Impact on symptomatic control and quality of life in patients with OSA and CPAP intolerance treated with mandibular advancement device after 5 years of follow-up.

<bold>Introduction</bold> Obstructive Sleep Apnea (OSA) represents a significant health issue. According to the international sleep consensus, the mandibular advancement device (MAD) is positioned as a therapeutic alternative. The aim of this study was to evaluate the symptomatic control and quality of life of a cohort of CPAP-intolerant patients treated with MAD for 5 years. <bold>Material and Methods</bold> A descriptive prospective study was conducted analyzing 62 patients with OSA undergoing MAD treatment (SomnoMed®) between 2018 and 2024. The Shapiro-Wilk test was used to determine the population type resulting in a non-parametric distribution. The Wilcoxon test was performed for quantitative variables analysis, and the Chi-square test for qualitative variables. <bold>Results</bold> Regarding patients’ baseline characteristics, 45 males (72.6%) had a mean age of 55 ± 11.6 years and an average BMI of 26.7 kg/m2 ± 4.9. The mean final advancement of the MAD was 6.01 ± 2.27mm (77% ± 20, relative to maximum protrusion). After 5 years, 26 patients (42%) continued MAD treatment. The initial mean AHI was 24/h (SD:15), decreasing significantly at 3 months, 3 years and 5 years (p<0.005). Reasons for MAD discontinuation among patients are in Figure 1. Daytime sleepiness (ESS) significantly decreased at 3 months, 3 years and 5 years (table 1) with all 3 QSQ domains showing improvement at 5 years. Compliance averaged 7.4 hours (SD 0.7). <bold>Conclusions</bold> MAD represents a therapeutic option in patients with OSA and CPAP intolerance, with good adherence at 5 years in patients persisting with MAD, as well as adequate symptomatic control and improvement in quality of life.