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Belanche Monterde A, Zubizarreta-Macho Á, Lobo Galindo AB, Albaladejo Martínez A, Montiel-Company JM. Mandibular advancement devices decrease systolic pressure during the day and night in patients with obstructive sleep apnea: A systematic review and meta-analysis. Sleep Breath 2024:10.1007/s11325-023-02984-0. [PMID: 38180683 DOI: 10.1007/s11325-023-02984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/25/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients with obstructive sleep apnea (OSA) in relation to use time and if the device is used at night or day. MATERIALS AND METHOD A systematic review of the literature and meta-analysis was carried out in accordance with PRISMA guidelines. In the bibliographic search, a total of four databases were consulted: PubMed-Medline, Scopus, Web of Science, and Cochrane. Of the 622 articles initially revealed, 160 duplicates were eliminated. After applying the selection criteria, 17 articles were included for the qualitative analysis and 4 for the meta-analysis. The studies were combined using a random effects model with the inverse method of variance, determining the mean differences in systolic and diastolic pressure before and after treatment using the MAD splint as the effect size. Day/night circadian effect and treatment time were analyzed using meta-regression with a mixed-effects model. RESULTS MAD treatment was not found to affect diastolic pressure. By combining the four studies with the control group in a meta-analysis (I2 = 75%; z = - 0.15; p-value = 0.882), the mean difference in diastolic pressure between the MAD group and the control group was estimated at - 0.06 (- 0.86; 0.74). The meta-regression also showed no significant effect of day/night (p = 0.560) or treatment time (p = 0.854) on diastolic pressure. When combining the four studies with the control group (I2 = 84%%; z = - 1.47; p-value = 0.142), a non-significant mean difference in systolic pressure between the MAD group and the control group of - 0.99 (- 2.31; 0.33) was estimated in the meta-analysis. However, when assessing the effect of day/night or treatment time on systolic blood pressure using a meta-regression, the latter showed significant covariates that reduce systolic blood pressure values in the model at night (p < 0.001) and in relation to treatment time (p < 0.001). CONCLUSIONS Only systolic pressure appears to be affected by the use of the MAD in patients with OSA, and this decrease in systolic pressure is greater at night and when treatment time is longer.
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Affiliation(s)
- Alba Belanche Monterde
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain.
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691, Madrid, Spain.
| | - Ana Belén Lobo Galindo
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain
| | | | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010, Valencia, Spain
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Bhosale TB, Shetty V. Salivary Biomarker Levels in Children with Sleep Problems Before and After Twin Block Therapy. Indian J Dent Res 2023; 34:391-395. [PMID: 38739818 DOI: 10.4103/ijdr.ijdr_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 09/22/2023] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Disturbances in sleep have a wide-ranging effect on a child's life profoundly impacting the standard of living. The aim of this study was to investigate levels of Salivary Tumor Necrosis Factor-Alpha (TNF-α) and Malondialdehyde (MDA) in a group of children with class II malocclusion and sleep problems before and after twin block appliance therapy. MATERIALS AND METHODS Eleven children aged 8-12 years with skeletal class II malocclusion and at least one sleep disorder participated in the study. All children were subjected to a recording of their sleep history and a clinical and radiographic examination. Pre-treatment levels of salivary TNF-α and MDA were recorded. A twin block appliance was custom made and delivered to every child. After a minimum follow-up period of 9 months, all children were recalled for a re-evaluation of salivary biomarker levels. RESULTS Levels of salivary biomarkers TNF-α and MDA significantly decreased in children following myofunctional therapy using a twin block appliance. CONCLUSION The measurement of TNF-α and MDA could be used as an alternative and noninvasive method to evaluate prognosis of twin block therapy for children with sleep-disordered breathing (SDB).
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Affiliation(s)
- Trupti Balasaheb Bhosale
- Department of Pediatric and Preventive Dentistry, Nitte (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Bhosale TB, Shetty V, Bhandary M, Nayak PP. Salivary biomarker C-reactive protein levels in children with sleep problems and Class II malocclusion before and after twin-block therapy. J Indian Soc Pedod Prev Dent 2023; 41:190-196. [PMID: 37861632 DOI: 10.4103/jisppd.jisppd_338_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023] Open
Abstract
Context Disturbances in sleep affects the overall quality of a child's life, with several short- and long-lasting consequences. Hence, early diagnosis and monitoring is crucial in the management of sleep disorders in children. Aims The aim of this study was to evaluate salivary C-reactive protein (CRP) levels in a group of children with Class II malocclusion and sleep problems before and after twin-block appliance therapy. Settings and Design The study was a prospective clinical study with a 9-month follow-up period. Subjects and Methods Eleven children aged 8-12 years with skeletal Class II malocclusion and at least one sleep disorder were enrolled in the study. All children were subjected to a recording of their sleep history and a clinical as well as radiographic examination. Pretreatment levels of salivary CRP were recorded. A twin-block appliance was custom made and delivered to every child. At the end of 9-month follow-up, all children were recalled for a re-evaluation of salivary biomarker levels. Statistical Analysis Pretreatment and posttreatment changes in biomarker levels were assessed statistically using the students paired t-test. Results Levels of salivary biomarker CRP were significantly decreased in children following myofunctional therapy using a twin-block appliance (P < 0.001). There was a considerable improvement in the clinical symptoms such as a decrease in snoring and noisy breathing in most children post-twin-block therapy. Conclusion The measurement of salivary biomarker CRP could be used as an alternative and noninvasive method to evaluate prognosis of oral myofunctional therapy for children with sleep disordered breathing.
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Affiliation(s)
- Trupti B Bhosale
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Vabitha Shetty
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Meghna Bhandary
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
| | - Prajna P Nayak
- Department of Pediatric and Preventive Dentistry, NITTE (Deemed to be University), AB Shetty Memorial Institute of Dental Sciences, Mangalore, Karnataka, India
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Kim HY, Jo JH, Chung JW, Park JW. The multisystemic effects of oral appliance therapy for obstructive sleep apnea: A narrative review. Medicine (Baltimore) 2022; 101:e29400. [PMID: 35866792 PMCID: PMC9302291 DOI: 10.1097/md.0000000000029400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a chronic condition accompanied by repeated obstruction of the upper airway during sleep despite respiratory efforts, resulting in intermittent hypoxemia, altered sleep structure, and sympathetic activation. Previous studies have shown a significant association between OSA and general health issues such as cardiovascular diseases, endocrine disorders, neurocognitive function decline, and poor quality of life. Continuous positive airway pressure (CPAP) has been considered as the first line treatment for OSA. However, accumulating evidence supports the role of oral appliance (OA) therapy, including mandibular advancement devices, as an alternative option for snoring and OSA patients who do not comply with or refuse CPAP usage. Despite a generally favorable outcome of OA therapy for OSA related respiratory indices, studies focusing on the impact of systemic effects of OA therapy in OSA patients are relatively scarce compared with the extensive literature focusing on the systemic effects of CPAP. Therefore, this article aimed to provide an overview of the current evidence regarding the multisystemic effects of OA therapy for OSA.
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Affiliation(s)
- Hee Young Kim
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jung Hwan Jo
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Jin Woo Chung
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Ji Woon Park
- Department of Oral Medicine, Seoul National University Dental Hospital, Seoul, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, School of Dentistry, Seoul National University, Seoul, Republic of Korea
- Dental Research Institute, Seoul National University, Seoul, Republic of Korea
- *Correspondence: Ji Woon Park, Orofacial Pain Clinic, Department of Oral Medicine and Oral Diagnosis, School of Dentistry and Dental Research Institute, Seoul National University, 101 Yunkeun-Dong, Chongro-Ku, Seoul 03080, Republic of Korea (e-mail: )
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Gambino F, Zammuto MM, Virzì A, Conti G, Bonsignore MR. Treatment options in obstructive sleep apnea. Intern Emerg Med 2022; 17:971-978. [PMID: 35460431 PMCID: PMC9135849 DOI: 10.1007/s11739-022-02983-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
Treatment of OSA with CPAP is currently the recommended treatment and has the greatest evidence of efficacy on AHI, symptoms and comorbidities. Symptomatic patients with moderate-severe OSA generally have good adherence to CPAP therapy, while those with mild OSA, female, young and generally paucisymptomatic, have lower CPAP adherence, especially in the medium and long term. The recent identification of different clinical and pathophysiological phenotypes of OSA has paved the way for alternative treatments to CPAP, leading to an increasingly personalized therapy. Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients. Mandibular advancement devices (MAD), positional therapy (PT) and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies on which there is promising and encouraging data but with still little strong scientific evidence. The purpose of this review is to compare the efficacy, adherence and costs of various therapeutic options for OSA patients in the light of recent evidence and to provide useful guidance for specialists.
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Affiliation(s)
- Francesco Gambino
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Marta Maria Zammuto
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Alessandro Virzì
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Giosafat Conti
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Maria Rosaria Bonsignore
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy.
- PROMISE Department, University of Palermo, Palermo, Italy.
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Belkhode V, Godbole S, Nimonkar S, Nimonkar P, Pisulkar S. Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-protocol for a randomized controlled trial. Trials 2022; 23:159. [PMID: 35172870 PMCID: PMC8848661 DOI: 10.1186/s13063-022-06070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option, i.e., mandibular advancement device (MAD), which is an oral appliance (OA), are the most preferred ones. This study aims to evaluate the efficacy of customized maxillary oral appliances with mandibular advancement devices in moderate OSA patients. Methods A prospective interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) > 15–30, recorded on polysomnography (PSG). Study participants will be randomly divided into the following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of the appliance, all the parameters, i.e., AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be re-evaluated and compared with the baseline measurements. Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p< 0.05. Discussion We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a “gold standard” for managing moderate OSA. Trial registration CTRI/2020/07/026936 Registered 31 July 2020.
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Affiliation(s)
- Vikram Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India.
| | - Pranali Nimonkar
- Trauma Care Centre, Government Medical College, Nagpur, Maharashtra, India
| | - Sweta Pisulkar
- Department of Prosthodontics, Sharad Pawar Dental College & Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University) Sawangi (Meghe), Wardha, Maharashtra, India
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Hedberg P, Nohlert E, Tegelberg Å. Effects of oral appliance treatment on inflammatory biomarkers in obstructive sleep apnea: A randomised controlled trial. J Sleep Res 2020; 30:e13253. [PMID: 33300239 PMCID: PMC8365722 DOI: 10.1111/jsr.13253] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/04/2020] [Accepted: 11/17/2020] [Indexed: 12/24/2022]
Abstract
Obstructive sleep apnea (OSA) may lead to increased circulating concentrations of inflammatory biomarkers and treatment may change these. We aimed to assess the effect of oral appliance (OA) therapy on inflammatory biomarkers in a randomised controlled pilot trial. A total of 71 patients with OSA and systemic hypertension were randomly allocated to an active, mandible protruded (OAa) or a passive, mandible non‐protruded device (OAp) treatment. Serum concentrations of the inflammatory biomarkers white blood cells, high‐sensitivity C‐reactive protein, interleukin 6, interleukin 10, and tumour necrosis factor‐α were measured at baseline and after 3 months of OA treatment. The differences between treatment groups in biomarker concentration change during the treatment were presented as the Vargha and Delaney effect size and evaluated with the Wilcoxon–Mann–Whitney test. This effect size expresses the probability of a higher value in a random participant from one group compared with a random patient from the other group, and a value of 0.5 means stochastically equal groups. After 3 months of treatment, there was a significant reduction of the apnea–hypopnea index in the OAa group compared with the OAp group (effect size 0.258, 95% confidence interval 0.146–0.386, p < .001). There were no significant differences between the groups in any of the inflammatory markers’ concentration changes during the treatment period (effect sizes between 0.488 and 0.524; all p values ≥.737). Thus, OA treatment for 3 months did not affect circulating concentrations of some common inflammatory markers in patients with OSA and systemic hypertension.
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Affiliation(s)
- Pär Hedberg
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden.,Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Eva Nohlert
- Centre for Clinical Research, Uppsala University, Västerås, Sweden
| | - Åke Tegelberg
- Centre for Clinical Research, Uppsala University, Västerås, Sweden.,Department of Orofacial pain and jaw function, Faculty of Odontology, Malmö University, Malmö, Sweden
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