I have mild obstructive sleep apnea (apnea‑hypopnea index 5–15) and recent nasal surgery; based on my oxygen desaturation index and nadir SpO₂, are there any concerns about switching from continuous positive airway pressure (CPAP) to a mandibular advancement device, and should I obtain an off‑CPAP polysomnography to establish a current baseline?

Mandibular Advancement Device for Mild OSA After Nasal Surgery

You are an appropriate candidate for a mandibular advancement device (MAD) as an alternative to CPAP for your mild OSA, and yes, you should obtain an off-CPAP polysomnography to establish a current baseline before transitioning, especially given your recent nasal surgery has altered your airway anatomy. 1

Oxygen Desaturation Concerns

Without seeing your specific oxygen desaturation data, I cannot definitively assess your desaturation severity. However, the following framework applies:

• MADs improve nocturnal oxygenation parameters, including oxygen desaturation index (ODI) and minimal oxygen saturation in patients with mild to moderate OSA 1
• If your nadir SpO₂ is above 80-85% and your ODI is proportional to your mild AHI (5-15), there are no specific contraindications to MAD therapy from an oxygenation standpoint 1
• Severe oxygen desaturation (nadir SpO₂ <80% or ODI significantly elevated relative to AHI) would favor CPAP over MAD, as CPAP more effectively normalizes oxygen parameters 1

Candidacy for MAD Therapy

You meet the primary criteria for MAD as a CPAP alternative:

• Mild OSA (AHI 5-15) represents the ideal indication for MAD therapy according to multiple international guidelines 1
• MADs are specifically recommended as accepted alternative therapy for patients with mild to moderate OSA without significant comorbidities 1
• Younger age, lower BMI, smaller neck circumference, and female gender predict better MAD outcomes, though success can occur across patient types 1
• Low baseline AHI (which you have) is a predictor of MAD treatment success 1

The Critical Importance of Post-Surgical Baseline Testing

You absolutely should obtain an off-CPAP sleep study before transitioning to MAD:

• Your nasal surgery has fundamentally changed your upper airway anatomy, and your current OSA severity may differ significantly from your original diagnosis 1
• Nasal patency evaluation should be performed to reduce the risk of MAD non-response, and your post-surgical anatomy needs reassessment 1
• A baseline sleep study equal to your initial diagnostic study is mandatory to allow comparison and proper MAD titration 1
• This study should be performed off CPAP to establish your true current disease severity and oxygen parameters 1

MAD Treatment Protocol

Once you obtain your updated baseline study, the following protocol applies:

• You must work with a qualified dentist with appropriate training in dental sleep medicine to fabricate a custom-made, titratable MAD 1
• The device must be individualized, made of biocompatible materials, engage both maxillary and mandibular arches, and allow mandibular advancement in increments of 1 mm or less with at least 5 mm protrusive range 1
• After final MAD adjustments, you require a follow-up sleep study with the appliance in place to confirm therapeutic efficacy 1
• Treatment success is defined as resolution of clinical symptoms, normalization of AHI, and normalization of oxygen saturation 1

Comparative Effectiveness: CPAP vs MAD

Understanding the trade-offs is essential:

• CPAP more effectively reduces AHI, arousal index, and oxygen desaturation index, and increases minimum oxygen saturation compared to MADs 1
• However, CPAP and MAD demonstrate comparable effects on symptoms and health-related quality of life measures, including daytime sleepiness, general physical and mental health, and driving performance 1
• MAD adherence is superior to CPAP adherence in patients with OSA 1
• For mild OSA specifically, the superior adherence with MAD may offset CPAP's greater physiologic efficacy, making MAD a reasonable choice 1

Follow-Up Requirements

MAD therapy requires structured long-term monitoring:

• Coordinated cooperation between your dental sleep specialist and sleep physician is mandatory for MAD initiation and long-term follow-up 1
• Follow-up every 6 months for the first year, then at least annually thereafter 1
• Monitor for dental side effects including occlusal changes, temporomandibular joint symptoms, and tooth movement 1
• If treatment becomes sub-therapeutic (symptoms return, weight gain occurs), repeat sleep testing is required to reassess and potentially adjust or change therapy 1

Common Pitfalls to Avoid

• Do not proceed with MAD fabrication without obtaining your post-surgical baseline sleep study – your OSA severity may have changed significantly 1
• Do not accept a non-titratable or over-the-counter oral appliance – only custom-made, titratable devices from qualified dentists are recommended 1
• Do not skip the post-MAD-fitting sleep study – you must document therapeutic efficacy objectively 1
• Do not assume MAD success without objective verification – subjective symptom improvement alone is insufficient 1