Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunc-tion and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.

Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyn-geal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.

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: Twentyfive 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 ten patients. Dental complications were observed in two patients. Sixtyfour per cent of the patients were still using the MAD at the 1-year follow-up. Conclusion: 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.