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Nakano H, Mishima K, Matsushita A, Suga H, Matsumura M, Mano T, Fukuda T, Hara H, Yamashita H, Ueyama Y. Efficacy of the Silensor for treating obstructive sleep apnea syndrome. Oral Maxillofac Surg 2012; 17:105-8. [PMID: 22570130 DOI: 10.1007/s10006-012-0332-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 04/21/2012] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although mandibular repositioning devices were found to be very effective for treating obstructive sleep apnea (OSAS), they can cause side effects such as temporomandibular joint disorder and occlusal deviation. A semi-rigid device with a low frequency of side effects, the Silensor, (Erkodent Gmbh, Tuttlingen, Germany) was reported previously. The purpose of this study is to determine whether the Silensor is effective for treating OSAS. MATERIALS AND METHODS Thirty-five OSAS patients (27 males and 8 females) who were treated with the Silensor were enrolled in this study. The mean age and body mass index of the patients were 52.2 years (23-72 years) and 24.5 kg/m(2) (19.3-31.6 kg/m(2)), respectively. The patients were classified into two groups based on the length of the apparatus connector: 0-2 or 3-4 mm. A polysomnography test was performed twice, at the first visit and after the improvement of subjective symptoms. These data were statistically analyzed using the Wilcoxon signed-rank test. RESULTS The apnea-hypopnea index significantly improved in all OSAS patients, the mild to moderate OSAS patients, severe OSAS patients, 0- to 2-mm group, and the 3- to 4-mm group (91.4 %; p < 0.01, 88.9 %; p < 0.01, 100 %; p < 0.05, 86.4 %; p < 0.01, 100 %; p < 0.01, respectively). The only side effects of the Silensor were broken apparatus and damage to the buccal mucosa. DISCUSSION The Silensor is useful for the treatment of OSAS. In particular, the Silensor is suitable for the first phase of OSAS treatment with oral appliances because the efficacy of the Silensor was equal to that of other oral appliances and had few side effects.
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Langzeiteffekte der Unterkieferprotrusionsschiene IST®. SOMNOLOGIE 2010. [DOI: 10.1007/s11818-010-0449-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance. We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%. The response rate, defined as at least 50% reduction in the initial apnea/hypopnea index (although it still remained above 10), is 21%. When only the results of randomized, crossover, placebo-controlled studies are considered, the success and response rates are 50% and 14%, respectively. Snoring was reduced by 45%. In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%. The majority of patients prefer using oral appliance than CPAP. Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients. A summary of the follow-up compliance data shows that at 30 months, 56–68% of patients continue to use oral appliance. Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort. Efficacy and side effects depend on the type of appliance, degree of protrusion, vertical opening, and other settings. We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.
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Affiliation(s)
- Victor Hoffstein
- Department of Medicine, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8.
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Loeb GE, Richmond FJR, Baker LL. The BION devices: injectable interfaces with peripheral nerves and muscles. Neurosurg Focus 2006; 20:E2. [PMID: 16711659 DOI: 10.3171/foc.2006.20.5.3] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
The purpose of this study was to describe a novel technology for implantable neuromuscular stimulation to treat complications of paralysis and disuse atrophy, including shoulder subluxation, hand contractures, drop foot, and osteoarthritis. The authors review the results so far of several pilot clinical studies of these muscle stimulation devices.
Methods
Miniature wireless stimulators received power and individually addressed command signals from an external radiofrequency transmission coil. One or more implants were injected through a 12-gauge hypodermic insertion tool into muscles or adjacent to motor nerves, where they provided the means to activate the muscles in any desired pattern of intensity and frequency. Randomized controlled studies in small numbers of patients are underway to identify efficacy, acceptability, best methods of practice, and any design changes that may be required to improve the technology.
Fifty patients have been enrolled in five studies; 35 patients have undergone implantation of a total of 79 BION1 devices. Comparisons with surface stimulation in patients who have suffered a stroke with shoulder subluxation and hand contractures show similar improvements in objective measures of efficacy but higher comfort levels for stimulation by implants.
Conclusions
Injected microstimulators represent a promising new class of technology for the rehabilitation of patients with upper motor neuropathies. As the technology evolves, practitioners may be able to use it to facilitate functional reanimation of paralyzed limbs.
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Affiliation(s)
- Gerald E Loeb
- Alfred Mann Institute for Biomedical Engineering and Department of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, California 90089-1112, USA.
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Ogutcen-Toller M, Sarac YS, Cakr-Ozkan N, Sarac D, Sakan B. Computerized tomographic evaluation of effects of mandibular anterior repositioning on the upper airway: a pilot study. J Prosthet Dent 2004; 92:184-9. [PMID: 15295329 DOI: 10.1016/j.prosdent.2004.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
STATEMENT OF PROBLEM Snoring is related to narrowing of the upper airway. Treatment options for snoring may have potential side effects or discomfort which may not be tolerated by some patients. Mandibular advancement devices may cause fewer negative side effects than other treatment modalities and have been advocated as a treatment for snoring. PURPOSE The aim of the pilot study was to evaluate effects of the anterior mandibular positioner (AMP) on upper airway structures in patients with a snoring problem. MATERIAL AND METHODS Fifteen subjects with snoring problems as identified by spouses or close relatives were selected to complete a questionnaire related to snoring, respiratory symptoms, body mass index (BMI), and smoking habits. Computerized tomography (CT) scans were obtained with and without AMP device fabricated as a monoblock of acrylic resin. Measurements of the oropharynx including length (mm), cross-sectional area (mm2), and plane angle (degrees) were made using anatomic landmarks on standardized CT images and lateral scanograms. The data were statistically evaluated using Wilcoxon signed rank test (alpha=.05). RESULTS When the AMP was inserted, the cross-sectional area of the oropharynx increased by 60 mm2 on average (P<.05). A mean increase of 2.4 mm (range 1-7 mm) was observed in the posterior airway space on lateral scanograms (P<.005). The range for mandibular advancement was between 4 and 8 mm (mean 5.73 mm). CONCLUSION The primary effect of the AMP was enlargement of the oropharyngeal airway. Within the limitations of this pilot study, the results suggest that CT evaluation of the upper airway structures may be helpful in determining treatment modality and monitoring the effectiveness of the positioner.
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Affiliation(s)
- Melahat Ogutcen-Toller
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey.
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Harada K, Higashinakagawa M, Omura K. Mandibular lengthening by distraction osteogenesis for treatment of obstructive sleep apnea syndrome: a case report. Cranio 2003; 21:61-7. [PMID: 12555933 DOI: 10.1080/08869634.2003.11746233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 31-year-old man who had been diagnosed with obstructive sleep apnea syndrome (OSAS) due to retrognathia was referred to our hospital. Before treatment, the angle of the sella-nasion-point B (SNB) was 67 degrees. The lowest oxygen saturation (SpO2) during sleep was 77%, the longest-running episode of sleep apnea was 128 seconds, and his apnea index (AI) was 29.9. He underwent bilateral horizontal mandibular distraction osteogenesis using intraoral distraction devices. After mandibular distraction, SNB increased to 72 degrees. The lowest SpO2 during sleep increased to 85%, the longest-running episode of sleep apnea decreased to 40 seconds, and his AI decreased to 4.1 (within normal range). No marked recurrence of OSAS was observed even at one year after mandibular distraction. This report suggests that mandibular lengthening by distraction osteogenesis is an effectual method for the treatment of OSAS due to retrognathia.
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Affiliation(s)
- Kiyoshi Harada
- Branch of Oral Surgery, Department of Oral Restitution, Division of Oral Health Sciences, Graduate School, Tokyo Medical and Dental University, Japan.
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Lowe AA. Principles of oral appliance therapy for the management of sleep disordered breathing. Oral Maxillofac Surg Clin North Am 2002; 14:305-17. [DOI: 10.1016/s1042-3699(02)00035-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Johal A, Battagel JM. Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances. Br Dent J 2001; 190:532-6. [PMID: 11411887 DOI: 10.1038/sj.bdj.4801025] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This paper looks at the role of mandibular advancement splints in the management of obstructive sleep apnoea, as part of a multidisciplinary approach. Clinical guidance is provided on the rationale for use, patient selection, design features and the associated risk to benefit ratio.
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Affiliation(s)
- A Johal
- Dept of Orthodontics, St Bartholomew's and The Royal London School of Medicine and Dentistry, London.
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Barthlen GM, Brown LK, Wiland MR, Sadeh JS, Patwari J, Zimmerman M. Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome. Sleep Med 2000; 1:299-305. [PMID: 11040462 DOI: 10.1016/s1389-9457(00)00030-7] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Objective: To compare three different oral appliances: a mandibular advancement device (Snoreguard), a tongue retaining device, and a soft palate lift, for treatment of severe obstructive sleep apnea syndrome (OSAS).Background: Oral appliances are therapeutic options for patients with OSAS.Methods: Eight patients with a mean apnea hypopnea index (AHI) of 72.1 (SD+/-39.9) were studied. Polysomnographic measures during each of the treatment nights were compared to baseline.Results: Eight out of 8 patients completed the mandibular advancement device (MAD) night; 5/8 tolerated the tongue retaining device (TRD); only 2/8 could sleep with the soft palate lift (SPL) in place. Improvement using the MAD reached significance: overall AHI (mean+/-SD) decreased from 72.1+/-39.9 at baseline to 35.5+/-39.4 with the appliance in place (P<0.02). There was a non-significant increase in slow wave sleep (SWS) from 9.6%+/-8.7 to 14.4%+/-10.5 with the MAD in place. In five responders, the mean AHI decreased from 60.0+/-36.6 to 9.0+/-4.8; all were subjectively improved, using the MAD at 1 year follow-up. However, three non-responders had persistence of AHI>40. With the TRD, AHI decreased from 50.3+/-18.9 at baseline to 43.5+/-32.5 (ns). The SPL was not effective with an AHI at baseline of 52.4+/-8.0, and 47.3+/-31.0 with the device in place (ns), and not well tolerated.Conclusions: A mandibular advancement device is an effective treatment alternative in some patients with severe OSAS. In comparison, the tongue retaining device and the soft palate lift do not achieve satisfactory results.
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Affiliation(s)
- GM Barthlen
- Department of Medicine, Mount Sinai School of Medicine, NY, New York, USA
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Yoshida K. Effects of a mandibular advancement device for the treatment of sleep apnea syndrome and snoring on respiratory function and sleep quality. Cranio 2000; 18:98-105. [PMID: 11202830 DOI: 10.1080/08869634.2000.11746120] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
In this study the fabrication of a simplified mandibular advancement device for sleep apnea syndrome was described. Its effect on respiratory function and sleep quality variables was evaluated polysomnographically in 256 patients with sleep apnea syndrome and snoring. Polysomnographic recordings were performed twice, before and after insertion of the oral appliance. The mean apneahypopnea index (AHI) decreased significantly (p < 0.0001) with the appliance to 18.2 from 43.2 without it. Responders defined by AHI < 10 were 54% and those defined as a 50% decrease of AHI were 66%. Oxygen saturation, duration of apnea, sleep efficiency, and total arousal were improved significantly after treatment without major side effects. The device improved significantly the respiratory function and sleep quality in patients with sleep apnea syndrome. Compliance was about 90% followed for 2.5 years. This appliance offers some advantages over other therapies because it is noninvasive, easy to fabricate, and well accepted by patients.
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Affiliation(s)
- K Yoshida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Sakyoku, Kyoto 606-8507, Japan.
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Kato J, Isono S, Tanaka A, Watanabe T, Araki D, Tanzawa H, Nishino T. Dose-dependent effects of mandibular advancement on pharyngeal mechanics and nocturnal oxygenation in patients with sleep-disordered breathing. Chest 2000; 117:1065-72. [PMID: 10767241 DOI: 10.1378/chest.117.4.1065] [Citation(s) in RCA: 188] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVES To examine dose-dependent effects of mandibular advancement on collapsibility of the passive pharynx and sleep-disordered breathing (SDB). DESIGN Prospective, randomized study. SETTING University hospital. PATIENTS Thirty-seven adult patients with SDB. INTERVENTIONS Oral appliances with 2-, 4-, and 6-mm advancement of the mandible. MEASUREMENTS AND RESULTS Overnight oximetry was performed with and without oral appliances. Each 2-mm mandibular advancement coincided with approximately 20% improvement in number and severity of nocturnal desaturations. Percentages of patients producing a > 50% improvement rate of the number of desaturations were 25%, 48%, and 65% with use of oral appliances with 2-, 4-, and 6-mm mandibular advancement, respectively. Static pharyngeal mechanics were evaluated in six completely paralyzed patients with SDB under general anesthesia with and without the oral appliances. Advancement of mandibular position was found to produce dose-dependent closing pressure reduction of all pharyngeal segments. Normalization of nocturnal oxygenation was associated with negative closing pressure, especially at the velopharynx. CONCLUSIONS We conclude that improvement of both nocturnal oxygenation and pharyngeal collapsibility significantly depends on the mandibular position.
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Affiliation(s)
- J Kato
- Department of Oral Surgery, Chiba University School of Medicine, Chiba, Japan
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Henke KG, Frantz DE, Kuna ST. An oral elastic mandibular advancement device for obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161:420-5. [PMID: 10673180 DOI: 10.1164/ajrccm.161.2.9903079] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Oral mandibular advancement devices are becoming an increasingly important treatment alternative for obstructive sleep apnea (OSA). The first aim of the study was to determine whether a new oral elastic mandibular advancement device (EMA) prevents pharyngeal airway closure during sleep in patients with OSA. The second aim of the study was to determine if the polysomnographic response to the oral mandibular advancement device was dependent on the site of airway closure. Overnight polysomnograms were performed in 28 untreated OSA subjects with and without EMA. A third polysomnogram was performed in 12 of the subjects to determine the site of airway closure without the device. Site of airway closure above or below the oropharynx was determined by measuring the respective presence or absence of respiratory fluctuations in oropharyngeal pressure during induced occlusions in non-rapid eye movement (NREM) sleep. Mean apnea-hypopnea index (AHI) was 52.6 +/- 28.2 (SD) events/h without the device and 21.2 +/- 19.3 events/h with the device. Nineteen subjects (68%) had at least a 50% reduction in AHI with the device. The change in AHI with the device (AHI without device - AHI with device) was directly related to the AHI without the device. All three subjects with airway closure in the lower pharyngeal airway had a greater than 80% reduction in AHI with the device. Two of the nine subjects with airway closure in the velopharynx had a similar therapeutic response. The results show the effectiveness of EMA in the treatment of OSA. The results also indicate that polysomnographic severity of OSA and the site of airway closure should not be used to exclude patients from this oral device treatment.
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Affiliation(s)
- K G Henke
- Sleep Disorders Center of Virginia, Richmond, Virginia, USA
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Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest 1999; 116:1511-8. [PMID: 10593770 DOI: 10.1378/chest.116.6.1511] [Citation(s) in RCA: 115] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To evaluate an adjustable mandibular positioning appliance for treatment of snoring and sleep apnea. METHODS One hundred thirty-four patients with baseline apnea/hypopnea index (AHI) of 37 +/- 28 events/h (mean +/- SD) received the appliance. The efficacy of the appliance was assessed by the following investigations, performed at baseline and with the appliance: polysomnography, Epworth sleepiness scale, bedpartners' assessment of snoring severity, patients' assessment of side effects, and overall satisfaction. RESULTS Thirteen patients were lost to follow-up. An additional 46 patients had no follow-up polysomnography, but answered the questionnaires. A total of 75 patients had polysomnography at baseline and with the appliance. We found a significant reduction in AHI from 44 +/- 28 events/h to 12 +/- 15 events/h (p < 0.0005) and a reduction in the arousal index from 37 +/- 27 events/h to 16 +/- 13 events/h (p < 0.05). Epworth scores fell from 11 +/- 5 to 7 +/- 3 (p < 0.0005). Bedpartners' assessment revealed marked improvement in snoring. For example, at baseline 96% of patients were judged to snore loudly "often" or "always" by their bedpartners, whereas only 2% were judged so while using dental appliance. The most frequent side effect was teeth discomfort, present "sometimes" or "often" in up to 32% of patients. Follow-up clinical assessment in 121 patients conducted on the average 350 days after the insertion of the appliance revealed that 86% of patients continued to use the appliance nightly; 60% were very satisfied with the appliance, 27% were moderately satisfied, 11% were moderately dissatisfied, and 2% were very dissatisfied. CONCLUSION We conclude that the adjustable mandibular positioning appliance is an effective treatment alternative for some patients with snoring and sleep apnea.
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Affiliation(s)
- J Pancer
- Department of Medicine, Respiratory Division, St. Michael's Hospital, University of Toronto, Ontario, Canada
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Ivanhoe JR, Cibirka RM, Lefebvre CA, Parr GR. Dental considerations in upper airway sleep disorders: A review of the literature. J Prosthet Dent 1999; 82:685-98. [PMID: 10588805 DOI: 10.1016/s0022-3913(99)70010-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Upper airway sleep disorders are becoming recognized as common medical concerns. Multiple treatment options have been advocated, including the use of dental devices. Dental practitioners are being asked by the medical profession to become a part of the treatment team. This may be a challenging task because of the large number of dental devices available, rapid advancement in the understanding of this disease, and numerous publications. PURPOSE This article reviews the anatomic features and etiologic factors of upper airway sleep disorders and medical and dental treatment options. METHODS The literature review was conducted with an accepted literature research tool, PubMed, developed by the National Library of Medicine. Key words searched included "obstructive sleep apnea," "sleep apnea," "sleep disorders," and "snoring". CONCLUSION Dental devices are indicated in snoring and mild-to-moderate obstructive sleep apnea patients after medical evaluation and referral.
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Affiliation(s)
- J R Ivanhoe
- School of Dentistry, Medical College of Georgia, Augusta, GA 30912-6276, USA.
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Yoshida K. Elastic retracted oral appliance to treat sleep apnea in mentally impaired patients and patients with neuromuscular disabilities. J Prosthet Dent 1999; 81:196-201. [PMID: 9922433 DOI: 10.1016/s0022-3913(99)70248-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
STATEMENT OF PROBLEM Various oral appliances have been successfully used in the treatment of sleep apnea. However, it is difficult for mentally impaired patients and patients with neuromuscular disabilities to insert and remove the appliance and to maintain it intraorally through the night. PURPOSE This study described the fabrication of an elastic retracted-type oral appliance to treat sleep apnea in mentally impaired patients and patients with neuromuscular disabilities and to evaluate its efficiency. MATERIAL AND METHODS Five patients, 3 with cerebral palsy and 2 with Down's syndrome, with sleep apnea were included in this study. Maxillary and mandibular splints were molded individually on casts by using copolyester foils. The splints were retracted forward by elastics, attached to wire hooks in the maxillary and mandibular incisal areas. The effect of the appliance was examined polysomnographically. RESULTS The apnea index was decreased significantly (P <.03) by the appliance. The appliance was easily inserted and removed, and the elastic force and mandibular position could be adjusted. The appliance, as used in this study, allowed free mandibular movement and maintained its correct position during sleep despite involuntary or voluntary mandibular movements. CONCLUSIONS The oral appliance was useful as an alternative to relieve the sleep apnea of patients with mental deficiencies and neuromuscular disabilities.
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Affiliation(s)
- K Yoshida
- Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Sakyoku, Japan
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Millman RP, Rosenberg CL, Kramer NR. Oral appliances in the treatment of snoring and sleep apnea. Otolaryngol Clin North Am 1998; 31:1039. [PMID: 9838016 DOI: 10.1016/s0030-6665(05)70106-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Oral appliances have been developed that are effective in snoring patients and in patients with mild to moderate sleep apnea. This article reviews the types of appliances that are available, their possible modes of action, and their efficacy. In addition, the clinician is provided with guidelines on how to choose the appropriate patient for this therapy.
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Affiliation(s)
- RP Millman
- Director, Sleep Disorders Center of Lifespan Hospitals; and Professor, Department of Medicine, Brown University School of Medicine, Providence, Rhode Island
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Effektivität einer den Unterkiefer vorverlagernden Protrusions-schiene bei der obstruktiven Schlafapnoe. SOMNOLOGIE 1998. [DOI: 10.1007/s11818-998-0017-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Marklund M, Franklin KA, Sahlin C, Lundgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 1998; 113:707-13. [PMID: 9515847 DOI: 10.1378/chest.113.3.707] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
OBJECTIVE To evaluate the effects of a mandibular advancement device on apneas and sleep in mild, moderate, and severe obstructive sleep apnea. DESIGN Prospective study. SUBJECTS Forty-four of 47 patients included. INTERVENTION Individually adjusted mandibular advancement devices. MEASUREMENTS Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings. RESULTS The device reduced the median obstructive apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range, 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range, 44 to 66) to 14 (range, 2 to 32) (p<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=-0.41; p<0.01). CONCLUSIONS A mandibular advancement device reduces apneas and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.
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Affiliation(s)
- M Marklund
- Department of Orthodontics, Umeå University, Sweden
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Abstract
Oral appliances have been developed that are effective in snoring patients and in patients with mild to moderate sleep apnea. This article reviews the types of appliances that are available, their possible modes of action, and their efficacy. In addition, the clinician is provided with guidelines on how to choose the appropriate patient for this therapy.
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Affiliation(s)
- R P Millman
- Sleep Disorders Center of Lifespan Hospitals, Providence, Rhode Island, USA
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Schönhofer B, Wenzel M, Barchfeld T, Siemon K, Rager H, Köhler D. [Value of various intra- and extraoral therapeutic procedures for treatment of obstructive sleep apnea and snoring]. MEDIZINISCHE KLINIK (MUNICH, GERMANY : 1983) 1997; 92:167-74. [PMID: 9173209 DOI: 10.1007/bf03043275] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Recently intra- and extraoral devices are increasingly used in order to treat obstructive sleep apnea (OSA) and snoring. We examined the value of some devices according to the literature and our own results. PATIENTS AND METHODS The mandibular advancing devices aim at increasing upper airway diameter. The active part of the tongue extending device (SnorEx) is a stamp connected to a piston which exerts pressure at the base of the tongue causing its forward displacement; we studied 23 patients. The principle of an optically stimulating system ("eye-cover", Snore-Stop) consists of a microphone and light diods which are integrated in the eye-cover. After detecting acoustic signals (for example snoring) optical stimuli are generated in front of the eyes, which are thought to induce arousals causing a change of body position and the reduction of the snoring and apneas; we measured 24 patients. The principle of the tongue-retainer (Snore-Master) is the fixation of the tongue in a ventral position, which is thought to enlarge the mesopharyngeal area; we studied 14 patients. The nose plaster (Breathe-Right) contains an elastic spine that pulls the alae nasi cranial. This manipulation is thought to increase the diameter of the nostril and reduce the airway resistance. We measured 30 patients with obstructive sleep apnea and 20 snoring subjects without obstructive sleep apnea. RESULTS Regarding the mandibular advancing due to different appliance designs and study protocols variable success rates have been documented. In patients with mild to moderate obstructive sleep apnea a reduction of the sleep related breathing disorder could be shown. Non compliance (NC) to the tongue extending device was 75% (17/23). Non-compliance-patients were characterized by unacceptable local-side-effects of the prosthesis, lacking improvement of symptoms and of the respiratory disturbance index. Both tongue-retainer and -extensor are characterized by a high incidence of local side effects. Neither the eye-cover nor the nose plaster could improve the severity of obstructive sleep apnoe or snoring. In contrast to another study we could not show a significant effect of the tongue-retainer. CONCLUSIONS Neither the nose plaster nor the optical stimulating device influenced the degree of obstructive sleep apnea and snoring. There are conflicting data regarding the tongue retainer. The high rate of non-compliant subjects and the low efficacy of the tongue extending prosthesis precludes large-scale use of this treatment modality in patients with obstructive sleep apnoe and snoring. In selected individuals suffering from a mild to moderate degree of obstructive sleep apnea with CPAP-inefficiency and -incompliance the mandibular advancing principle may be an therapeutic alternative to CPAP.
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Affiliation(s)
- B Schönhofer
- Krankenhaus Kloster Grafschaft, Zentrum für Pneumologie, Beatmungs- und Schlafmedizin, Schmallenberg-Grafschaft
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Affiliation(s)
- V Hoffstein
- Department of Medicine, St. Michael's Hospital, University of Toronto, Canada
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Hasegawa M. Is UPPP the treatment of choice for obstructive sleep apnea? Acta Otolaryngol 1991; 111:1178. [PMID: 1763642 DOI: 10.3109/00016489109100774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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