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Wang W, Pang J, Zhang YX, Mo YM, Zhang J, Wei ZH. Clinical Effect of Personalized Adjustable Mandibular Advancement Device on Obstructive Sleep Apnea. Br J Hosp Med (Lond) 2024; 85:1-17. [PMID: 39212566 DOI: 10.12968/hmed.2024.0189] [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] [Indexed: 09/04/2024]
Abstract
Aims/Background: Mandibular advancement devices are effective in treating mild or moderate obstructive sleep apnea (OSA), but such devices that are commonly used in clinical settings require further improvement. In this study, we evaluated the clinical effects of personalized adjustable mandibular advancement devices on mild or moderate OSA. Methods: Forty patients with mild or moderate OSA were randomly divided into experimental (personalized adjustable device) and control (traditional device) groups. Side effects, including increased salivation, dry mouth, muscle aches, and temporomandibular joint discomfort, were assessed. Respiratory markers during sleep, including the apnea-hypopnea index, mean blood oxygen saturation, lowest blood oxygen saturation and maximum apnea time, were evaluated using polysomnography. The upper airway cross-sectional area and temporomandibular joint morphology and motion trajectory were evaluated using cone beam computed tomography. Results: Side effects were significantly lower in the experimental group than in the control group. Respiratory marker levels were significantly restored post-treatment. Soft palate- and tongue-pharyngeal cross-sectional areas were significantly increased in both groups, but temporomandibular joint morphology or motion trajectory remained unchanged. Conclusion: The personalized adjustable mandibular advancement devices may reduce side effects and are effective in treating patients with OSA. Clinical Trial Registration: The study was registered and approved by the Chinese Clinical Trial Registry (ChiCTR2400080306). https://www.chictr.org.cn/showproj.html?proj=206538.
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Affiliation(s)
- Wei Wang
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Jian Pang
- Department of Respiratory, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Yi-Xue Zhang
- Department of Respiratory, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Yi-Meng Mo
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Jiao Zhang
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
| | - Zhen-Hui Wei
- Department of Stomatology, Air Force Hospital from Northern Theater of PLA, Shenyang, Liaoning, China
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Liao J, Shi Y, Gao X, Zhang B, Li Y, Xu W, Han D. Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:1270-1279. [PMID: 38363016 DOI: 10.1002/ohn.676] [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: 09/20/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Oral appliances (OA) are the recommended first-line option for mild-to-moderate obstructive sleep apnea (OSA)-hypopnea. However, there is a lack of evidence to compare the effectiveness of OA in different severities of OSA. The purpose of this study was to investigate the therapeutic effects of preferred OA (tongue retention devices [TRD] and mandibular advancement device [MAD]) in different severities of OSA. DATA SOURCES PubMed/MEDLINE, The Cochrane Library, and Web of Science. REVIEW METHODS Concentrating on the efficacy of OA, 2 authors searched 3 databases up to November 10, 2022, independently and systematically, following the requirements and steps of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Ultimately, 42 studies with 2265 patients met the criteria for inclusion in OA. Overall, the apnea-hypopnea index improved by 48% (5.6), 67% (14.92), and 62% (32.1) in mild, moderate, and severe OSA, respectively. Subgroup analysis showed a significant difference between MAD and TRD efficacy in mild OSA (58% vs 21%). However, no significant difference was seen between MAD and TRD efficacy in moderate (67% vs 66%) and severe OSA (66% vs 51%). There was no significant difference across groups in the Epworth Sleepiness Scale, oxygen desaturation index (ODI), and lowest oxygen saturation (LSAT). CONCLUSION Overall, both TRD and MAD are effective treatments for moderate and severe OSA. MAD is efficacious in mild OSA, while TRD requires further validation. Furthermore, mild-moderate and severe OSA received similar improvements in sleepiness, ODI, and LSAT. This study complements the evidence for the efficacy of OA.
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Affiliation(s)
- Jianhong Liao
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Yunhan Shi
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Xiang Gao
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Bowen Zhang
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Yanru Li
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Wen Xu
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Demin Han
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
- Xinjiang Key Laboratory of Biopharmaceuticals and Medical Devices, Xinjiang Medical University, Xinjiang, China
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Lv R, Liu X, Zhang Y, Dong N, Wang X, He Y, Yue H, Yin Q. Pathophysiological mechanisms and therapeutic approaches in obstructive sleep apnea syndrome. Signal Transduct Target Ther 2023; 8:218. [PMID: 37230968 DOI: 10.1038/s41392-023-01496-3] [Citation(s) in RCA: 46] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a common breathing disorder in sleep in which the airways narrow or collapse during sleep, causing obstructive sleep apnea. The prevalence of OSAS continues to rise worldwide, particularly in middle-aged and elderly individuals. The mechanism of upper airway collapse is incompletely understood but is associated with several factors, including obesity, craniofacial changes, altered muscle function in the upper airway, pharyngeal neuropathy, and fluid shifts to the neck. The main characteristics of OSAS are recurrent pauses in respiration, which lead to intermittent hypoxia (IH) and hypercapnia, accompanied by blood oxygen desaturation and arousal during sleep, which sharply increases the risk of several diseases. This paper first briefly describes the epidemiology, incidence, and pathophysiological mechanisms of OSAS. Next, the alterations in relevant signaling pathways induced by IH are systematically reviewed and discussed. For example, IH can induce gut microbiota (GM) dysbiosis, impair the intestinal barrier, and alter intestinal metabolites. These mechanisms ultimately lead to secondary oxidative stress, systemic inflammation, and sympathetic activation. We then summarize the effects of IH on disease pathogenesis, including cardiocerebrovascular disorders, neurological disorders, metabolic diseases, cancer, reproductive disorders, and COVID-19. Finally, different therapeutic strategies for OSAS caused by different causes are proposed. Multidisciplinary approaches and shared decision-making are necessary for the successful treatment of OSAS in the future, but more randomized controlled trials are needed for further evaluation to define what treatments are best for specific OSAS patients.
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Affiliation(s)
- Renjun Lv
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xueying Liu
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China
| | - Yue Zhang
- Department of Geriatrics, the 2nd Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Na Dong
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Xiao Wang
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Yao He
- The First School of Clinical Medicine, Lanzhou University, Lanzhou, 730000, China
| | - Hongmei Yue
- Department of Pulmonary and Critical Care Medicine, The First Hospital of Lanzhou University, Lanzhou, 730000, China.
| | - Qingqing Yin
- Department of Geriatric Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
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Vimal J, Dutt P, Singh N, Singh BP, Chand P, Jurel S. To compare different non-surgical treatment modalities on treatment of obstructive sleep apnea: A systematic review and meta-analysis. J Indian Prosthodont Soc 2022; 22:314-327. [PMID: 36511065 PMCID: PMC9709867 DOI: 10.4103/jips.jips_261_22] [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: 05/25/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/07/2022] Open
Abstract
The study aimed to assess the effect of mandibular advancement device (MAD) in patients with obstructive sleep apnea for reduction in 24-h mean blood pressure, sleep quality, Apnea Hypopnea Index (AHI), and patient compliance, compared to continuous positive airway pressure (CPAP), other interventions, or no treatment. Three different databases such as PubMed, EMBASE, and CENTRAL were searched using different search terms till July 2021 as per the inclusion and exclusion criteria. After inclusion of studies, data extraction including risk of bias assessment was done. For each study, we used odds ratio, mean difference, and 95% confidence interval to assess and synthesize the outcomes. The quality of evidence was evaluated as per the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Twenty-one randomized controlled trials were included: 497 patients in the MAD group, 239 patients in the CPAP group, and 274 patients in the sham group. In MAD-CPAP comparison, the results favored CPAP in the reduction of AHI of 3.48 (1.76-5.19). However, unclear results were found for sleep quality measured as Epworth Sleepiness Scale (ESS), patient compliance, and 24-h mean blood pressure. In MAD-sham comparison, the results favored MAD in the reduction of AHI of - 8.39 (-10.90--5.88] and ESS of - 0.91 (-1.70--0.12) and favored sham in terms of patient compliance while, unclear results for 24-h mean blood pressure. The GRADE score indicated that the quality of evidence is very low, low, and moderate for different outcomes. CPAP in comparison to MAD and MAD in comparison to sham showed a significant AHI reduction. However, patient compliance and 24-h mean blood pressure were not significantly different in MAD-CPAP or MAD-sham. Quality of evidence is very low and low when MAD was compared with CPAP and sham, respectively, for AHI.
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Affiliation(s)
- Jyotsna Vimal
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pranjali Dutt
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Nishi Singh
- Department of Conservative Dentistry and Endodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Balendra P. Singh
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Pooran Chand
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sunit Jurel
- Department of Prosthodontics, Faculty of Dental Sciences, King George's Medical University, Lucknow, Uttar Pradesh, India
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Belkhode V, Godbole S, Nimonkar S, Parhad S, Nimonkar P. Oral appliances for obstructive sleep apnea: Emerging issues, upcoming challenges, and possible solutions. J Family Med Prim Care 2021; 10:3172-3175. [PMID: 34760725 PMCID: PMC8565156 DOI: 10.4103/jfmpc.jfmpc_54_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 07/05/2021] [Accepted: 07/09/2021] [Indexed: 11/04/2022] Open
Abstract
Background As per the current epidemiological studies, the prevalence of obstructive sleep apnea (OSA) among the adult population is very high. Oral appliances (OAs) have emerged as the most recommended alternative treatment option for mild to moderate OSA. Objective The objective of this article is to propose or develop a new design of OA named "customized maxillary oral appliance (CMOA)," for managing moderate OSA syndrome. Methods The design proposed in this article is first of its kind that is fabricated on the maxillary arch. CMOA is developed by combining the principles of the three most popular OAs used in OSA, namely, soft palate lifters, tongue retaining devices, and mandibular advancement devices. Conclusions Given the potential impact of OSA on general and mental health and the side effects of existing appliances, there is a need for a new remedy to be introduced in the field of sleep medicine. This novel design can provide a new therapeutic option for patients with moderate OSA.
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Affiliation(s)
- Vikram Belkhode
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Surekha Godbole
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sharayu Nimonkar
- Department of Prosthodontics, Sharad Pawar Dental College and Hospital, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
| | - Sameer Parhad
- Department of Orthodontics, Dr. Rajesh Ramdasji Kambe Dental College and Hospital, Akola, Maharashtra, India
| | - Pranali Nimonkar
- Trauma Care Centre, Government Medical College and Hospital, Nagpur, Maharashtra, India
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