Screening and Treatment of Snoring in Function of MAD-Therapy

by De Meyer Miche

Snoring is a common sleep-related acoustical nuisance, at the most for the bedpartner or co-sleeper(s) within the dyad of the snorer-patient. According to the 2005 National Sleep Foundation poll, 61% of adults sleep with a significant other. For the snorer, it is a precursor for sleep-related disorder breathing with a range of harmful sequelae. For both bed attendees, there is a notice of acoustical, psychoacoustical, and physical consequences. The medical implications of snoring are depending on the severity of the anatomical obstruction within the snorer-patient and the trespassing of the WHO noise threshold of 30-45 dB indoors, the noise sensitivity, and the health condition of the listener. Along the International Classification of Sleep Disorders in 2014 the severity of the medical condition in relation to snoring is currently expressed and classified by its (obstructive) Apnea/Hypopnea index and measured during polysomnography. The snoring phenomenon is considered as being ‘pandemic’ within a global adult population, namely ‘non-specified’ snoring with 4 billion at the age 20-65 y (Deary et al) and about 1 billion for ‘apneïc’ snoring in the age group 30-69 y (Peppard et al) as a principal hallmark for Obstructive Sleep Apnea Syndrome (OSAS) with an AHI ≥ 5 (American Academy of Sleep Medicine (AASM), 2014). Sanna in 2017 stipulated that ‘snoring’ is still 80% un- or under-diagnosed, due to different factors such as a lack of consensus on - a universally accepted definition (De Meyer et al, 2019) - screening modalities with high sensitivity and specificity (Pevernagie,2010) - the important impact on the health of both bed attendees within the dyad The role of screening snoring by ‘well-trained’ dentists’ must become a priority by the professional associations involved in (dental) sleep medicine all over the world. The AASM and American Academy of Dental Sleep Medicine (AADSM in the update of their guidelines of 2015, stressed the role of the dentist-specialist in the therapy of Primary and snoring with mild to moderate OSA and OSAS patients not compliant with Continuous Positive Airway Pressure (CPAP) therapy. Moreover, in 2021, De Meyer et al. published a systematic review on the use of Mandibular Advancement Devices (MAD) for the treatment of snoring with or without Obstructive Sleep Apnea (OSA).

Learning Objectives

After this lecture, you will be able to focus on the snoring problem of adults in the daily clinical practice by screening and therapy.
After this lecture, you will be able to choose an evidenced based screening tool for snoring
After this lecture, you will be able to understand the mechanism of titration and design of Mandibular Advancement Devices for optimizing therapy outcomes for snoring without and with apnea