Mandibular Advancement Device Therapy in 182 DISE-Selected Adults with Moderate-to-Severe Obstructive Sleep Apnea: A Multicenter Real-World Study

Background/Objectives: The study evaluates the effectiveness of mandibular advancement device (MAD) treatment in drug-induced sleep endoscopy (DISE) preselected adults with moderate-to-severe obstructive sleep apnea (OSA). Methods: It is a retrospective observational cohort study without a control arm/treatment, including 182 patients with an apnea–hypopnea index (AHI) ≥ 15 events/h of sleep (Level-1 polysomnography) from six Belgian hospitals. After DISE preselection, a custom-made MAD (EVO, ProSomnus, Pleasanton, CA, USA) was titrated to symptom relief or physiological limits. Level-3 home polygraphy with MAD was performed within five months. The primary outcome was change in AHI from baseline. Secondary outcomes included percentage change in AHI, change in OSA severity category, snoring loudness and Epworth Sleepiness Scale (ESS) scores. Analysis of covariance methods adjusting for baseline AHI were employed. Exploratory analyses compared outcome measures by OSA severity at baseline. ‘Success’ equaled AHI < 10 with ≥50% improvement. Results: Mean AHI significantly decreased from 24.4 to 7.1 (p < 0.0001) with a significant mean percent decrease by 68.6% (p < 0.0001), improving more (p < 0.0001) in severe cases. Mean change in snoring loudness improved significantly from a mean of 7.1 to 1.7 (p < 0.0001), improving more (p = 0.049) in moderate cases. Mean change from baseline in overall ESS score was −1.7 (p < 0.0001). Greater improvements were observed in participants with elevated baseline ESS scores. MAD significantly (p = 0.03) improved OSA category: moderate OSA cases improved by a mean of 1.4 levels, severe cases by a mean of 2.1 levels (p < 0.0001). A total of 75.8% of participants achieved ‘Success’. Conclusions: In this retrospective multicenter cohort, MAD therapy was associated with significant reductions in AHI, snoring loudness, and ESS scores among DISE-preselected adults with moderate-to-severe OSA. Because treatment outcomes were assessed using Level-3 home polygraphy, the findings should be interpreted as real-world effectiveness outcomes obtained within the Belgian clinical care pathway.