Mandibular advancement devices and treatment-emergent central sleep apnea (TECSA): Coincidental or critical finding?

Treatment-emergent central sleep apnea (TECSA) can occasionally be observed when obstructive sleep apnea (OSA) is managed with most therapeutic approaches, including the mandibular advancement device (MAD). Although TECSA appears to be a low-incidence condition, evidence is lacking on its mechanism and possible health risks. The primary objective of this critical review is to provide guidance to clinicians managing OSA with MAD. Prompt return to a sleep medicine specialist is recommended, however, when a patient continues to present complaints or reports potentially associated with central sleep apnea (CSA): sleepiness, difficulty initiating or maintaining sleep, frequent awakenings or nonrestorative sleep, awakening from sleep with shortened breath, or witnessed apneas.