Abstract

Mandibular advancement devices (MAD) are an evidence-based alternative for adults with obstructive sleep apnea, but the amount of mandibular advancement associated with objective response is unstudied.

To evaluate the amount of mandibular advancement that leads to reduced AHI in patients with mild (n=41) and moderate (n=20) sleep disordered breathing (SDB).

The retrospective analytic sample of 61 adults with baseline apnea-hypopnea index between 5 and 30 events per hour we divided into mild and moderate SDB groups. Titrated mandibular advancement was performed until: 1) 50% baseline AHI and 2) AHI was below 10. Paired tests evaluated change in apnea-hypopnea index. Fisher's exact test compared success proportions. The Mann-Whitney U test compared observed advancement among successfully treated patients. Exploratory robust regression modeled follow-up apnea-hypopnea index.

Mean apnea-hypopnea index decreased from 12.83 to 4.07 events per hour, a mean reduction of 8.76 events per hour (p < .001). Fifty-one patients (83.6%) met the primary success definition. Success was 82.9% in mild OSA and 85.0% in moderate OSA (p = 1.000). Among successful patients, mean observed advancement was 2.38 mm in mild OSA and 2.53 mm in moderate OSA (mean difference = 0.15 mm, 95% CI [-0.80, 1.10]; p = .768).

AHI was substantially lower at follow-up and approximately 84% of patients met the prespecified success criterion. Observed advancement did not differ detectably by baseline severity. One efficacy-test observation per patient precluded identification of a minimum effective advancement or within-patient dose-response threshold. Notably, successful patients were observed at mean advancements of approximately 2.4–2.5 mm, substantially less than the approximately 4–6 mm commonly associated with 50% of maximum protrusion, suggesting that meaningful AHI reduction may be achievable with more conservative mandibular advancement in some patients.

LLU Discipline

Orthodontics and Dentofacial Orthopedics

Department

Orthodontics and Dentofacial Orthopedics

School

School of Dentistry

First Advisor

V. Leroy Leggitt

Second Advisor

Todd Ehrler

Third Advisor

Jim Farrage

Degree Name

Master of Science in Orthodontics and Dentofacial Orthopedics (MSODO)

Degree Level

M.S.

Year Degree Awarded

2026

Date (Title Page)

9-2026

Language

English

Library of Congress/MESH Subject Headings

Sleep apnea syndromes — Treatment; Mandibular advancement devices (Dental instruments); Orthodontics

Type

Thesis

Page Count

xi, 35 p.

Digital Format

PDF

Digital Publisher

Loma Linda University Libraries

Usage Rights

This title appears here courtesy of the author, who has granted Loma Linda University a limited, non-exclusive right to make this publication available to the public. The author retains all other copyrights.

Collection

Loma Linda University Electronic Theses and Dissertations

Collection Website

http://scholarsrepository.llu.edu/etd/

Repository

Loma Linda University. Del E. Webb Memorial Library. University Archives

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