Four novel prosthodontic methods for managing upper airway resistance syndrome: An investigative analysis revealing the efficacy of the new nasopharyngeal aperture guard appliance

Double Barrel Nasal Trumpets to Prevent Upper Airway Obstruction after Nasal and Non-Nasal Surgery

Objectives

During anesthesia emergence, patients are extubated and the upper airway can become vulnerable to obstruction. Nasal trumpets can help prevent obstruction. However, we have found no manuscript describing how to place nasal trumpets after nasal surgery (septoplasties or septorhinoplasties), likely because (1) the lack of space with nasal splints in place and (2) surgeons may fear that removing the trumpets could displace the splints. The objective of this manuscript is to describe how to place nasal trumpets even with nasal splints in place.

Materials and Methods

The authors describe techniques (Double Barrel Technique and Modified Double Barrel Technique) that were developed over three years ago and have been used in patients with obstructive sleep apnea (OSA) and other patients who had collapsible or narrow upper airways (i.e., morbidly obese patients).

Results

The technique described in the manuscript provides a method for placing one long and one short nasal trumpet in a manner that helps prevent postoperative upper airway obstruction. The modified version describes a method for placing nasal trumpets even when there are nasal splints in place. Over one-hundred patients have had nasal trumpets placed without postoperative oxygen desaturations.

Conclusions

The Double Barrel Technique allows for a safe emergence from anesthesia in patients predisposed to upper airway obstruction (such as in obstructive sleep apnea and morbidly obese patients). To our knowledge, the Modified Double Barrel Technique is the first description for the use of nasal trumpets in patients who had nasal surgery and who have nasal splints in place.

Long-Term Oral Appliance Therapy Improves Daytime Function and Mood in Upper Airway Resistance Syndrome Patients

Objectives

To evaluate the long-term effects of an oral appliance on clinical symptoms, respiratory sleep parameters, sleep quality, and sustained attention in patients with upper airway resistance syndrome (UARS) were compared with placebo.

Methods

This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. All patients completed the Pittsburgh Sleep Quality Index (PSQI), the Functional Outcomes of Sleep Questionnaire, the Beck Anxiety and Depression Inventories, underwent full-night polysomnography, multiple sleep latency test, and Psychomotor Vigilance Test (PVT). Evaluations were performed before and after 1.5 years of treatment.

Results

RDI, number of respiratory effort-related arousal, percentage of total sleep time with flow limitation, and arousal index significantly decreased after 1.5 years of MAD treatment. PSQI total score improved, severity of depression symptoms decreased, and mean reaction time in the PVT, based on the first measurement taken at 8:00 am, significantly decreased (p = .03) at the end of the protocol.

Conclusions

The MAD was effective in decreasing respiratory events in UARS patients. For UARS, 1.5 years of oral appliance therapy also improved sleep quality and sustained attention, and decreased the severity of depression symptoms.

Clinical Trial

Efficacy of Oral Appliance for Upper Airway Resistance Syndrome: Randomized, Parallel, Placebo-Controlled Study, NCT02636621.

Treatment of upper airway resistance syndrome in adults: Where do we stand?

OBJECTIVE

To evaluate the available literature regarding Upper Airway Resistance Syndrome (UARS) treatment.

METHODS

Keywords "Upper Airway Resistance Syndrome," "Sleep-related Breathing Disorder treatment," "Obstructive Sleep Apnea treatment" and "flow limitation and sleep" were used in main databases.

RESULTS

We found 27 articles describing UARS treatment. Nasal continuous positive airway pressure (CPAP) has been the mainstay therapy prescribed but with limited effectiveness. Studies about surgical treatments had methodological limitations. Oral appliances seem to be effective but their efficacy is not yet established.

CONCLUSION

Randomized controlled trials with larger numbers of patients and long-term follow-up are important to establish UARS treatment options.

Nasopharyngeal airway stenting devices for obstructive sleep apnoea: a systematic review and meta-analysis

OBJECTIVE

To systematically review outcomes of adults with obstructive sleep apnoea treated with nasopharyngeal airway stenting devices.

METHODS

Medline, Scopus, Web of Science and the Cochrane Library databases were searched, and data on device use and tolerability, sleepiness, oxygen saturation, apnoea index, apnoea-hypopnoea index, and sleep quality were collected.

RESULTS

Of 573 potential studies, 29 were retrieved for detailed evaluation and 16 met the study criteria. Polysomnography data for patients treated with nasal trumpets as an isolated therapy were pooled for meta-analysis. The mean apnoea index ± standard deviation, for 53 patients, decreased from 32.4 ± 15.9 to 9.0 ± 7.2 episodes per hour (p < 0.00001). The mean apnoea-hypopnoea index, for 193 patients, decreased from 44.1 ± 18.9 to 22.7 ± 19.3 episodes per hour (p < 0.00001). The mean lowest oxygen saturation, for 193 patients, increased from 66.5 ± 14.2 to 75.5 ± 13.9 per cent (p < 0.00001).

CONCLUSION

Some studies have demonstrated limited effectiveness and low tolerability of nasopharyngeal airway stenting devices, while other studies have shown a significant benefit in treating obstructive sleep apnoea, with a high level of patient acceptance. Nasal trumpets have been successful in decreasing airway obstruction in the short term.

Effect of thermocycling on the shear bond strength of different resins bonded to thermoplastic foil applied in occlusal splint therapy

PURPOSE

Temporomandibular disorders are a group of symptoms related to the impaired function of the temporomandibular joints and associated muscles. Occlusal splint therapy is a common treatment in the aforementioned syndrome. One of the methods of manufacturing occlusal splints is to place a polymer on thermoplastic foil. The aim of this study was to evaluate the shear bond strength of light- and self-cured resins bonded to thermoplastic foil dependent on artificial aging.

MATERIALS AND METHODS

Thirty cylinders composed of light-cured resin and 30 cylinders made of self-cured resin were attached to 60 rectangular thermoplastic plates. All specimens were divided into six groups. A control study was conducted for groups 1 and 2. The other preparation groups were subjected to thermocycling by setting appropriately 1000 cycles for groups 3 and 4 and 3000 cycles for groups 5 and 6 in distilled water. Bond strength was measured in a universal testing machine. The results were subjected to statistical analysis using the Mann-Whitney U test (p ≤ 0.05).

RESULTS

The statistics revealed that the values of the shear bond strength for specimens composed of self-cured resin after 1000 and 3000 thermocycles were significantly higher than on those made of light-cured resin (p = 0.003 and p = 0.002).

CONCLUSION

The shear bond strength between the self-cured resin and the thermoplastic foil was higher and more resistant to aging than the shear bond strength between the light-cured resin and the thermoplastic foil.