pneumology and Allergology Center for Sleep Medicine and Respiratory Care, Bethanien Hospital, Solingen, Germany
JAMA Intern Med. 2015;175(8):1285-1287. doi:10.1001/jamainternmed.2015.2059

Obstructive sleep apnea (OSA) is a major medical challenge: it affects 4% to 13% of the general population, impairs quality of life, and substantially increases the risk of motor vehicle accidents. Obstructive sleep apnea is associated with cardiovascular and metabolic consequences and increased mortality, particularly among the most severely affected patients. In severe OSA, the most effective treatment for respiratory dysfunction is continuous positive airway pressure (CPAP).1 However, many patients suffer from mild to moderate OSA, as indicated by the numbers of apneas and hypopneas per hour (mild, 5-15/hour; moderate, 15-30/hour; severe, >30/hour), often presenting to the primary care physician with disturbed sleep, daytime sleepiness, or impaired cognitive functions. The long-term effect of mild to moderate OSA is less clear. What is the most effective and most feasible treatment option for these patients? Because of the discomfort of CPAP, patients seek less burdensome and complex alternatives. However, there is a paucity of evidence to support the use of surgical, orthodontic, or more conservative approaches.2

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