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Ioerger P, Afshari A, Hentati F, Strober W, Kallogjeri D, Ju YE, Piccirillo JF. Mandibular Advancement vs Combined Airway and Positional Therapy for Snoring: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024:2819305. [PMID: 38780959 PMCID: PMC11117146 DOI: 10.1001/jamaoto.2024.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
Importance Approximately 150 million individuals in the US snore in the absence of obstructive sleep apnea (primary snoring), but few studies have examined the efficacy of treatments for snoring or evaluated the effect of snoring in sleeping partners. Objective To evaluate the efficacy of 2 treatments for primary snoring. Design, Setting, and Participants This pilot randomized clinical trial that included a convenience sample of people who snore without sleep apnea and their sleeping partner who underwent 4 weeks of snoring treatment was conducted at an academic medical center between October 3, 2022, and July 3, 2023. Interventions Fifty couples were randomized to either use a mandibular advancement device (MAD) or receive combined airway and positional therapy (CAPT; external nasal dilator, nasal saline lavage with mometasone, mouth taping, and lateral positional therapy). Main Outcome and Measure Percentage of sleeping partners who reported that their partner's snoring was either very much improved or much improved (responder) on the Clinical Global Impression of Improvement scale. Results A total of 42 dyads completed the study; 23 (55%) were randomized to MAD and 19 (45%) to CAPT. Among people who snore, 26 (62%) were female, and the mean (SD) age was 48 (14) years. Of 23 dyads randomized to MAD, 21 people who snore (91%) were rated by the sleeping partner as a responder, while 11 of the 19 dyads (58%) randomized to CAPT were rated by the sleeping partner as responder, resulting in a difference of 33 percentage points (95% CI, 8-58) and a number needed to treat of 3. Of the 10 participants who were withdrawn, 4 were withdrawn due to adverse effects of the treatment that were evenly distributed between the MAD (n = 2) and CAPT (n = 2) groups. Conclusion and Relevance The results of this randomized clinical trial showed that the MAD may be more effective than CAPT for treating primary snoring, while both treatment options were found to reduce primary snoring. Physicians should have a patient-centered discussion to determine which treatment is best for individual patients with primary snoring, weighing convenience, adverse effects, and cost as factors. Trial Registration ClinicalTrials.gov Identifier: NCT05756647.
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Affiliation(s)
- Patrick Ioerger
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- University of Kansas Medical Center, Kansas City
| | - Azadeh Afshari
- Department of Maxillofacial Prosthodontics, Barnes-Jewish Hospital, St Louis, Missouri
| | - Firas Hentati
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - William Strober
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery
| | - Yo-El Ju
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri
- Center on Biological Rhythms and Sleep, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Jay F. Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Editor in Chief, JAMA Otolaryngology–Head & Neck Surgery
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Jafarimehrabady N, Scribante A, Defabianis P, Merlati G, Vitale MC. A Systematic Review of Oral Modifications Caused by the Prolonged Application of Continuous Positive Airway Pressure (CPAP) and Intraoral Appliances in Patients with Obstructive Sleep Apnea (OSA). BIOMED RESEARCH INTERNATIONAL 2024; 2024:9361528. [PMID: 38435538 PMCID: PMC10907106 DOI: 10.1155/2024/9361528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Objective Prolonged use of oral devices as a substitute for traditional treatments has been studied in relation to the dental and skeletal changes associated with obstructive sleep apnea syndrome (OSA), which is a sleep-breathing disorder. Materials and Methods A review of articles indexed in PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, and CINHAL databases in September 2022 based on MeSH-based keywords with "dental and skeletal" and "oral appliance" and "obstructive sleep apnea" was examined to ensure that the keywords alone or cross-linked, depending on which base of the searched data, were used. 16 articles out of 289 articles were included in the research, and 273 articles were excluded due to lack of study. Conclusions CPAP treatment has limited dental or skeletal effects in short-term or long-term use. OAs and MADs show significant dental changes with prolonged use. MAS and TSD are more effective in short-term goals than CPAP. OAs' increase may cause dental and skeletal changes. MPD shows notable cephalometric alterations.
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Affiliation(s)
- Niloofar Jafarimehrabady
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Andrea Scribante
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Patrizia Defabianis
- Department of Surgical Sciences, C.I.R. Dental School-Section of Pediatric Dentistry, University of Turin, Turin, Italy
| | - Giuseppe Merlati
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Marina Consuelo Vitale
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
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Raoof M, Verhoeff MC, Kooshki R, Aarab G, Lobbezoo F. Self-reported oral moistening disorders in obstructive sleep apnoea: A scoping review. J Oral Rehabil 2024; 51:226-239. [PMID: 37282351 DOI: 10.1111/joor.13532] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is a highly prevalent problem with significant consequences. Continuous positive airway pressure (CPAP) and oral mandibular advancement device (MAD) are considered the standard treatments for OSA. Patients may experience self-reported oral moistening disorders (OMDs) (i.e. xerostomia or drooling) at the beginning, throughout and after treatment. This affects oral health, quality of life and treatment effectiveness. The exact nature of the associations between OSA and self-reported OMD is still unknown. We aimed to provide an overview of the associations between self-reported OMD on the one hand and OSA and its treatment (namely CPAP and MAD) on the other hand. In addition, we sought to determine whether OMD affects treatment adherence. MATERIALS AND METHODS A literature search in PubMed was performed up to 27 September 2022. Two researchers independently assessed studies for eligibility. RESULTS In total, 48 studies were included. Thirteen papers investigated the association between OSA and self-reported OMD. They all suggested an association between OSA and xerostomia but not between OSA and drooling. The association between CPAP and OMD was addressed in 20 articles. The majority of studies have indicated xerostomia as a CPAP side effect; however, some have observed that xerostomia diminishes with CPAP therapy. In 15 papers, the association between MAD and OMD was investigated. In most publications, both xerostomia and drooling have been described as common side effects of MADs. These side effects are often mild and transient, and they improve as patients continue to use their appliance. Most studies found that these OMDs do not cause or are not a strong predictor of non-compliance. CONCLUSION Xerostomia is a common side effect of CPAP and MAD, as well as a significant symptom of OSA. It may be regarded as one of the indicators of sleep apnoea. Moreover, MAD therapy can be associated with OMD. However, it seems that OMD may be mitigated by being adherent to the therapy.
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Affiliation(s)
- Maryam Raoof
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Merel C Verhoeff
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Razieh Kooshki
- Department of Biology, Faculty of Sciences, Lorestan University, Khorramabad, Iran
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Ciavarella D, Campobasso A, Conte E, Burlon G, Guida L, Montaruli G, Cassano M, Laurenziello M, Illuzzi G, Tepedino M. Correlation between dental arch form and OSA severity in adult patients: an observational study. Prog Orthod 2023; 24:19. [PMID: 37246168 DOI: 10.1186/s40510-023-00464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 03/27/2023] [Indexed: 05/30/2023] Open
Abstract
BACKGROUND The role of interdental widths and palatal morphology on the development of obstructive sleep apnea (OSA) has not been well investigated in adult patients yet. The aim of this paper was to assess the morphology of maxilla and mandibular dental arches on three-dimensional (3D) casts and to correlate these measurements with the severity of OSA. METHODS Sixty-four patients (8 women and 56 men, mean age 52.4) with a diagnosis of mild-to-moderate OSA were retrospectively enrolled. On each patient, home sleep apnea test and 3D dental models were collected. Apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) were recorded, as well as the dental measurements including inter-molar distance, anterior and posterior widths of maxillary and mandibular arches, upper and lower arch lengths, palatal height, and palatal surface area. The respiratory and dental variables were then correlated. RESULT A statistically inverse correlation was found between ODI and anterior width of lower arch, maxillary arch length, palatal height, and palatal area. AHI showed a significant inverse correlation with anterior width of mandibular arch and maxillary length. CONCLUSION A significant inverse correlation between maxillary and mandibular morphology and respiratory parameters was shown in the present paper.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Elisa Conte
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy.
| | - Giuseppe Burlon
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Laura Guida
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Graziano Montaruli
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Michele Cassano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Gaetano Illuzzi
- Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli, 50, 71122, Foggia, Italy
| | - Michele Tepedino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Zhang X, Zhang N, Yang Y, Wang S, Yu P, Guan BY, Wang CX. Living alone and health-related quality of life among adults with obstructive sleep apnea in a single-center cohort study. Sleep Breath 2023; 27:221-227. [PMID: 35352266 PMCID: PMC8964248 DOI: 10.1007/s11325-022-02604-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 03/04/2022] [Accepted: 03/17/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the impact of a solitary lifestyle on health-related quality of life (HRQoL) in adults with obstructive sleep apnea (OSA). METHODS This was a prospective cohort study; patients diagnosed with OSA but not receiving continuous positive airway pressure (CPAP) therapy were enrolled in our study. These participants completed basic information and the Short Form-36 Health Survey (SF-36) at baseline and were divided into the living alone and living with others groups. Telephone follow-up was performed 1 year later to re-evaluate the SF-36. Differences in health status between and within groups were assessed. In addition, variables associated with changes in the health of the whole population were examined. RESULTS A total of 402 patients with OSA were enrolled, including 120 in the living alone group and the rest in the living with others group. After a year, mental health scores of the living alone group decreased (55.7 ± 21.5 versus 54.1 ± 22.7, p = 0.001), while physical functioning scores of the living with others group increased significantly (82.1 ± 24.7 versus 82.6 ± 24.2, p = 0.006). In the whole population, the determinants of mental health change after 1 year from baseline were alcohol drinking (beta coefficient - 1.169, 95% CI - 2.03 to - 0.309, p = 0.008) and solitary living (beta coefficient - 1.135, 95% CI - 2.072 to - 0.199, p = 0.018). CONCLUSION Regarding all initial variables, alcohol drinking and solitary living seem to be the predictors of mental health change of patients with OSA in China. We speculate that to improve the quality of life of such people, the medical staff could provide certain social support for them.
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Affiliation(s)
- Xuan Zhang
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Ning Zhang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
- Department of Clinical Psychology, Capital Medical University, Beijing, China
| | - Yang Yang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shuo Wang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Ping Yu
- Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
| | - Bo-Yuan Guan
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Chun-Xue Wang
- Department of Neuropsychiatry & Behavioral Neurology and Clinical Psychology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, China.
- China National Clinical Research Center for Neurological Diseases, Beijing, China.
- Department of Clinical Psychology, Capital Medical University, Beijing, China.
- Beijing Institute of Brain Disorders, Beijing, China.
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Sarkis LM, Jones AC, Ng A, Pantin C, Appleton SL, MacKay SG. Australasian Sleep Association position statement on consensus and evidence based treatment for primary snoring. Respirology 2023; 28:110-119. [PMID: 36617387 PMCID: PMC10108143 DOI: 10.1111/resp.14443] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/11/2022] [Indexed: 01/09/2023]
Abstract
Primary snoring impacts a significant portion of the adult population and has the potential to significantly impair quality of life. The purpose of these guidelines is to provide evidence-based recommendations to assist Australasian practitioners in the management of adult patients who present with primary snoring without significant obstructive sleep apnoea. The Timetable, Methodology and Standards by which this Position Statement has been established is outlined in the Appendix S1. The main recommendations are: Weight loss, and reduced alcohol consumption should be recommended, where appropriate If clinical judgement dictates, benzodiazepine and opioid reduction or avoidance may be advised Positional therapy should be considered in supine dominant snorers In dentate patients, Mandibular advancement devices (MAD) should be recommended as a first line treatment following assessment by both an appropriate Dentist and Sleep physician Continuous positive airway pressure (CPAP) devices may be recommended in patients with primary snoring in those already committed to their use or willing to try Surgical treatment of primary snoring by an appropriately credentialled surgeon may be advised and includes nasal (adjunctive), palatal and other interventions This position statement has been designed based on the best available current evidence and our combined expert clinical experience to facilitate the management of patients who present with primary snoring. It provides clinicians with a series of both non-surgical and surgical options with the aim of achieving optimal symptom control and patient outcomes. This is the first such set of recommendations to be established within Australasia and has also been reviewed and endorsed by the Australasian Sleep Association.
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Affiliation(s)
- Leba M Sarkis
- Otolaryngology Head and Neck Surgery Department, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew C Jones
- Respiratory and Sleep Medicine Department, The Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Andrew Ng
- Centre for Sleep Disorders & Respiratory Failure St George Hospital, The Lucas Institute NSW, Australia
| | | | - Sarah L Appleton
- Flinders Health and Medical Research Institute- Sleep Health (Adelaide Institute for Sleep Health), College of Medicine of Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Stuart G MacKay
- Otolaryngology Head and Neck Surgery Department, The Wollongong Hospital, Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, New South Wales, Australia
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Xu Y, Wu H, Lu X. Influence of continuous positive airway pressure on lipid profiles of obstructive sleep apnea: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31258. [PMID: 36281141 PMCID: PMC9592280 DOI: 10.1097/md.0000000000031258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND To investigate the influence of continuous positive airway pressure (CPAP) on lipid profiles of the patients with obstructive sleep apnea (OSA) in this meta-analysis. METHODS Relevant studies reporting the correlation between CPAP and lipid profiles of OSA patients were searched in Pubmed, Cochrane Library and Embase before January 1, 2021. Data of eligible studies were extracted and analyzed using the fixed-effect or random-effect model. Standard mean difference (SMD) and 95% confidence interval (95% CI) were calculated to assess such influence. Subgroup analysis based on CPAP duration was further performed. STATA 12.0 was used in this meta-analysis. RESULTS A total of 12 independent randomized controlled studies involved 1129 OSA patients were recruited in this meta-analysis. The analyzed lipid profiles included total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL) and high density lipoprotein (HDL). CPAP was not correlated to TC (SMD = -0.07, 95% CI = -0.33 to 0.19), TG (SMD = -0.01, 95% CI = -0.19 to 0.17), LDL (SMD = -0.01, 95% CI = -0.23 to 0.21) and HDL (SMD = 0.10, 95% CI = -0.03 to 0.22) in OSA patients. Moreover, CPAP duration (=12 weeks; >12 weeks; <12 weeks) also did not influence lipid profiles of OSA patients as well. CONCLUSIONS Regardless of the treatment in CPAP duration, it doses does not influence lipid profiles of OSA patients, including TC, TG, LDL and HDL. The results are inconsistent with previous findings, which should be further validated in the multi-center, long-term randomized controlled trials.
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Affiliation(s)
- Yinghua Xu
- Department of Anesthesiology, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi, Jiangsu, PR China
- * Correspondence: Yinghua Xu, Department of Anesthesiology, 904th Hospital of Joint Logistic Support Force of PLA, Wuxi 214044, Jiangsu Province, PR China (e-mail: )
| | - Haiyan Wu
- Department of Respiratory, Zhejiang Hospital, 12 Lingyin Road, West Lake District, Hangzhou, Zhejiang, PR China
| | - Xiaoling Lu
- Department of Respiratory, Zhejiang Hospital, 12 Lingyin Road, West Lake District, Hangzhou, Zhejiang, PR China
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2022; 128:248-330. [PMID: 36096911 DOI: 10.1016/j.prosdent.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/15/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022]
Abstract
The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of the 2021 dental literature in restorative dentistry to inform busy dentists regarding noteworthy scientific and clinical progress over the past year. Each member of the committee brings discipline-specific expertise to coverage of this broad topical area. Specific subject areas addressed, in order of the appearance in this report, include COVID-19 and the dental profession (new); prosthodontics; periodontics, alveolar bone, and peri-implant tissues; implant dentistry; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine and oral and maxillofacial surgery; and dental caries and cariology. The authors focused their efforts on reporting information likely to influence daily dental treatment decisions with an emphasis on future trends in dentistry. With the tremendous volume of dentistry and related literature being published daily, this review cannot possibly be comprehensive. Rather, its purpose is to update interested readers and provide important resource material for those interested in pursuing greater details on their own. It remains our intent to assist colleagues in negotiating the extensive volume of important information being published annually. It is our hope that readers find this work useful in successfully managing the patients and dental problems they encounter.
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Olszewska E, Vasilenok N, Polecka A, Stróżyński A, Olszewska N, Rogowski M, Fiedorczuk P. Long-term outcomes of pharyngoplasty for Obstructive Sleep Apnea Syndrome. Otolaryngol Pol 2022; 76:18-25. [DOI: 10.5604/01.3001.0015.7672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction: </b> Pharyngoplasty techniques for the treatment of obstructive sleep apnea syndrome (OSAS) have evolved, which improved the understanding of the anatomy, patient selection, and adoption of functional approaches. </br></br> <b>Aim:</b> To analyze long-term results of pharyngoplasty in OSAS patients. </br></br> <b>Material and methods:</b> Between 2007 and 2021, a total of 234 adult patients with OSAS who had previously failed positive airway pressure (PAP) therapy underwent sleep surgery. Of this group, 75 patients met the criteria of a minimum 5-year follow-up. To date, 25 patients completed the follow-up study protocol, including the medical history, visual analog scale (VAS) for snoring loudness, body mass index (BMI), endoscopy of the upper airways, type III sleep study, and standardized questionnaires including Epworth Sleepiness Scale (ESS) and EQ-5D-5L Euro – Quality of Life Questionnaire. </br></br> <b>Results:</b> The average period of follow-up was 96.80 ± 30.20 months. The mean age of participants was 54.6 ± 14.02 and the mean BMI 30.28 ± 2.74. Patients underwent uvulopalatopharyngoplasty (n = 21) and expansion sphincterpharyngoplasty (n = 4) between 2008–2015. A long-term improvement in sleep parameters was observed for the mean AHI (29.84 ± 20.06before and 19.45 ± 18.53 after surgery, p = 0.0294), and the median VAS (8.13 before and 3.78 after surgery), mean oxygen saturation during sleep 94,5% (IQR 93.0–95.25), and the median ESS score was 6.17 ± 4.57. The majority of patients reported subjective long-term improvement in sleep quality and a reduction of snoring. </br></br> <b>Conclusions:</b> In OSAS patients who failed PAP therapy, pharyngoplasty may provide a long-term improvement in upper airway obstruction during sleep.
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Affiliation(s)
- Ewa Olszewska
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Nataliya Vasilenok
- Doctoral School of the Medical University of Bialystok, Bialystok, Poland
| | | | | | | | - Marek Rogowski
- Department of Otolaryngology, Medical University of Bialystok, Bialystok, Poland
| | - Piotr Fiedorczuk
- Doctoral School of the Medical University of Bialystok, Bialystok, Poland
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Ciavarella D, Campobasso A, Suriano C, Lo Muzio E, Guida L, Salcuni F, Laurenziello M, Illuzzi G, Tepedino M. A new design of mandibular advancement device (IMYS) in the treatment of obstructive sleep apnea. Cranio 2022:1-8. [PMID: 35171757 DOI: 10.1080/08869634.2022.2041271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The mandibular advancement device (MAD) is currently suggested in patients with mild to moderate obstructive sleep apnea (OSA). This study investigated the effects of a new fully customizable MAD-type device called, "It Makes You Sleep" (IMYS), in patients with mild to moderate OSA. METHODS Sixteen patients (14 men and 2 women; mean age 62; SD ± 11 years) were retrospectively enrolled. Each patient received home sleep apnea testing (HSAT) at baseline (T0) and after three months (T1) of IMYS treatment. The Apnea-Hypopnea Index (AHI), the Oxygen Desaturation Index (ODI), the Minimum Oxygen Saturation (minSO2) and the Medium Oxygen Saturation (medSO2) were analyzed. RESULTS From T0 to T1, the IMYS treatment showed a significant reduction of AHI and ODI and a significant increase of minSO2 and medSO2. CONCLUSION The IMYS appliance is an effective device for treating mild or moderate OSA.
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Affiliation(s)
- Domenico Ciavarella
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Alessandra Campobasso
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Carmela Suriano
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | | | - Laura Guida
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Fabio Salcuni
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Michele Laurenziello
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Gaetano Illuzzi
- Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
| | - Michele Tepedino
- Department of Biotecnologica and Applied Clinical Sciences, Dental School of L'Aquila, University of L'Aquila, L'Aquila, Italy
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Niu Y, Sui X, He Y, Xi H, Zhu R, Xu H, Li Y, Zhang Z, Guo L. Association between self-reported snoring and hypertension: a systematic review and meta-analysis. Sleep Med 2021; 88:140-148. [PMID: 34749273 DOI: 10.1016/j.sleep.2021.10.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/01/2021] [Accepted: 10/12/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The purpose of this study is to summarize the evidence for the association between snoring and hypertension and the effect of snoring on hypertension in men and/or women. METHODS We searched the articles in the Cochrane Library, PubMed, Scopus, Web of Science and Embase published up to 12 November 2020 to evaluate the association between snoring and hypertension. Studies were selected according to the predefined screening criteria and their qualities were assessed by Newcastle-Ottawa Quality Evaluation Scale. The odds ratio and 95% confidence interval were used as effective indicators. It was registered in PROSPERO with the number: CRD42021224912. RESULTS According to the inclusion/exclusion criteria, 11 studies including eight prospective cohort studies and three cross-sectional studies were included. The results showed that compared with non-snoring participants, snoring significantly increased the risk of hypertension in both men and women [odds ratio (OR) = 1.32, 95% confidence interval (CI), 1.23-1.42; men: odds ratio (OR) = 1.32; 95% confidence interval (CI), 1.18-1.49; women: odds ratio (OR) = 1.26; 95% confidence interval (CI), 1.14-1.40]. Besides, the risk of hypertension was significantly increased when the snoring frequency was ≥4 nights/week [frequency≥4 nights/week: odds ratio (OR) = 1.42; 95% confidence interval (CI), 1.21-1.66; 4 nights/week >frequency>0: odds ratio (OR) = 1.23; 95% confidence interval (CI),1.13-1.34]. CONCLUSIONS Snoring is considered as an independent predictor of hypertension in both men and women, which may play a role in the prevention and control of hypertension. People who snore frequently should pay close attention to their blood pressure levels to prevent hypertension.
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Affiliation(s)
- Yirou Niu
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Xin Sui
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Yayu He
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Huihui Xi
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Ruiting Zhu
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Haiyan Xu
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Yuewei Li
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Zhuo Zhang
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
| | - Lirong Guo
- School of Nursing, Jilin University, Changchun, Jilin, 130000, China.
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OSA Upper Airways Surgery: A Targeted Approach. ACTA ACUST UNITED AC 2021; 57:medicina57070690. [PMID: 34356971 PMCID: PMC8305825 DOI: 10.3390/medicina57070690] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 06/24/2021] [Accepted: 06/28/2021] [Indexed: 01/12/2023]
Abstract
Obstructive sleep apnea syndrome (OSA) is a multi-factorial disorder, with quite complex endotypes, consisting of anatomical and non-anatomical pathophysiological factors. Continuous positive airway pressure (CPAP) is recognized as the first-line standard treatment for OSA, whereas upper airway (UA) surgery is often recommended for treating OSA patients who have refused or cannot tolerate CPAP. The main results achievable by the surgery are UA expansion, and/or stabilization, and/or removal of the obstructive tissue to different UA levels. The site and pattern of UA collapse identification is of upmost importance in selecting the customized surgical procedure to perform, as well as the identification of the relation between anatomical and non-anatomical factors in each patient. Medical history, sleep studies, clinical examination, UA endoscopy in awake and drug-induced sedation, and imaging help the otorhinolaryngologist in selecting the surgical candidate, identifying OSA patients with mild UA collapsibility or tissue UA obstruction, which allow achievement of the best surgical outcomes. Literature data reported that the latest palatal surgical procedures, such as expansion sphincter palatoplasty or barbed reposition palatoplasty, which achieve soft palatal and lateral pharyngeal wall remodeling and stiffening, improved the Apnea Hypopnea Index, but the outcome analyses are still limited by methodological bias and the limited number of patients' in each study. Otherwise, the latest literature data have also demonstrated the role of UA surgery in the improvement of non-anatomical factors, confirming that a multidisciplinary and multimodality diagnostic and therapeutical approach to OSA patients could allow the best selection of customized treatment options and outcomes.
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