Mandibular advancement appliances (MAD) have long been used to treat OSA. Most of the international sleep medicine societies recommend MAD in mild and moderate OSA. Most studies with MAD exclude patients with severe OSA and include patients who failed other treatment modalities with significant source of bias .Cephalometric and BMI factors are often not factored while prescribing MAD. So we undertook a pilot study to evaluate the therapeutic efficacy of Thornton adjustable positioner (TAP), a

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... tratable MAD in severe adult OSA cases. We have observed significant (p< .0001) improvement in Apnea-Hypopnea index and Epworth sleepiness scale. We concluded that factoring predictable cephalometric measurements, BMId< < < < <30 Kg/m2, and mandibular protrusion of 70%; severe OSA can be effectively managed with TAP.