Titration Protocol

A period of acclimatization, over a period of weeks or months, is generally needed to initiate treatment. During this period incremental advancement of the mandible is performed according to clinical response and comfort, followed by medical reassessment to determine clinical response. This is currently a major limitation of the therapy, particularly in patients where rapid initiation of treatment is warranted. Furthermore, there is considerable interindividual variability in the degree of protrusion and time frame required to achieve a positive clinical outcome. The degree of protrusion required generally ranges between 50% and 90% of the maximum protrusion (12,35,63). The correlation between the amount of advancement and therapeutic effect is not strong. Hence, there is no basis for providing a fixed amount of advancement (e.g., 75% of maximal protrusion) to all patients, as has been proposed by some authors (64,65). The amount of advancement may be also limited by the degree of tolerance of the patient. Essentially no research has been undertaken to define the optimal procedures for this acclimatization period. It is unclear whether the advent of single-night titration procedures will enable a reduction in the duration of acclimatization required to attain an optimal result (66).

Sleep Apnea

Sleep Apnea

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