1
|
Gogou ES, Psarras V, Giannakopoulos NN, Minaritzoglou A, Tsolakis IA, Margaritis V, Tzakis MG. Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea. Sleep Breath 2024; 28:773-788. [PMID: 38085497 DOI: 10.1007/s11325-023-02958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 05/31/2024]
Abstract
PURPOSE The purpose of this study was to compare objective and self-reported outcomes of two treatments for managing mild, moderate, and severe obstructive sleep apnea (OSA) in adults: a mandibular advancement device (MAD) and continuous positive airway pressure (CPAP). METHODS Patients diagnosed with OSA by means of polysomnography (PSG) included one group treated with a custom-made, two-piece, adjustable MAD and a second group treated with CPAP for 8 weeks. Before the initiation of the treatment, all patients assigned to MAD underwent drug-induced sleep endoscopy (DISE), and all CPAP group patients underwent manual titration of CPAP after PSG. Objective (PSG) and self-reported (Epworth Sleepiness Scale [ESS] and Short Form Health Survey [SF-36]) data were used to assess outcomes. Collected data included apnea-hypopnea index (AHI), mean capillary oxygen saturation (SpO2), oxygen desaturation index (ODI), arousal index (AI), degree of daytime sleepiness, and quality of life. A PSG follow-up after 8 weeks with MAD in situ, and data from the CPAP data card were used to assess the effect of the two treatments. RESULTS A total of 59 patients included 30 treated with MAD and 29 treated with CPAP. Between baseline and the 8-week follow-up, the mean AHI score decreased significantly from 35.1 to 6.8 episodes/h (p < 0.001) in patients treated with MAD and from 35.2 to 3.0 episodes/h (p < 0.001) in patients treated with CPAP. The mean AHI score at the 8-week follow-up was significantly lower in CPAP group than in MAD group (p = 0.003). The two groups did not differ significantly at follow-up regarding SpO2 (p = 0.571), ODI (p = 0.273), AI (p = 0.100), ESS score (p = 0.648), and SF-36 score (p = 0.237). CONCLUSION In the short term, patients on CPAP attained better PSG outcomes in terms of AHI reduction. Both MAD after DISE evaluation and CPAP resulted in similar improvements in clinical symptoms and health-related quality of life, even in patients with severe OSA.
Collapse
Affiliation(s)
- Evgenia Sp Gogou
- School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece.
| | - Vasileios Psarras
- School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Nikolaos Nikitas Giannakopoulos
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527, Athens, Greece
- Department of Prosthodontics, University Clinic of Würzburg, Würzburg, Germany
| | - Aliki Minaritzoglou
- Center of Sleep Disorders, Department of Critical Care and Pulmonary Services, Medical School of National and Kapodistrian University of Athens, Evaggelismos Hospital, Athens, Greece
| | - Ioannis A Tsolakis
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | | | - Michail Ger Tzakis
- School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece
| |
Collapse
|
2
|
Sangalli L, Yanez-Regonesi F, Fernandez-Vial D, Moreno-Hay I. Self-reported improvement in obstructive sleep apnea symptoms compared to treatment response with mandibular advancement device therapy: a retrospective study. Sleep Breath 2023; 27:1577-1588. [PMID: 36449217 DOI: 10.1007/s11325-022-02754-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/09/2022] [Accepted: 11/21/2022] [Indexed: 12/02/2022]
Abstract
PURPOSE Mandibular advancement device (MAD) is recognized as the treatment option for management of obstructive sleep apnea (OSA) in mild-moderate cases or those unable to tolerate positive airway pressure therapy. Post-treatment sleep study is recommended to establish MAD efficacy when maximal therapeutic benefit is achieved based on OSA symptom improvement or maximum anatomical protrusion. The aim of this study was to investigate the difference between responders and non-responders in OSA symptom improvement and predictors of treatment success. METHODS Medical charts of patients referred to the Orofacial Pain Clinic between 2016 and 2021 for management of OSA with MAD were retrospectively evaluated. Participants with post-treatment sleep study with MAD in situ were included. Participants were categorized as responders according to different criteria: 50% reduction in apnea-hypopnea index (AHI) compared to baseline; post-treatment AHI ≤ 10 with ≥ 50% reduction from baseline; AHI ≤ 5 with ≥ 50% reduction. OSA symptoms included snoring, apneas, sleep quality, tiredness upon awakening, daytime sleepiness, and subjective improvement. Differences in pre- and post-treatment variables within/between groups and predictors were analyzed with t test and logistic regression. RESULTS Among 53 participants (30 females), mean age was 64.2 ± 10.7 and pre-treatment was AHI 23.3 ± 17.2. Depending upon the criteria, responders ranged between 26 and 57%. At first follow-up after MAD delivery, non-responders reported less tiredness upon awakening (p = 0.003), better sleep quality (p = 0.005), and greater subjective improvement (p = 0.012) than responders. Among significant OSA symptoms, tiredness upon awakening, poorer sleep quality, and less subjective improvement were consistently found as predictors of treatment response. CONCLUSION Subjective improvement, sleep quality, and tiredness upon awakening significantly improved in non-responders at first follow-up compared to responders, according to the strictest definition of treatment response. Therefore, a post-treatment sleep study is crucial to confirm proper management of OSA with MAD.
Collapse
Affiliation(s)
- Linda Sangalli
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA.
- College of Dental Medicine-Illinois (CDMI), Midwestern University, Downers Grove, IL, USA.
| | - Fernanda Yanez-Regonesi
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA
| | - Diego Fernandez-Vial
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA
| | - Isabel Moreno-Hay
- Department of Oral Health Science, College of Dentistry, Orofacial Pain Clinic, University of Kentucky, Lexington, KY, USA
| |
Collapse
|
3
|
Dieltjens M, Vanderveken OM, Shivalkar B, Van Haesendonck G, Kastoer C, Heidbuchel H, Braem MJ, Van De Heyning CM. Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea. J Clin Sleep Med 2022; 18:903-909. [PMID: 34728052 PMCID: PMC8883081 DOI: 10.5664/jcsm.9766] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) is associated with cardiovascular comorbidities such as left ventricular (LV) hypertrophy. Whether OSA is an independent etiological factor for this hypertrophic remodeling is yet unknown. Continuous positive airway pressure partially reverses this hypertrophy, but data regarding the effect of mandibular advancement devices on LV remodeling are scarce. The aim of this prospective trial is to evaluate the effect of mandibular advancement device therapy on LV geometry and function in patients with OSA. METHODS At baseline and 6-month follow-up, participants underwent a home sleep apnea test, 24-hour ambulatory blood pressure monitoring and a 2-dimensional Doppler and tissue Doppler echocardiography. RESULTS Sixty-three patients (age: 49 ± 11 years; body mass index: 27.0 ± 3.4 kg/m2; baseline apnea-hypopnea index home sleep apnea test: 11.7 [8.2; 24.9] events/h) completed the 6-month follow-up visit. Overall, blood pressure values and parameters of LV function were within normal ranges at baseline and did not change under mandibular advancement device therapy. In contrast, the interventricular septum thickness was at the upper limits of normal at baseline and showed a significant decrease at 6-month follow-up (11.1 ± 2.1 mm vs 10.6 ± 2.0 mm, P = .03). This significant improvement is only found in responders but not in nonresponders. There was no correlation between the decrease of interventricular septum thickness and the change in blood pressure. CONCLUSIONS In mildly obese, normotensive patients with OSA we observed significant reverse hypertrophic remodeling after 6 months of successful mandibular advancement device therapy, with maintained normotensive systemic blood pressure. This suggests that OSA is an independent factor in the pathophysiology of LV hypertrophy in these patients. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Evaluation of the Cardiovascular Effects of the MAS in the Treatment of Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT02320877; Identifier: NCT02320877. CITATION Dieltjens M, Vanderveken OM, Shivalkar B, et al. Mandibular advancement device treatment and reverse left ventricular hypertrophic remodeling in patients with obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):903-909.
Collapse
Affiliation(s)
- Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium,Address correspondence to: Marijke Dieltjens, PhD, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1–D.T.493, 2610 Wilrijk, Belgium;
| | - Olivier M. Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Bharati Shivalkar
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Delta (CHIREC) Hospital, Brussels, Belgium,Pfizer Biopharmaceuticals, Brussels, Belgium
| | - Gilles Van Haesendonck
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Chloé Kastoer
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Hein Heidbuchel
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| | - Marc J. Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Otolaryngology and Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Caroline M. Van De Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium,Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
4
|
Barbosa DF, Meira E Cruz M, Alves MC, Zancanella E, Berzin F, Júnior AJM. Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study. Eur J Dent 2022; 16:564-572. [PMID: 35181870 PMCID: PMC9507576 DOI: 10.1055/s-0041-1735933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives
Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OA
m
) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OA
m
is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OA
m
use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures.
Materials and Methods
A retrospective longitudinal study of 33 OSA patient treated with a different OA
m
, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance.
Results
Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters.
Conclusion
In this pilot study, DIORS OA
m
as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.
Collapse
Affiliation(s)
- Denise Fernandes Barbosa
- Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
| | - Miguel Meira E Cruz
- Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Lisbon, Portugal.,Research Laboratory on the Neuroimmune Interface of Pain São Leopoldo Mandic College, Campinas, São Paulo, Brazil
| | | | - Edilson Zancanella
- Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
| | - Fausto Berzin
- Department of Odontology, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Almiro José Machado Júnior
- Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
| |
Collapse
|
5
|
A pilot study on comparison of subjective titration versus remotely controlled mandibular positioning during polysomnography and drug-induced sleep endoscopy, to determine the effective protrusive position for mandibular advancement device therapy. Sleep Breath 2022; 26:1837-1845. [PMID: 35064876 PMCID: PMC9663400 DOI: 10.1007/s11325-022-02569-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/24/2021] [Accepted: 01/05/2022] [Indexed: 11/29/2022]
Abstract
Study objectives The aim of this pilot study was to evaluate the clinical effectiveness of subjective titration versus objectively guided titration during polysomnography (PSG) and drug-induced sleep endoscopy (DISE) in mandibular advancement device (MAD) therapy for patients with obstructive sleep apnea (OSA). Methods In this pilot cross-over study, patients underwent three titration procedures in randomized order: (1) subjective titration, (2) PSG-guided titration using a remotely controlled mandibular positioner (RCMP) and (3) DISE-assisted titration using RCMP. After each titration procedure, patients used the MAD for 1 month at the targeted protrusion obtained according to the preceding titration procedure. For each procedure, a follow-up PSG was performed after 1 month of MAD use in order to evaluate the efficacy of the MAD. Results Ten patients were included in the study. Overall, no significant differences in targeted optimal protrusion compared to maximal comfortable protrusion among the three titration methods were observed. There was no significant difference in reduction in AHI. In this study, PSG titration correctly classified 50% of patients as ‘responder’. A higher predictive accuracy was found for DISE titration with a sensitivity of 83.3% and a specificity of 100%. Conclusions This pilot randomized cross-over trial showed no differences in optimal mandibular positioning and corresponding efficacy of MAD between subjective titration, DISE titration or PSG titration.
Collapse
|
6
|
Li WY, Masse JF, Gakwaya S, Zhao Z, Wang W, Sériès F. Differences in Predicted Therapeutic Outcome of Mandibular Advancement Determined by Remotely Controlled Mandibular Positioner in Canadian and Chinese Apneic Patients. Nat Sci Sleep 2022; 14:1611-1622. [PMID: 36105925 PMCID: PMC9467296 DOI: 10.2147/nss.s377758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 08/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In-lab mandibular protrusive titration using a remotely controlled mandibular positioner (RCMP) could predict the success rate of mandibular advancement device (MAD) and reliably determine the Optimal Protrusive Position (OPP) for obstructive sleep apnea (OSA) patients. The aim of this study was to compare MAD success rate using in-lab RCMP manual titration performed in Caucasian and Chinese OSA patients. METHODS Manual RCMP titration was performed during an in-lab sleep study using the same procedure that had been previously reported in untreated Caucasian and Chinese OSA patients. Success rate was determined according to classical success criteria or to those previously used for RCMP titration. RESULTS A total of 160 subjects were included in this study, and conclusive data were obtained from 141 (71 Chinese and 70 Caucasian OSA patients). Chinese patients were significantly younger, with lower BMI and more severe OSA disease than the Canadian counterparts. Among patients with predicted success, the OPP expressed in % of full protrusion position did not differ between the two ethnic groups. Chinese ethnicity, younger age and lower baseline AHI were significant determinants of RCMP success. In a multivariate analysis, only ethnicity and AHI were found to significantly account for success, the odds ratio for success in Chinese compared to Caucasians corrected for AHI being 3.7 and 4.6 depending on criteria used to define success. CONCLUSION Although the OSA disease was more severe in Chinese patients, the predicted success rate of MAD according to RCMP titration was higher in Chinese than in Caucasians. This study was registered on ClinicalTrials.gov (NCT03231254).
Collapse
Affiliation(s)
- Wen-Yang Li
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | | | - Simon Gakwaya
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Zhenjin Zhao
- Institute of Orthodontics, The Stomatological Hospital of China Medical University, Shenyang, People's Republic of China
| | - Wei Wang
- Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People's Republic of China
| | - Frédéric Sériès
- Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| |
Collapse
|
7
|
Choi JH. Treatments for Adult Obstructive Sleep Apnea. SLEEP MEDICINE RESEARCH 2021. [DOI: 10.17241/smr.2021.00913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
8
|
Vonk PE, Uniken Venema JAM, Hoekema A, Ravesloot MJL, van de Velde-Muusers JA, de Vries N. Jaw thrust versus the use of a boil-and-bite mandibular advancement device as a screening tool during drug-induced sleep endoscopy. J Clin Sleep Med 2021; 16:1021-1027. [PMID: 32056536 DOI: 10.5664/jcsm.8378] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The objectives of this study were to analyze agreement in degree of obstruction and configuration of the upper airway between jaw thrust and an oral device in situ during drug-induced sleep endoscopy and to evaluate clinical decision making using jaw thrust or a boil-and-bite mandibular advancement device (MAD; the MyTAP). METHODS This was a single-center prospective cohort study in patients with obstructive sleep apnea who underwent drug-induced sleep endoscopy between January and July 2019. RESULTS Sixty-three patients were included. Agreement among observations in the supine position for degree of obstruction was 60% (n = 36, κ = 0.41) at the level of the velum, 68.3% (n = 41, κ = 0.35) for oropharynx, 58.3% (n = 35, κ = 0.28) for tongue base, and 56.7% (n = 34, κ = 0.14) for epiglottis; agreement among observations in the lateral position were 81.7% (n = 49, κ = 0.32), 71.7% (n = 43, κ = 0.36), 90.0% (n = 54, κ = 0.23), and 96.7% (n = 58, κ = could not be determined), respectively. In the supine position, agreement for configuration of obstruction at the level of the velum was found in 20 of 29 patients (69.0%, κ = 0.41) and in the lateral position was 100%. Thirty patients would have been prescribed a MAD using jaw thrust and 34 using the boil-and-bite MAD as a screening instrument. The main reason for being labeled as nonsuitable was complete residual retropalatal collapse during jaw thrust. Using the boil-and-bite MAD, this was caused by complete retropalatal or hypopharyngeal collapse. CONCLUSIONS There is only slight to moderate agreement in degree of obstruction for jaw thrust and a new-generation boil-and-bite MAD during drug-induced sleep endoscopy. Greater improvement of upper airway patency at the hypopharyngeal level was observed during jaw thrust, but this maneuver was less effective in improving upper airway obstruction at the retropalatal level.
Collapse
Affiliation(s)
- Patty E Vonk
- Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, Netherlands.,Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Julia A M Uniken Venema
- Department of Oral and Maxillofacial Surgery, Amsterdam Universitair Medische Centra/Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands.,Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands
| | - Aarnoud Hoekema
- Department of Oral and Maxillofacial Surgery, Amsterdam Universitair Medische Centra/Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands.,Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands.,Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Madeline J L Ravesloot
- Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, Netherlands.,Department of Otorhinolaryngology, Medical Centre Jan van Goyen, Amsterdam, Netherlands
| | | | - Nico de Vries
- Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, Netherlands.,Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands.,Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| |
Collapse
|
9
|
Ishiyama H, Hideshima M, Inukai S, Tamaoka M, Nishiyama A, Miyazaki Y. Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study. J Clin Med 2021; 10:jcm10061255. [PMID: 33803610 PMCID: PMC8002844 DOI: 10.3390/jcm10061255] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 03/06/2021] [Accepted: 03/16/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, p < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA (p < 0.05). There was no significant difference in non-responders (p > 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5–28.0; p = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.
Collapse
Affiliation(s)
- Hiroyuki Ishiyama
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (H.I.); (A.N.)
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Masayuki Hideshima
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
- Correspondence: ; Tel.: +81-3-5803-4551
| | - Shusuke Inukai
- Removable Partial Prosthodontics, Oral Health Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Meiyo Tamaoka
- Department of Respiratory Physiology and Sleep Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| | - Akira Nishiyama
- Dental Anesthesiology and Orofacial Pain Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan; (H.I.); (A.N.)
- Dental Clinic for Sleep Disorders (Apnea and Snoring), Oral and Maxillofacial Rehabilitation, Dental Hospital, Tokyo Medical and Dental University, Tokyo 113-8549, Japan
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8549, Japan;
| |
Collapse
|
10
|
Uniken Venema JAM, Doff MHJ, Joffe-Sokolova DS, Wijkstra PJ, van der Hoeven JH, Stegenga B, Hoekema A. Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study. Clin Oral Investig 2019; 24:3069-3076. [PMID: 31863188 DOI: 10.1007/s00784-019-03175-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with obstructive sleep apnea (OSA) are usually treated with either mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) therapy. The objective of this study is to evaluate changes in dental occlusion associated with long-term MAD and CPAP therapy. MATERIALS AND METHODS Data from 14 OSA patients using MAD and 17 OSA patients using CPAP therapy were evaluated at baseline, 2-year and 10-year follow-up. Changes in dental occlusion were analyzed from dental plaster casts with a digital sliding caliper. RESULTS At 2-year follow-up, MAD therapy resulted in significant dental changes when compared with baseline values. In MAD therapy, overjet and overbite decreased with 1.1 ± 1.8 mm and 1.1 ± 1.2 mm respectively. With CPAP therapy overjet and overbite decreased significantly with 0.2 ± 0.5 mm and 0.3 ± 0.5 mm, respectively. Both groups also showed significant changes in molar occlusion. After a 10-year follow-up, significant and more pronounced changes were seen in overjet and overbite. In MAD therapy, overjet and overbite decreased with 3.5 ± 1.5 mm and 2.9 ± 1.5 mm respectively when compared with baseline values. In CPAP therapy, overjet and overbite decreased with 0.7 ± 1.5 mm and 0.8 ± 1.4 mm respectively when compared with baseline values. CONCLUSIONS This study demonstrates that MAD and CPAP therapy result in significant changes in dental occlusion. These changes appear progressive and more pronounced with MAD compared to CPAP therapy. CLINICAL RELEVANCE Long-term OSA treatment results in significant dental side effects that may progress over time. Informed consent is fundamental before starting MAD treatment and individualized long-term follow-up is of eminent importance.
Collapse
Affiliation(s)
- Julia Anne Margarethe Uniken Venema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
| | - Michiel H J Doff
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Dilyana S Joffe-Sokolova
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Department of Home Mechanical Ventilation, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Johannes H van der Hoeven
- Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Boudewijn Stegenga
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aarnoud Hoekema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
11
|
Dupuy-Bonafe I, Francois C, Lachiche V, Castel M, Duminil G. [OSA in adults: Role of the mandibular advancement device (MAD)]. Orthod Fr 2019; 90:389-399. [PMID: 34643524 DOI: 10.1051/orthodfr/2019024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mandibular advancement devices are an alternative to continuous positive airway pressure for patients with mild or moderate obstructive sleep apnea/ hypopnea syndrome (OSA). Oral appliances advance the mandible and tongue, enlarge and stabilize the upper airways during sleep. Clinical examination is used to select candidates for oral appliances and a particular appliance for a given patient. Titration of the advancement will optimize its effectiveness by resolving subjective clinical symptoms. Polygraphic or ventilatory polysomnography controls the effectiveness of the treatment (IAH reduction, increase of oxygen saturation and improvement of the main symptoms). Clinical follow-up is required to assess longterm outcomes, side effects and treatment adherence. Oral appliances are effective in the short-term provided they achieved a 50% reduction in IAH and complete symptom resolution.
Collapse
Affiliation(s)
- Isabelle Dupuy-Bonafe
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Cindy Francois
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Virginie Lachiche
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | - Manon Castel
- Département d'Occlusodontie CSERD, 549 avenue du Pr JL Viala, 34193 Montpellier, France
| | | |
Collapse
|
12
|
Park SM, Park S, Shin S, Lee H, Ahn SJ, Kim L, Lee SH, Noh G. Designing a mandibular advancement device with topology optimization for a partially edentulous patient. J Prosthet Dent 2019; 123:850-859. [PMID: 31590981 DOI: 10.1016/j.prosdent.2019.05.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/13/2019] [Accepted: 05/13/2019] [Indexed: 10/25/2022]
Abstract
STATEMENT OF PROBLEM Patients with partial tooth loss treated with implant-supported fixed partial dentures (FPDs) have difficulty using conventional mandibular advancement devices (MADs) because of the risk of side effects. Also, which design factors affect biomechanical stability when designing MADs with better stability is unclear. PURPOSE The purpose of this finite element (FE) analysis study was to analyze the effect of the MAD design on biomechanical behavior and to propose a new design process for improving the stability of MADs. MATERIAL AND METHODS Each 3D model consisted of the maxillofacial bones, teeth, and implant-supported FPDs located in the left tooth loss area from the first premolar to the second molar and a MAD. Three types of custom-made MADs were considered: a complete-coverage MAD covering natural tooth-like conventional MADs, a shortened MAD excluding the coverage on the implant-supported FPD, and a newly designed MAD without anterior coverage. For the new MAD design, topology optimization was conducted to reduce the stress exerted on the teeth and to improve retention of the MAD. The new MAD design was finished by excluding the coverage of the maxillary and mandibular central incisors based on the results of the topology optimization. A mandibular posterior restorative force for a protrusion amount of 40% was used as the loading condition. The principal stress and pressure of the cancellous bone and periodontal ligaments (PDLs) were identified. RESULTS Considering the load concentration induced by the complete-coverage MAD, bone resorption risk and root resorption risk were observed at both ends of the mandibular teeth. The shortened MAD resulted in the highest stress concentration and pressure with the worst stability. However, in the case of the complete-coverage MAD, the pressure in the PDLs was reduced to the normal range, and the risk of root resorption was reduced. CONCLUSIONS For patients with implant-supported FPDs, MAD designs with different extents of coverage had an influence on biomechanical behavior in terms of stress distribution in cancellous bone and PDLs. A MAD design without anterior coverage provided improved stability compared with complete-coverage or shortened designs. The presented method for MAD design, which combined FE analysis and topology optimization, could be effectively applied in the design of such improved MADs.
Collapse
Affiliation(s)
- Si-Myung Park
- Graduate student, Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea; Graduate student, School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Soyeon Park
- Graduate student, School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Sangkyun Shin
- Researcher, School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Hyeonjong Lee
- Assistant Professor, Department of Prosthodontics, Pusan National University, Yangsan, Republic of Korea
| | - Su-Jin Ahn
- Professor, Department of Biomaterials & Prosthodontics, Kyung Hee University Hospital at Gangdong, School of Dentistry, Kyung Hee University, Seoul, Republic of Korea
| | - Laehyun Kim
- Principal Researcher, Center for Bionics, Korea Institute of Science and Technology, Seoul, Republic of Korea
| | - Soo-Hong Lee
- Professor, School of Mechanical Engineering, Yonsei University, Seoul, Republic of Korea
| | - Gunwoo Noh
- Assistant Professor, School of Mechanical Engineering, Kyungpook National University, Daegu, Republic of Korea.
| |
Collapse
|
13
|
The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173182. [PMID: 31480465 PMCID: PMC6747445 DOI: 10.3390/ijerph16173182] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 08/24/2019] [Accepted: 08/25/2019] [Indexed: 11/17/2022]
Abstract
Oral appliance (OAm) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OAm therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OAm versus Bi-block OAm) remained eligible after applying the exclusion criteria. When comparing Mono-block OAm and Bi-block OAm, Mono-block OAm significantly reduced the apnea-hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; p = 0.0006), and patient preference for Mono-block OAm was significantly higher (2.06; 95%CI, 1.44 to 2.06; p < 0.0001). Lowest SpO2, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO2: -11.18; 95%CI, -26.90 to 4.54; p = 0.16, arousal index: 4.40; 95%CI, -6.00 to 14.80; p = 0.41, non-REM stage 3: -2.00; 95%CI, -6.00 to 14.80; p = 0.41, sleep efficiency: -1.42, 95%CI, -4.71 to 1.86; p = 0.40, ESS: 0.12; 95%CI, -1.55 to 1.79; p = 0.89, Snoring Scale: 0.55; 95%CI, -0.73 to 1.83, p = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, p = 1.00). In this systematic review, the use of Mono-block OAm was more effective than Bi-block OAm for OSA patients.
Collapse
|
14
|
Metz JE, Attarian HP, Harrison MC, Blank JE, Takacs CM, Smith DL, Gozal D. High-Resolution Pulse Oximetry and Titration of a Mandibular Advancement Device for Obstructive Sleep Apnea. Front Neurol 2019; 10:757. [PMID: 31379712 PMCID: PMC6650535 DOI: 10.3389/fneur.2019.00757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
Background: To determine whether utilizing high-resolution pulse oximetry is a viable method for evaluating the successful titration of oral appliances for the treatment of obstructive sleep apnea (OSA) patients. Methods: Of 136 consecutive potentially eligible OSA patients, 133 were fitted with mandibular advancement devices (MADs), and 101 completed all phases of treatment. The vertical and horizontal dimensions of the appliances were adjusted based on three-nights with a high-resolution pulse oximeter during sleep and associated software after each adjustment. Results: Significant improvements in OSA severity were apparent in patients at all disease severity levels. High-resolution pulse oximetry provided reliable guidance in the titration process of mandibular advancement therapy. In 67 subjects (66.3%), a respiratory event index of <5 events/hour was achieved. Conclusions: OSA can be effectively treated with a MAD at any severity level, and high-resolution pulse oximetry provides critical information to guide oral appliance titration.
Collapse
Affiliation(s)
- James E Metz
- The Metz Center for Sleep Apnea, Columbus, OH, United States
| | - Hrayr P Attarian
- Circadian Rhythms and Sleep Research Lab, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | - James E Blank
- The Metz Center for Sleep Apnea, Columbus, OH, United States
| | | | - Dale L Smith
- Department of Behavioral Sciences, Olivet Nazarene University, Bourbonnais, IL, United States
| | - David Gozal
- Department of Child Health, University of Missouri School of Medicine, Columbia, MO, United States
| |
Collapse
|
15
|
Castillo Y, Blanco-Almazan D, Whitney J, Mersky B, Jane R. Characterization of a tooth microphone coupled to an oral appliance device: A new system for monitoring OSA patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2018; 2017:1543-1546. [PMID: 29060174 DOI: 10.1109/embc.2017.8037130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, especially in elderly and obese populations. Despite constituting a serious health, social and economic problem, most patients remain undiagnosed and untreated due to limitations in current equipment. In this work, we propose a novel method to diagnose OSA and monitor therapy adherence and effectiveness at home in a non-invasive and inexpensive way: combining acoustic analysis of breathing and snoring sounds with oral appliance therapy (OA). Audiodontics has introduced a new sensor, a tooth microphone coupled to an OA device, which is the main pillar of this system. The objective of this work is to characterize the response of this sensor, comparing it with a commercial tracheal microphone (Biopac transducer). Signals containing OSA-related sounds were acquired simultaneously with the two microphones for that purpose. They were processed and analyzed in time, frequency and time-frequency domains, in a custom MATLAB interface. We carried out a single-event approach focused on breaths, snores and apnea episodes. We found that the quality of the signals obtained by both microphones was quite similar, although the tooth microphone spectrum concentrated more energy at the high-frequency band. This opens a new field of study about high-frequency components of snores and breathing sounds. These characteristics, together with its intraoral position, wireless option and combination with customizable OAs, give the tooth microphone a great potential to reduce the impact of sleep disorders, by enabling prompt detection and continuous monitoring of patients at home.
Collapse
|
16
|
Zhang M, Liu Y, Liu Y, Yu F, Yan S, Chen L, Lv C, Lu H. Effectiveness of oral appliances versus continuous positive airway pressure in treatment of OSA patients: An updated meta-analysis. Cranio 2018; 37:347-364. [PMID: 29793390 DOI: 10.1080/08869634.2018.1475278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Objective: To update the meta-analysis comparing the effectiveness of oral appliance (OA) with continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea (OSA). Methods: PubMed, ISI Web of Knowledge, Ovid, EBSCO Dentistry & Oral Science Source, The Cochrane Library, and Embase database were searched for RCTs until 23 May 2017. Meta-analyses were performed using RevMan 5.3. Results: Sixteen RCTs were included. Compared with OA, CPAP significantly decreased AHI, min SaO2, ARI, ESS (p < 0.05), with no significant difference in REM%, FOSQ, BP (p ≥ 0.05). OA significantly improved REM% in the severe groups and ESS in the adjustable OA group (p < 0.05). OA shared greater preference. Conclusion: Even though CPAP can better decrease the severity of OSA, more patients opted for OA, which showed better results in severe patients, especially adjustable OA.
Collapse
Affiliation(s)
- Menghan Zhang
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China
| | - Yuehua Liu
- Shanghai Stomatological Hospital, Fudan University , Shanghai , China
| | - Yuanshun Liu
- The Second Clinical Medical College, Zhejiang Chinese Medical University , Hangzhou , China
| | - Fengyang Yu
- Orthodontic Center, Perfect Dental Care, Golden Mansion , Hangzhou , China
| | - Shaowen Yan
- Zhejiang Provincial People's Hospital , Hangzhou , China
| | - Lulu Chen
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China
| | - Chenxing Lv
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China
| | - Haiping Lu
- School of Stomatology, Zhejiang Chinese Medical University , Hangzhou , China.,Orthodontic Center, Perfect Dental Care, Golden Mansion , Hangzhou , China
| |
Collapse
|
17
|
Saglam-Aydinatay B, Taner T. Oral appliance therapy in obstructive sleep apnea: Long-term adherence and patients experiences. Med Oral Patol Oral Cir Bucal 2018; 23:e72-e77. [PMID: 29274155 PMCID: PMC5822544 DOI: 10.4317/medoral.22158] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/10/2017] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Despite the advances in the treatment of obstructive sleep apnea (OSA) with mandibular advancement appliances (MAA), their effectiveness is dependent on the patients compliance. Our aims were to evaluate the long-term adherence to MAA therapy and patients experiences of the treatment in OSA. MATERIAL AND METHODS Sixty-nine patients (52 males, 17 females; Mean age: 54.4±10.8 years) were included in the study. The subjects were mild (56%) and moderate (44%) OSA patients who had been treated using MAA at least 4 years prior to the study. A phone survey was used to determine the demographic characteristics of the patients, as well as to assess self-reported adherence to therapy, subjective long-term effectiveness, and patient experiences with the appliance. Descriptive statistics, Pearson Chi-square test, and independent samples t-test were used for data analysis. RESULTS Only 22 (32%) patients reported using the appliance regularly. Most of the non-adherent patients had stopped using their appliances in the first year (55%). The mean duration of appliance use was 33.5 months (Median: 12 months). No significant differences in appliance type, OSA severity, educational level, gender, marital status, income status, employment status or place of residence existed between adherent and non-adherent subjects. Adherent subjects were significantly younger than non-adherent subjects (Age: 50.6 ± 11.9 versus 56.1 ± 9.9, p < 0.05). The most common reasons reported by patients were inability to adapt to the appliance (62%) and pain in the temporomandibular joint (38%). The most common factors associated with continued usage were effectiveness (100%) and ease of use (64%). CONCLUSIONS The overall long-term nonadherence to MAA therapy in mild-to moderate OSA patients was high suggesting that barriers to MAA therapy adherence should be prevented to increase the efficiency of oral appliance treatment in OSA and achieve better outcomes for this disease.
Collapse
Affiliation(s)
- B Saglam-Aydinatay
- Department of Orthodontics, Faculty of Dentistry, Hacettepe University, Sihhiye, Ankara 06100, Turkey,
| | | |
Collapse
|
18
|
El-Solh AA, Homish GG, Ditursi G, Lazarus J, Rao N, Adamo D, Kufel T. A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder. J Clin Sleep Med 2017; 13:1327-1335. [PMID: 29065960 PMCID: PMC5656482 DOI: 10.5664/jcsm.6808] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/30/2017] [Accepted: 08/14/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Despite the overall improvement in posttraumatic stress disorder (PTSD) symptomatology with continuous positive airway pressure (CPAP) therapy, adherence to CPAP is far worse in veterans with PTSD compared to the general population with obstructive sleep apnea (OSA). The aim of this study was to compare the efficacy, adherence, and preference of CPAP versus mandibular advancement device (MAD) and the effect of these treatments on health outcomes in veterans with PTSD. METHODS Forty-two subjects with PTSD and newly diagnosed OSA by polysomnography were treated in a randomized, crossover trial of 12 weeks with CPAP alternating with MAD separated by a 2-week washout period. The primary outcome was the difference in titration residual apnea-hypopnea index (AHI) between CPAP and MAD. Secondary outcome measures included PTSD Checklist and health-related quality of life (Medical Outcomes Study 36-Item Short Form and Pittsburgh Sleep Quality Index). RESULTS Analyses were limited to the 35 subjects (mean age 52.7 ± 11.6 years) who completed the trial, regardless of compliance with their assigned treatment. CPAP was more efficacious in reducing AHI and improving nocturnal oxygenation than MAD (P < .001 and P = .04, respectively). Both treatments reduced PTSD severity and ameliorated scores of the Medical Outcomes Study Short Form 36 and Pittsburgh Sleep Quality Index, although no differences were detected between the CPAP and MAD arms. The reported adherence to MAD was significantly higher than CPAP (P < .001), with 58% preferring MAD to CPAP. CONCLUSIONS Although CPAP is more efficacious than MAD at improving sleep apnea, both treatment modalities imparted comparable benefits for veterans with PTSD in relation to PTSD severity and health-related quality of life. MAD offers a viable alternative for veterans with OSA and PTSD who are nonadherent to CPAP. CLINICAL TRIAL REGISTRATION Title: A Randomized Cross Over Trial of Two Treatments for Sleep Apnea in Veterans With Post-Traumatic Stress Disorder; URL: https://www.clinicaltrials.gov/ct/show/NCT01569022; Identifier: NCT01569022.
Collapse
Affiliation(s)
- Ali A. El-Solh
- VA Western New York Healthcare System, Buffalo, New York
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Gregory G. Homish
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
- Department of Community and Health Behavior, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
| | - Guy Ditursi
- VA Western New York Healthcare System, Buffalo, New York
| | - John Lazarus
- VA Western New York Healthcare System, Buffalo, New York
| | - Nithin Rao
- VA Western New York Healthcare System, Buffalo, New York
| | - David Adamo
- VA Western New York Healthcare System, Buffalo, New York
| | - Thomas Kufel
- VA Western New York Healthcare System, Buffalo, New York
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| |
Collapse
|
19
|
Haviv Y, Zini A, Almoznino G, Keshet N, Sharav Y, Aframian DJ. Assessment of interfering factors in non-adherence to oral appliance therapy in severe sleep apnea. Oral Dis 2017; 23:629-635. [DOI: 10.1111/odi.12633] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/26/2016] [Accepted: 12/26/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Y Haviv
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - A Zini
- Department of Community Dentistry; Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - G Almoznino
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
- Department of Oral Medicine; Oral and Maxillofacial Center; Tel-Hashomer, Medical Corps; Israel Defence Forces; Jerusalem Israel
| | - N Keshet
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - Y Sharav
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| | - DJ Aframian
- Department of Oral Medicine; Sedation and Maxillofacial Imaging Hebrew University - Hadassah School of Dental Medicine; Jerusalem Israel
| |
Collapse
|
20
|
Effect of jaw-opening exercise on prevention of temporomandibular disorders pain associated with oral appliance therapy in obstructive sleep apnea patients: A randomized, double-blind, placebo-controlled trial. J Prosthodont Res 2017; 61:259-267. [PMID: 28063976 DOI: 10.1016/j.jpor.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 11/11/2016] [Accepted: 12/02/2016] [Indexed: 11/22/2022]
Abstract
PURPOSE There are no studies on the prevention of temporomandibular joint and/or masticatory muscle pain (TMD pain) associated with oral appliance (OA) therapy in patients with obstructive sleep apnea (OSA). The aim of this study was to determine the effect of jaw-opening exercise on TMD pain associated with OA therapy in OSA patients. METHODS Twenty-five OSA patients without pain-related TMD were consecutively enrolled into a two-arm, randomized, double-blind, placebo-controlled trial. One group performed jaw-opening exercise (JE, n=13), and the other group performed placebo exercise (PE, n=12) for 1-month, and had started 2-weeks prior to insertion of an adjustable OA. TMD sign using the Research Diagnostic Criteria for Temporomandibular Disorders and TMD pain intensity using a visual analog scale (VAS) in the morning and daytime were evaluated at baseline (pre-exercise) and at 2-weeks, 1-month, and 3-months after OA insertion. RESULTS Pain-related TMD was not observed in the JE-group at all evaluation periods, although one subject in the PE-group was diagnosed with arthralgia at the 1-month evaluation. The JE-group showed lower morning and daytime VAS scores than the those of the PE-group at all evaluation periods, and significant group differences were found in terms of chewing pain and jaw-opening pain in the morning at the 1-month evaluation, and of jaw-opening pain during daytime at the 3-month evaluation (P<0.05). CONCLUSIONS Within the limitations of the study, jaw-opening exercise prior to OA therapy reduced the risk of TMD pain associated with OA use. Therefore, jaw-opening exercise may contribute to the prevention of TMD pain.
Collapse
|
21
|
|
22
|
Nikander K, von Hollen D, Larhrib H. The size and behavior of the human upper airway during inhalation of aerosols. Expert Opin Drug Deliv 2016; 14:621-630. [PMID: 27547842 DOI: 10.1080/17425247.2016.1227780] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION The mouth, the pharynx and the larynx are potential sites of aerosol deposition in the upper airway during inhalation of aerosolized drugs. The right angle bend of the lumen at the back of the mouth, the position of the tongue, the variable size and shape of the lumen in the pharynx and the larynx, and the breathing pattern could increase aerosol deposition in the upper airway and decrease lung deposition. Areas covered: In this review, the anatomy of the upper airway from the oral cavity to the glottis and the impact of mandibular protrusion and incisal opening on the size of the upper airway are highlighted. In addition, the impact of inhalation maneuvers, inhaler mouthpiece geometries and a stepped mouthpiece on the size of the upper airway are discussed. Expert opinion: The structure of the upper airway lumen does not have a fixed cross sectional area and is susceptible to both constriction and distension during inhalation. The size of the upper airway can be enlarged through mandibular protrusion and/or incisal opening which might decrease aerosol deposition in the upper airway and increase lung deposition.
Collapse
Affiliation(s)
| | - Dirk von Hollen
- b Respironics Inc., a Philips Healthcare Company , Murrysville , PA , USA
| | - Hassan Larhrib
- c Department of Pharmacy and Pharmaceutical Sciences , University of Huddersfield , Huddersfield , UK
| |
Collapse
|
23
|
Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing. J Clin Sleep Med 2016; 12:1175-83. [PMID: 27397656 PMCID: PMC4957196 DOI: 10.5664/jcsm.6062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). METHODS SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. RESULTS Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. CONCLUSIONS Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB.
Collapse
Affiliation(s)
- Thikriat S. Al-Jewair
- Clinical Assistant Professor and Program Director, Department of Orthodontics, State University of New York at Buffalo, Buffalo, NY
| | - Balgis O. Gaffar
- Lecturer, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Saudi Arabia
| | - Carlos Flores-Mir
- Professor, Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta Canada
| |
Collapse
|
24
|
Little known but important aspect of long term dental stability. Cranio 2016; 34:218. [DOI: 10.1080/08869634.2016.1186886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
25
|
To KW, Chan TO, Ng S, Ngai J, Hui DSC. Role of nasal positive end expiratory pressure valve as an alternative treatment for obstructive sleep apnoea in Chinese patients. Respirology 2015; 21:541-5. [DOI: 10.1111/resp.12703] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/18/2015] [Accepted: 09/02/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Kin Wang To
- Division of Respiratory Medicine; Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Tat O. Chan
- Division of Respiratory Medicine; Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Susana Ng
- Division of Respiratory Medicine; Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - Jenny Ngai
- Division of Respiratory Medicine; Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| | - David SC. Hui
- Division of Respiratory Medicine; Department of Medicine and Therapeutics; Prince of Wales Hospital; The Chinese University of Hong Kong; Shatin Hong Kong
| |
Collapse
|
26
|
Heidsieck DSP, de Ruiter MHT, de Lange J. Management of obstructive sleep apnea in edentulous patients: an overview of the literature. Sleep Breath 2015; 20:395-404. [PMID: 26585170 PMCID: PMC4792362 DOI: 10.1007/s11325-015-1285-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 10/20/2015] [Accepted: 10/28/2015] [Indexed: 11/26/2022]
Abstract
Purpose A high prevalence of obstructive sleep apnea (OSA) is seen in edentulous individuals. Treatment options for edentulous OSA patients however are limited with continuous positive airway pressure therapy (CPAP) remaining the current therapy of choice. As CPAP is associated with high non-adherence rates and oral appliance therapy requiring sufficient dentition, there is a clinical need for effective treatment strategies aimed at edentulous OSA patients. The purpose of this study was to present a thorough overview of the literature regarding (1) the effects of nocturnal denture wearing on OSA, (2) the outcomes of oral appliance therapy, and (3) surgical treatment in edentulous OSA patients. Methods A computer-assisted literature search was performed in the MEDLINE database on “edentulism” and “obstructive sleep apnea.” The search yielded a total of 34 original articles. Results A total of 20 studies were included after exclusion of non-relevant, duplicate, and non-English publications, comprising 4 randomized clinical trials, 12 case reports, and 4 cohort or cross-sectional studies. The outcomes of these studies were addressed in detail concerning nocturnal wearing of dentures, oral appliance therapy, and surgical treatment. Conclusion Currently, there is no consensus in the literature on the effects of nocturnal wearing of dentures on OSA. Several studies report the successful use of oral appliance therapy, including implant-retained mandibular advancement devices (MADs), in selected cases of edentulous patients with varying stages of OSA. Little evidence is available regarding outcomes of surgical procedures in edentulous patients. Based on the results of this literature overview, the paucity of effective evidence-based treatment strategies for edentulous OSA patients indicates the further need of clinical studies to improve clinical management.
Collapse
Affiliation(s)
- David S P Heidsieck
- Department of Oral and Maxillofacial Surgery, Suite A1-121, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Maurits H T de Ruiter
- Department of Oral and Maxillofacial Surgery, Suite A1-121, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Suite A1-121, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| |
Collapse
|
27
|
Wang X, Gong X, Yu Z, Gao X, Zhao Y. Follow-up study of dental and skeletal changes in patients with obstructive sleep apnea and hypopnea syndrome with long-term treatment with the Silensor appliance. Am J Orthod Dentofacial Orthop 2015; 147:559-65. [PMID: 25919101 DOI: 10.1016/j.ajodo.2015.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 01/01/2015] [Accepted: 01/01/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In this study, we aimed to investigate the dental and skeletal changes associated with long-term use of the Silensor appliance (Erkodent, Cologne, Germany) in patients with obstructive sleep apnea and hypopnea syndrome. METHODS The sample included 42 patients with mild-to-severe obstructive sleep apnea and hypopnea syndrome (mean apnea-hypopnea index, 27; range, 5-74) who had been treated with the Silensor appliance for an average of 4 years (range, 1-11 years). A questionnaire was used to assess of the side effects subjectively; the cephalometric analysis was conducted to identify the dental and skeletal changes of different treatment times objectively. RESULTS The Silensor appliance was associated with few subjective side effects. Most subjective side effects decreased after long-term use of the Silensor appliance. Significant changes after long-term use of the Silensor appliance were observed in incisor angulation, overbite, overjet, mandibular plane angle, anterior lower facial height, and anterior facial height. Overbite and skeletal changes at treatment times between 1 year and 3 years were a decrease in overbite and increases in the mandibular plane angle, anterior lower facial height, and anterior facial height. Overjet and other dental changes at treatment times longer than 3 years were a decrease in overjet, retroclination of the maxillary incisors, and proclination of the mandibular incisors. CONCLUSIONS The Silensor appliance was well tolerated and preferred by most subjects. Common but mild dental and skeletal changes resulted from using the appliance over a long period of time. The changes after 1 to 3 years of use were skeletal changes predominantly. Both dental and skeletal changes were observed simultaneously at treatment times longer than 3 years.
Collapse
Affiliation(s)
- Xiaoyu Wang
- Resident, Department of Dentistry, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xu Gong
- Lecturer, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Zhe Yu
- Lecturer, Department of Dentistry, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xuemei Gao
- Professor, Department of Orthodontics, School and Hospital of Stomatology, Peking University, Beijing, China
| | - Ying Zhao
- Professor, Department of Dentistry, Xuanwu Hospital, Capital Medical University, Beijing, China.
| |
Collapse
|
28
|
Piskin B, Karakoc O, Genc H, Akay S, Sipahi C, Erdem M, Karaman B, Gorgulu S, Yetkin S, Ayyildiz S. Effects of varying mandibular protrusion and degrees of vertical opening on upper airway dimensions in apneic dentate subjects. J Orofac Orthop 2015; 76:51-65. [PMID: 25613384 DOI: 10.1007/s00056-014-0259-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Accepted: 01/24/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Despite numerous studies investigating the dimensional and therapeutic effects of mandibular advancement splints (MASs), data regarding the effects of differently designed individual and non-adjustable MASs on the upper airway in fully dentate apneic subjects in the sagittal plane including comparison of these effects with a placebo device are sparse. The present study aimed to determine the dimensional changes in the sagittal plane created by differently designed MASs in the upper airway in fully dentate apneic subjects and to compare these changes with the effects of a placebo device. MATERIALS AND METHODS Magnetic resonance (MR) images of 9 dentate apneic subjects with 5 differently designed MASs and without a MAS were obtained. We measured the area of the entire pharynx (velopharynx, oropharynx, hypopharynx) on these MR images and compared the dimensional changes. RESULTS The dimensional changes triggered by two specific MASs (75% of the maximum mandibular protrusion with 5 mm vertical opening, and 75% of the maximum mandibular protrusion with 10 mm of vertical opening) in the entire pharynx in the sagittal plane were statistically significant compared to the other MASs (p < 0.05). The MAS effecting 75% of the maximum mandibular protrusion and 10 mm of vertical opening created a significant dimensional increase only in the velopharyngeal area among the three pharyngeal sites (p ≤ 0.003). CONCLUSION While the degree of mandibular protrusion created by the MAS affects the dimensions of the upper airway, the degree of the vertical opening exerts no significant dimensional effect in the sagittal plane in fully dentate apneic patients. The mandibular protrusion effect is comparatively larger in the velopharyngeal region.
Collapse
Affiliation(s)
- B Piskin
- Department of Prosthodontics, Gulhane Military Medical Academy, Ankara, Turkey
| | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Different therapeutic mechanisms of rigid and semi-rigid mandibular repositioning devices in obstructive sleep apnea syndrome. J Craniomaxillofac Surg 2014; 42:1650-4. [DOI: 10.1016/j.jcms.2014.05.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 11/24/2022] Open
|
30
|
Haviv Y, Bachar G, Aframian DJ, Almoznino G, Michaeli E, Benoliel R. A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study. Oral Dis 2014; 21:386-92. [PMID: 25207802 DOI: 10.1111/odi.12291] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/30/2014] [Accepted: 08/31/2014] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Oral appliances for treating severe obstructive sleep apnea (OSA) are recommended for patients who failed to comply with continuous positive airway pressure (CPAP) treatment. The objective of this study was to evaluate medium long-term outcome and success rates of oral appliances in patients with severe OSA. METHODS In a retrospective study, 52 OSA patients with an apnea-hypopnea index (AHI) ≥40, who did not tolerate CPAP treatment, were enrolled and fitted with a modified Herbst oral appliance. A 2-year mean follow-up including a second somnography was conducted in 36 of the patients. RESULTS A significant reduction (P < 0.0001) in the AHI was demonstrated between the initial somnography (55.25 ± 10.79,) and the followed one (17.74 ± 11.0, n = 36). Overall, 57.7% of total study subjects (n = 52) and 63.9% (n = 36) that had sequential sonmogarphy continued using the device. The reduction in AHI in the user group was 42.4 ± 3.1 (n = 23), which was significantly higher (P = 0.013) than in the non-user group (28.9 ± 17.2; n = 13). Moreover, 53% (n = 19) reached AHI of <15. CONCLUSIONS Oral appliances were found to be successful for treating for severe OSA after first-line treatment had failed.
Collapse
Affiliation(s)
- Y Haviv
- Department of Oral Medicine, Hebrew University - Hadassah School of Dental Medicine, Jerusalem, Israel
| | | | | | | | | | | |
Collapse
|
31
|
Banhiran W, Kittiphumwong P, Assanasen P, Chongkolwatana C, Metheetrairut C. Adjustable thermoplastic mandibular advancement device for obstructive sleep apnea: Outcomes and practicability. Laryngoscope 2014; 124:2427-32. [DOI: 10.1002/lary.24607] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 01/04/2014] [Accepted: 01/21/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Wish Banhiran
- Department of OtorhinolaryngologyFaculty of Medicine, Siriraj Hospital, Mahidol UniversityBangkok Thailand
| | - Phantipar Kittiphumwong
- Department of OtorhinolaryngologyFaculty of Medicine, Siriraj Hospital, Mahidol UniversityBangkok Thailand
| | - Paraya Assanasen
- Department of OtorhinolaryngologyFaculty of Medicine, Siriraj Hospital, Mahidol UniversityBangkok Thailand
| | - Cheerasook Chongkolwatana
- Department of OtorhinolaryngologyFaculty of Medicine, Siriraj Hospital, Mahidol UniversityBangkok Thailand
| | - Choakchai Metheetrairut
- Department of OtorhinolaryngologyFaculty of Medicine, Siriraj Hospital, Mahidol UniversityBangkok Thailand
| |
Collapse
|
32
|
Videoendoscopic diagnosis for predicting the response to oral appliance therapy in severe obstructive sleep apnea. Sleep Breath 2014; 18:809-15. [PMID: 24532144 DOI: 10.1007/s11325-014-0947-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Revised: 01/19/2014] [Accepted: 01/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE In treatment for obstructive sleep apnea (OSA), oral appliance (OA) therapy is indicated in patients with mild-moderate OSA. However, since patients with severe OSA in whom OA therapy was effective have also been reported, it may not be possible to determine indications for OA therapy based on the severity alone. The purpose of this study was to determine indications for OA therapy using endoscopy during wakefulness in patients with severe OSA. METHODS The subjects consisted of 36 patients (27 males and 9 females) diagnosed with severe OSA using all-night polysomnography. In each patient, a nasoendoscope was inserted in a horizontal position during nasal breathing, and morphological changes in the airway of the velopharynx and oro-hypopharynx with mandibular advancement were evaluated. RESULTS With mandibular advancement, the oro-hypopharynx was widened in all patients while the velopharynx was widened in 29 patients, but not in 7. The apnea hypopnea index (AHI) reduction rate after OA application was 79.8% (SD, 13.0%) in the group with and 40.6% (SD, 27.0%) in the group without velopharyngeal widening, being significantly different between the two groups. In the group showing velopharyngeal widening, evaluation of the direction of widening revealed two types: the "all-round type", which is circumferential widening in the anteroposterior-lateral directions, and the "lateral dominant type", which is widening mainly in the lateral direction. The AHI reduction rate was 80.1% (SD, 15.0%) for the all-round type and 79.3% (SD, 10.6%) for the lateral dominant type showing no significant difference. DISCUSSION (1) Concerning indications for OA therapy, findings in the velopharynx rather than those in the hypopharynx may be important. (2) The effects of OA therapy can be expected in the presence of velopharyngeal widening irrespective of its direction. Thus, to determine whether OA therapy is indicated, endoscopic evaluation of morphological changes in the velopharynx with mandibular advancement may be important.
Collapse
|
33
|
Bilston LE, Gandevia SC. Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea. J Appl Physiol (1985) 2014; 116:314-24. [DOI: 10.1152/japplphysiol.00539.2013] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The upper airway is a complex, multifunctional, dynamic neuromechanical system. Its patency during breathing requires moment-to-moment coordination of neural and mechanical behavior and varies with posture. Failure to continuously recruit and coordinate dilator muscles to counterbalance the forces that act to close the airway results in hypopneas or apneas. Repeated failures lead to obstructive sleep apnea (OSA). Obesity and anatomical variations, such as retrognathia, increase the likelihood of upper airway collapse by altering the passive mechanical behavior of the upper airway. This behavior depends on the mechanical properties of each upper airway tissue in isolation, their geometrical arrangements, and their physiological interactions. Recent measurements of respiratory-related deformation of the airway wall have shown that there are different patterns of airway soft tissue movement during the respiratory cycle. In OSA patients, airway dilation appears less coordinated compared with that in healthy subjects (matched for body mass index). Intrinsic mechanical properties of airway tissues are altered in OSA patients, but the factors underlying these changes have yet to be elucidated. How neural drive to the airway dilators relates to the biomechanical behavior of the upper airway (movement and stiffness) is still poorly understood. Recent studies have highlighted that the biomechanical behavior of the upper airway cannot be simply predicted from electromyographic activity (electromyogram) of its muscles.
Collapse
Affiliation(s)
- Lynne E. Bilston
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, New South Wales, Sydney, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia and Prince of Wales Clinical School, University of New South Wales, New South Wales, Sydney, Australia
| |
Collapse
|
34
|
Park JG, Morgenthaler TM, Gay PC. Novel and Emerging Nonpositive Airway Pressure Therapies for Sleep Apnea. Chest 2013; 144:1946-1952. [DOI: 10.1378/chest.13-0273] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
35
|
Doff MHJ, Hoekema A, Wijkstra PJ, van der Hoeven JH, Huddleston Slater JJR, de Bont LGM, Stegenga B. Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome: a 2-year follow-up. Sleep 2013; 36:1289-96. [PMID: 23997361 DOI: 10.5665/sleep.2948] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
STUDY OBJECTIVES Oral appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of oral appliance therapy and CPAP in patients with OSAS. DESIGN Cohort study of a previously conducted randomized clinical trial. SETTING University Medical Center, Groningen, The Netherlands. PATIENTS OR PARTICIPANTS One hundred three patients with OSAS. INTERVENTIONS CPAP and oral appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA). MEASUREMENTS AND RESULTS Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was < 5 or showed substantial reduction, defined as reduction in the index of at least 50% from the baseline value to a value of < 20 in a patient without OSAS symptoms while undergoing therapy. Regarding the proportions of successful treatments, no significant difference was found between oral appliance therapy and CPAP in treating mild to severe OSAS in a 2-year follow-up. More patients (not significant) dropped out under oral appliance therapy (47%) compared with CPAP (33%). Both therapies showed substantial improvements in polysomnographic and neurobehavioral outcomes. However, CPAP was more effective in lowering the AHI and showed higher oxyhemoglobin saturation levels compared to oral appliance therapy (P < 0.05). CONCLUSIONS Oral appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. CLINICAL TRIAL INFORMATION The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: oral appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.
Collapse
Affiliation(s)
- Michiel H J Doff
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
PURPOSE OF REVIEW This article introduces readers to the clinical presentation, diagnosis, and treatment of sleep-disordered breathing and reviews the associated risk factors and health consequences. RECENT FINDINGS Sleep-disordered breathing is associated with significant impairments in daytime alertness and cognitive function as well as adverse health outcomes. The initial treatment of choice is positive airway pressure. Improvements in technology and mask delivery systems have helped to make this treatment more comfortable and convenient for many patients. SUMMARY Sleep-disordered breathing, particularly in the form of obstructive sleep apnea, is highly prevalent in the general population and has important implications for neurology patients. Sleep-disordered breathing is characterized by repetitive periods of cessation in breathing, termed apneas, or reductions in the amplitude of a breath, known as hypopneas, that occur during sleep. These events are frequently associated with fragmentation of sleep, declines in oxygen saturation, and sympathetic nervous system activation with heart rate and blood pressure elevation. Obstructive sleep apnea, which represents cessation of airflow, develops because of factors such as anatomic obstruction of the upper airway related to obesity, excess tissue bulk in the pharynx, and changes in muscle tone and nerve activity during sleep. Central sleep apnea represents cessation of airflow along with absence or significant reduction in respiratory effort during sleep and is more commonly found in the setting of congestive heart failure, neurologic disorders, or cardiopulmonary disease.
Collapse
Affiliation(s)
- Lori Panossian
- University of Pennsylvania, Translational Research Laboratories, 125 South 31st St Room 2125, Philadelphia, PA 19104, USA.
| | | |
Collapse
|
37
|
Sharma S, Essick G, Schwartz D, Aronsky AJ. Sleep medicine care under one roof: a proposed model for integrating dentistry and medicine. J Clin Sleep Med 2013; 9:827-33. [PMID: 23946715 DOI: 10.5664/jcsm.2934] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Integrating oral appliance therapy into the delivery of care for sleeprelated breathing disorders has been a challenge for dental and medical professionals alike. We review the difficulties that have been faced and propose a multidisciplinary care delivery model that integrates dental sleep medicine and sleep medicine under the same roof with educational and research components. The model promises to offer distinct advantages to improved patient care, continuity of treatment, and the central coordination of clinical and insurance-related benefits.
Collapse
Affiliation(s)
- Sunil Sharma
- Jefferson Sleep Center, Thomas Jefferson University & Hospitals, Philadelphia, PA 19107, USA
| | | | | | | |
Collapse
|
38
|
Mathews AMV, Goh JPS, Teo LM. A Case Report on the Anaesthetic Management of Dexmedetomidine-Induced Sleep Endoscopy and Transoral Robotic Surgery for the Treatment of Obstructive Sleep Apnoea. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 44-year-old male presented with severe obstructive sleep apnoea (OSA) which persisted despite septoplasty, inferior turbinectomy, uvulopalatopharyngoplasty and tonsillectomy. He underwent a diagnostic drug-induced sleep endoscopy which showed his tongue base as another source of obstruction. This was followed by the first transoral robotic surgery (TORS) of the tongue base performed in our centre. We discuss the novel use of dexmedetomidine for drug-induced sleep endoscopy and the anaesthetic management of this challenging group of patients undergoing this new surgical procedure.
Collapse
Affiliation(s)
| | - June Pheck Suan Goh
- Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore
| | - Li Ming Teo
- Anaesthesia and Surgical Intensive Care, Singapore General Hospital, Singapore
| |
Collapse
|
39
|
M. Ester Hidalgo B, Gisela Fuchslocher K, Marisa Vargas I, M José Palacios F. Rol del ortodoncista en ronquidos y apneas obstructivas. REVISTA MÉDICA CLÍNICA LAS CONDES 2013. [DOI: 10.1016/s0716-8640(13)70187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
40
|
Iftikhar IH, Hays ER, Iverson MA, Magalang UJ, Maas AK. Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2013; 9:165-74. [PMID: 23372472 PMCID: PMC3544387 DOI: 10.5664/jcsm.2420] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is an independent risk factor for the development of hypertension. However the effect of continuous positive airway pressure (CPAP) on lowering systemic blood pressure (BP) in OSA patients has been conflicting. Oral appliance (OA) therapy is an important alternative therapy to CPAP for patients with mild to moderate OSA. OBJECTIVE To conduct a meta-analysis of studies which have evaluated the effect of OAs on BP in patients with OSA. DATA SOURCES Studies were retrieved by searching PubMed (all studies that were published until December 15, 2011) STUDY SELECTION Three independent reviewers screened citations to identify trials of the effect of OA on BP. DATA EXTRACTION Data from observational and randomized controlled trial (RCT) studies was extracted for pre- and post-treatment systolic, diastolic, and mean arterial blood pressure (SBP, DBP, and MAP). DATA SYNTHESIS A total of 7 studies that enrolled 399 participants met the inclusion criteria. The pooled estimate of mean changes and the corresponding 95% CIs for SBP, DBP, and MAP from each trial are -2.7 mm Hg (95% CI: -0.8 to -4.6), p-value 0.04; -2.7 mm Hg (95% CI: -0.9 to -4.6), p-value 0.004; and -2.40 mm Hg (95% CI: -4.01 to -0.80), p-value 0.003 (Figures 2-4). The pooled estimate of mean changes and the corresponding 95% CIs for nocturnal SBP, DBP, and MAP from each trial are -2.0 mm Hg (95% CI: 1.1 to -5.3), p-value 0.212; -1.7 mm Hg (95% CI: -0.1 to -3.2), p-value 0.03; and -1.9 mm Hg (95% CI: 1.3 to -5.1), p-value 0.255 (Figures 5-7) respectively. CONCLUSIONS The pooled estimate shows a favorable effect of OAs on SBP, MAP, and DBP. Most of the studies were observational. Therefore, more RCTs are warranted involving a larger number of patients and longer treatment periods to confirm the effects of OA on BP.
Collapse
Affiliation(s)
- Imran H Iftikhar
- University of South Carolina, School of Medicine, Columbia, SC, USA.
| | | | | | | | | |
Collapse
|
41
|
Zhao M, Barber T, Cistulli P, Sutherland K, Rosengarten G. Computational fluid dynamics for the assessment of upper airway response to oral appliance treatment in obstructive sleep apnea. J Biomech 2013; 46:142-50. [DOI: 10.1016/j.jbiomech.2012.10.033] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 10/23/2012] [Accepted: 10/26/2012] [Indexed: 10/27/2022]
|
42
|
Näpänkangas R, Raunio A, Sipilä K, Raustia A. Effect of mandibular advancement device therapy on the signs and symptoms of temporomandibular disorders. EJOURNAL OF ORAL MAXILLOFACIAL RESEARCH 2013; 3:e5. [PMID: 24422023 PMCID: PMC3886094 DOI: 10.5037/jomr.2012.3405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 12/04/2012] [Indexed: 11/25/2022]
Abstract
Objectives Mandibular advancement device therapy is effectively used in the treatment of
obstructive sleep apnea, but also several side effects in the masticatory
system have been reported. The aim of this study was to evaluate the
subjective symptoms and clinical signs of temporomandibular disorders
connected to mandibular advancement device therapy. Material and Methods The material consisted of 15 patients (9 men and 6 women, mean age 51.1
years, range 21 to 70 years) diagnosed with obstructive sleep apnea (OSA).
Subjective symptoms and clinical temporomandibular disorders (TMD) signs
were recorded at the beginning of the treatment (baseline) and at 1-month,
3-month, 6-month and 24-month follow-ups. The degree of TMD was assessed
using the anamnestic (Ai) and the clinical dysfunction index (Di) of
Helkimo. For assessing the effect of TMD the patients were divided in
discontinuing and continuing groups. Results According to Ai and Di, the severity of TMD remained unchanged during the
follow-up in most of the patients. Temporomandibular joint (TMJ) crepitation
was found more frequently in discontinuing patients at all follow-ups. The
difference was statistically significant (P < 0.05) at the six-month
follow-up. Masticatory muscle pain during palpation was a frequent clinical
sign at the baseline and during the follow-up period but the difference
between discontinuing and continuing patients was not significant. Conclusions It seems that signs and symptoms of temporomandibular disorders do not
necessarily increase during long-term mandibular advancement device therapy.
However, it seems that patients with clinically assessed temporomandibular
joint crepitation may discontinue their mandibular advancement device
therapy due to temporomandibular disorders.
Collapse
Affiliation(s)
- Ritva Näpänkangas
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Oulu Finland. ; Department of Oral and Maxillofacial Surgery, Oulu University Hospital Finland
| | - Antti Raunio
- Department of Oral and Maxillofacial Surgery, Oulu University Hospital Finland. ; Department of Oral and Maxillofacial Surgery, Institute of Dentistry, University of Oulu Finland
| | - Kirsi Sipilä
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Oulu Finland. ; Institute of Dentistry, University of Eastern Finland, Finland and Oral and Maxillofacial Department, Kuopio University Hospital Finland
| | - Aune Raustia
- Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Oulu Finland. ; Department of Oral and Maxillofacial Surgery, Oulu University Hospital Finland
| |
Collapse
|
43
|
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.
Collapse
|
44
|
Chen H, Lowe AA. Updates in oral appliance therapy for snoring and obstructive sleep apnea. Sleep Breath 2012; 17:473-86. [DOI: 10.1007/s11325-012-0712-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 01/27/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
|
45
|
Awad KM, Malhotra A, Barnet JH, Quan SF, Peppard PE. Exercise is associated with a reduced incidence of sleep-disordered breathing. Am J Med 2012; 125:485-90. [PMID: 22482846 PMCID: PMC3339801 DOI: 10.1016/j.amjmed.2011.11.025] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Revised: 11/04/2011] [Accepted: 11/04/2011] [Indexed: 01/13/2023]
Abstract
BACKGROUND The effect of exercise on sleep-disordered breathing is unknown. While diet and weight loss have been shown to reduce the severity of sleep-disordered breathing, it is unclear whether exercise has an independent effect. METHODS A population-based longitudinal epidemiologic study of adults measured the association between exercise and incidence and severity of sleep-disordered breathing. Hours of weekly exercise were assessed by 2 mailed surveys (1988 and 2000). Sleep-disordered breathing was assessed by 18-channel in-laboratory polysomnography at baseline and at follow-up. RESULTS Associations were modeled using linear and logistic regression, adjusting for body mass index, age, sex, and other covariates. Hours of exercise were associated with reduced incidence of mild (odds ratio 0.76, P=.011) and moderate (odds ratio 0.67, P=.002) sleep-disordered breathing. A decrease in exercise duration also was associated with worsening sleep-disordered breathing, as measured by the apnea-hypopnea index (β=2.368, P=.048). Adjustment for body mass index attenuated these effects. CONCLUSIONS Exercise is associated with a reduced incidence of mild and moderate sleep-disordered breathing, and decreasing exercise is associated with worsening of sleep-disordered breathing. The effect of exercise on sleep-disordered breathing appears to be largely, but perhaps not entirely, mediated by changes in body habitus.
Collapse
Affiliation(s)
- Karim M Awad
- Division of Sleep Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | | | |
Collapse
|
46
|
Lettieri CJ, Paolino N, Eliasson AH, Shah AA, Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med 2012; 7:439-45. [PMID: 22003337 DOI: 10.5664/jcsm.1300] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To compare the efficacy of adjustable and fixed oral appliances for the treatment of OSA. METHODS Retrospective review of consecutive patients with OSA treated with either adjustable or fixed oral appliances. Polysomnography was conducted before and during therapy. Effective treatment was defined as an apnea-hypopnea index (AHI) < 5 events/h or < 10 events/h with resolution of sleepiness (Epworth < 10). We compared efficacy rates between fixed and adjustable appliances and sought to identify factors associated with greater success. RESULTS We included 805 patients, 602 (74.8%) treated with an adjustable and 203 (25.2%) a fixed oral appliances. Among the cohort, 86.4% were men; mean age was 41.3 ± 9.2 years. Mean AHI was 30.7 ± 25.6, with 34.1% having mild (AHI 5-14.9), 29.2% moderate (AHI 15-29.9), and 36.8% severe (AHI ≥ 30) OSA. Successful therapy was significantly more common with adjustable appliances. Obstructive events were reduced to < 5/h in 56.8% with adjustable compared to 47.0% with fixed appliances (p = 0.02). Similarly, a reduction of events to < 10 with resolution of sleepiness occurred in 66.4% with adjustable appliances versus 44.9% with fixed appliances (p < 0.001). For both devices, success was more common in younger patients, with lower BMI and less severe disease. CONCLUSIONS Adjustable devices produced greater reductions in obstructive events and were more likely to provide successful therapy, especially in moderate-severe OSA. Fixed appliances were effective in mild disease, but were less successful in those with higher AHIs. Given these findings, the baseline AHI should be considered when selecting the type of oral appliance.
Collapse
Affiliation(s)
- Christopher J Lettieri
- Pulmonary, Critical Care, and Sleep Medicine, Walter Reed Army Medical Center, Washington, DC 20307, USA.
| | | | | | | | | |
Collapse
|
47
|
Pişkin B, Sipahi C, Köse M, Karakoç Ö, Şevketbeyoğlu H, Ataç GK. Use of an individual mandibular advancement device for an?obstructive sleep apnoea patient with facial paralysis: a short-term follow-up case report. J Oral Rehabil 2012; 39:472-8. [PMID: 22329406 DOI: 10.1111/j.1365-2842.2012.02287.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This case report aimed to describe the fabrication procedure and treatment efficacy of an individual, one-piece, non-adjustable mandibular advancement device (MAD) for a moderate obstructive sleep apnoea patient with facial paralysis (FP). Mandibular advancement device was fabricated with autopolymerising acrylic resin. The intermaxillary relations were recorded such as to fix the mandible at a protruded position with increased vertical dimension. Initial evaluation of the MAD was made with axial magnetic resonance imaging and polysomnography on the first day of usage. Following evaluations were made on the third and sixth month. After a follow-up period of 6 months, Apnoea/Hypopnea Index (AHI) significantly decreased from 26·7 to 3·0. However, the average oxygen saturation did not improve as expected initially. The MAD therapy decreased the AHI scores of a patient with FP. At the end of a follow-up period of 6 months, the patient did not report any serious complaint except temporary tooth pains.
Collapse
Affiliation(s)
- B Pişkin
- Gulhane Military Medical Academy, Department of Prosthodontics, Ankara MediSina Hospital, Van, Turkey
| | | | | | | | | | | |
Collapse
|
48
|
Abstract
Obstructive Sleep Apnoea (OSA) is increasingly recognised as a condition that not only causes excessive daytime sleepiness, but is also an important cardiovascular risk factor. Treatment of OSA should include conservative measures such as weight loss and positional therapy, the nuances of which are discussed in this article. However this in itself is not sufficient treatment for most patients. The first line of treatment for OSA that is recommended across the entire spectrum of disease is continuous positive airway pressure (CPAP) therapy. Indications for initiating CPAP are discussed, as well as possible alternatives to CPAP such as surgery or dental devices. In initiating CPAP treatment, machine-patient interface needs to be carefully considered, as there is a wide range of masks available. Factors to be considered in the choice of CPAP machine and mode are discussed. Finally, patient-specific factors such as patient acceptance of treatment, common problems encountered in CPAP follow-up and the importance of patient education are addressed.
Collapse
Affiliation(s)
- Thun How Ong
- Department of Respiratory and Critical Care Medicine, Sleep Disorders Unit, Singapore General Hospital
| |
Collapse
|
49
|
Steier J, Seymour J, Rafferty GF, Jolley CJ, Solomon E, Luo Y, Man WDC, Polkey MI, Moxham J. Continuous Transcutaneous Submental Electrical Stimulation in Obstructive Sleep Apnea. Chest 2011; 140:998-1007. [DOI: 10.1378/chest.10-2614] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
50
|
Mostafiz W, Dalci O, Sutherland K, Malhotra A, Srinivasan V, Darendeliler MA, Cistulli PA. Influence of oral and craniofacial dimensions on mandibular advancement splint treatment outcome in patients with obstructive sleep apnea. Chest 2011; 139:1331-1339. [PMID: 21292761 PMCID: PMC5989786 DOI: 10.1378/chest.10-2224] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/11/2010] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Mandibular advancement splints (MASs) can effectively treat obstructive sleep apnea (OSA); however, no validated and reliable prediction method for treatment outcome currently exists. The efficacy of MAS may relate to anatomic factors, including craniofacial size and upper-airway soft-tissue volume and anatomic balance between them. We aimed to assess whether craniofacial and oral measurements are associated with MAS treatment outcome. METHODS Dental impressions and lateral cephalometric radiographs were obtained from patients with OSA prior to commencing MAS treatment. Intertooth distances and palatal depths were measured on dental casts, and standard cephalometric analysis was performed with the addition of cross-sectional area (CSA) of the tongue and bony oral enclosure. Treatment outcome was determined by polysomnography. RESULTS Of 53 patients, 25 were complete responders (posttreatment apnea-hypopnea index [AHI] < 5/h), 17 were partial responders (≥ 50% AHI reduction), and 11 were nonresponders (< 50% AHI reduction). Cephalometric analyses did not reveal any significant differences between responders and nonresponders. Oral cavity measurements or CSA did not differ with treatment outcome; however, there was a trend toward a larger tongue CSA in complete vs partial and nonresponders (39.5 ± 1.3 cm(2) vs 35.5 ± 0.5 cm(2), P = .09). Tongue/oral enclosure CSA ratio, indicating a larger tongue for a given oral cavity size, was greater in complete responders (P = .012, n = 30). CONCLUSIONS Oral dimensions do not appear to differ between patients who respond and those who do not respond to MAS treatment. However, the larger tongue for a given oral cavity size in responders suggests that MAS may help to correct anatomic imbalance. Further research to assess whether the ratio between tongue and bony oral enclosure size may be useful in selecting patients for MAS treatment is warranted.
Collapse
Affiliation(s)
- Whitney Mostafiz
- Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, NSW, Australia; Harvard School of Dental Medicine, Boston, MA
| | - Oyku Dalci
- Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, NSW, Australia
| | - Kate Sutherland
- Woolcock Institute of Medical Research, University of Sydney, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Atul Malhotra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Vasanth Srinivasan
- Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, NSW, Australia
| | - M Ali Darendeliler
- Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, Sydney, NSW, Australia
| | - Peter A Cistulli
- Woolcock Institute of Medical Research, University of Sydney, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia.
| |
Collapse
|