To evaluate the efficacy (non-inferiority) in terms of response between patients using custom fitted mandibular advancement devices ONIRIS® and patient using laboratory custom made devices TALI, after 2 months of use. Sleeping tests were performed.

Open, non-inferiority, controlled and rndomised clinical trial. Six months of inclusion. Each included patient will be followed during 12 months.

Inclusion Criteria:

• patients with severe syndrome of obstructive sleep apnea and hypopneas refusing or withdrawal from continuous positive pression ventilation
• no dental, paro-dental or articular contraindication
• patients never treated by mandibular advancement devices

Exclusion Criteria:

• severe psychiatric or neuromuscular disorders appreciated by the investigator
• more than 20% of apneas and central hypoapneas
• severe syndrome of obstructive sleep apnea and hypopneas with IAH > 30% associated with another sleeping pathology
• BMI > 30kg/m2
• patient with an uncontrollable nausea reflex
• epileptic patients
• pregnant patients
• patient without written informed consent