Titration of Oral Appliance Therapy: a Prospective, Randomized Cross-over Trial.

In this prospective randomized cross-over trial, 3 different titration procedures will be compared: 1. titration of the mandibular advancement device (MAD) in the home setting based on both the physical limits of the patient's mandibular protrusion and the resolution of subjective complaints, as currently often used in routine clinical practice; 2. an overnight titration PSG using the remotely controlled mandibular positioner (RCMP) with stepwise mandibular protrusion until respiratory events are reduced and 3. incremental protrusion of the mandible during DISE using the RCMP until upper airway collapse at all collapsible levels is eliminated. The aim of this study is to prospectively compare the target protrusion, as well as the treatment outcome in terms of treatment efficacy, of the 3 different titration protocols.