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Van den Bossche K, Van de Perck E, Vroegop AV, Verbraecken JA, Braem MJ, Dieltjens M, Op de Beeck S, Vanderveken OM. Quantitative Measurement of Pharyngeal Dimensions During Drug-induced Sleep Endoscopy for Oral Appliance Outcome. Laryngoscope 2023; 133:3619-3627. [PMID: 37366240 DOI: 10.1002/lary.30823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/20/2023] [Accepted: 05/17/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE To quantitatively investigate the effect of mandibular advancement devices (MADs) on pharyngeal airway dimensions in a transverse plane as measured during drug-induced sleep endoscopy (DISE). METHODS Data from 56 patients, treated with MAD at 75% maximal protrusion and with baseline Apnea-Hypopnea Index ≥10 events/h, were analyzed. For each patient, three snapshots were selected from DISE video footage at baseline, with MAD presence, and during chin lift, resulting in 498 images (168/168/162, baseline/MAD/chin lift). Cross-sectional areas, anteroposterior (AP) and laterolateral (LL) dimensions on both retroglossal and retro-epiglottic levels were measured. To define the effect of MAD and chin lift on pharyngeal dimensions, linear mixed-effect models were built. Associations between MAD treatment response and pharyngeal expansion (MAD/chin lift) were determined. RESULTS Significant differences were found between retroglossal cross-sectional areas, AP, and LL dimensions at baseline and with MAD presence. At a retro-epiglottic level, only LL dimensions differed significantly with MAD presence compared to baseline, with significant relation of LL expansion ratio to treatment response (p = 0.0176). After adjusting the response definition for the sleeping position, greater retroglossal expansion ratios were seen in responders (1.32 ± 0.48) compared to non-responders (1.11 ± 0.32) (p = 0.0441). No significant association was found between response and pharyngeal expansion by chin lift. CONCLUSION Our observations highlight the additional value of quantitative pharyngeal airway measurements during DISE with MAD presence in evaluating MAD treatment outcome. These findings demonstrate an increase in retroglossal airway dimensions during DISE, with MAD presence, and more pronounced increase in retroglossal expansion ratios in MAD treatment responders compared to non-responders after sleeping position correction. LEVEL OF EVIDENCE 3 Laryngoscope, 133:3619-3627, 2023.
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Affiliation(s)
- Karlien Van den Bossche
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Eli Van de Perck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Anneclaire V Vroegop
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Johan A Verbraecken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Marc J Braem
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Marijke Dieltjens
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Sara Op de Beeck
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
| | - Olivier M Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
- ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
- Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium
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Leigh C, Faigenblum M, Fine P, Blizard R, Leung A. General dental practitioners' knowledge and opinions of snoring and sleep-related breathing disorders. Br Dent J 2021; 231:569-574. [PMID: 34773028 PMCID: PMC8589666 DOI: 10.1038/s41415-021-3573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022]
Abstract
Aims There is increasing recognition that sleep disturbances can affect lifestyle, economy and health. General dental practitioners (GDPs) can play a vital role in helping to identify at-risk patients through screening as well as aid in the management of these conditions. The aim of this study was to assess the knowledge of UK-based GDPs in relation to sleep-related breathing disorders (SRBDs).Material and methods A questionnaire was developed to assess GDPs' knowledge of SRBDs and their current practice in relation to the management of SRBDs, and identify the factors associated with improved knowledge and management. A volunteer sample was recruited from social media platforms and conference attendees.Results In total, 152 GDPs completed the questionnaire; 101 (66% [95% CI 59%,74%]) agreed that GDPs should ask their patients about sleep disorders, while only 82 (54% [95% CI 46%,62%]) confirmed that they actually asked their patients about the problem. On a 22-point knowledge scale, the mean score was 12.93 (95%CI 12.23, 13.63). Postgraduate education (F = 5.47; p = 0.001), increasing age (r = 0.23; p = 0.005) and GDP workplace (F = 4.98; p = 0.008) contributed to a higher knowledge score. GDPs were strongly in favour of having more information (N = 141; 93% [95% CI 87%,97%]).Conclusion Although GDPs' knowledge of SRBDs was better than anticipated, they clearly felt a need for further information and training. There is a compelling case to include this subject in the undergraduate dental curriculum.
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Affiliation(s)
| | | | - Peter Fine
- UCL Eastman Dental Institute, London, UK.
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Alessandri-Bonetti G, D'Antò V, Stipa C, Rongo R, Incerti-Parenti S, Michelotti A. Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients. Eur J Orthod 2018; 39:482-488. [PMID: 27932405 DOI: 10.1093/ejo/cjw078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients. Methods Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05. Results At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011). Limitations A larger sample size could increase the generalizability of the findings. Conclusion MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.
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Affiliation(s)
| | - Vincenzo D'Antò
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.,Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Stipa
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'
| | - Roberto Rongo
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'
| | | | - Ambrosina Michelotti
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'
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Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, Bruehlmann S, Charkhandeh S, Zareian Jahromi SA. A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy. J Clin Sleep Med 2017; 13:871-880. [PMID: 28502280 DOI: 10.5664/jcsm.6656] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 05/03/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Mandibular protruding oral appliances represent a potentially important therapy for obstructive sleep apnea (OSA). However, their clinical utility is limited by a less-than-ideal efficacy rate and uncertainty regarding an efficacious mandibular position, pointing to the need for a tool to assist in delivery of the therapy. The current study assesses the ability to prospectively identify therapeutic responders and determine an efficacious mandibular position. METHODS Individuals (n = 202) with OSA participated in a blinded, 2-part investigation. A system for identifying therapeutic responders was developed in part 1 (n = 149); the predictive accuracy of this system was prospectively evaluated on a new population in part 2 (n = 53). Each participant underwent a 2-night, in-home feedback-controlled mandibular positioner (FCMP) test, followed by treatment with a custom oral appliance and an outcome study with the oral appliance in place. A machine learning classification system was trained to predict therapeutic outcome on data obtained from FCMP studies on part 1 participants. The accuracy of this trained system was then evaluated on part 2 participants by examining the agreement between prospectively predicted outcome and observed outcome. A predicted efficacious mandibular position was derived from each FCMP study. RESULTS Predictive accuracy was as follows: sensitivity 85%; specificity 93%; positive predictive value 97%; and negative predictive value 72%. Of participants correctly predicted to respond to therapy, the predicted mandibular protrusive position proved efficacious in 86% of cases. CONCLUSIONS An unattended, in-home FCMP test prospectively identifies individuals with OSA who will respond to oral appliance therapy and provides an efficacious mandibular position. CLINICAL TRIAL REGISTRATION The trial that this study reports on is registered on www.clinicaltrials.gov, ID NCT03011762, study name: Feasibility and Predictive Accuracy of an In-Home Computer Controlled Mandibular Positioner in Identifying Favourable Candidates for Oral Appliance Therapy.
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Affiliation(s)
- John E Remmers
- University of Calgary, Calgary, Canada.,Zephyr Sleep Technologies, Calgary, Canada
| | - Zbigniew Topor
- University of Calgary, Calgary, Canada.,Zephyr Sleep Technologies, Calgary, Canada
| | | | | | | | - Rollin Brant
- University of British Columbia, Vancouver, Canada
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Nishigawa K, Hayama R, Matsuka Y. Complications causing patients to discontinue using oral appliances for treatment of obstructive sleep apnea. J Prosthodont Res 2017; 61:133-138. [DOI: 10.1016/j.jpor.2016.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 07/18/2016] [Accepted: 08/03/2016] [Indexed: 11/28/2022]
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Abstract
OBJECTIVE: The study goal was to critically evaluate 3 popular noninvasive treatments for snoring: an oral spray lubricant applied before bedtime, a nasal strip designed to maintain nasal valve patency, and a head-positioning pillow. STUDY DESIGN: Prospective, randomized blinded clinical trial of 3 popular noninvasive snore aids using objective acoustic snoring analysis and subjective patient and bed-partner questionnaires in 40 snoring patients. A digital recorder allowed snoring analysis with data collected in the home environment over 1 week. RESULTS: There is neither objective nor subjective benefit to the use of tested popular noninvasive snore aids. Palatal snoring, palatal loudness, average loudness of snoring, averaged palatal flutter frequency, and respiratory disturbance index did not significantly change when comparing the 3 snoring aids with no treatment. Subjective comments and complications are reviewed as well. CONCLUSION: This is the first prospective comparison trial of popular noninvasive snoring aids. There is no significant objective or subjective snoring improvement in the anti-snoring aids studied compared with the use of no aid. SIGNIFICANCE: Outcome studies aid in verifying or refuting claims made by popular noninvasive snore aids. (Otolaryngol Head Neck Surg 2004;130: 649-58.)
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Affiliation(s)
- Peter G Michaelson
- Department of Otolaryngology-Head and Neck Surgery, Wilford Hall USAF Medical Center, San Antonio, TX 78236, USA
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Jackson GW. Orthodontic and Orthognathic Surgical Treatment of a Pediatric OSA Patient. Case Rep Dent 2016; 2016:5473580. [PMID: 27668098 PMCID: PMC5030400 DOI: 10.1155/2016/5473580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 07/19/2016] [Indexed: 11/18/2022] Open
Abstract
A case report is presented which demonstrates the effectiveness of comprehensive orthodontic treatment combined with orthognathic surgery in the correction of malocclusion and reduction in the sequelae of Obstructive Sleep Apnea (OSA). The patient's severe OSA was improved to very mild as evaluated by full overnight polysomnogram. The orthodontic treatment included the expansion of both dental arches and mandibular advancement surgery. There was significant improvement in the patient's sleep continuity and architecture with the elimination of obstructive apneas.
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Affiliation(s)
- Gregory W. Jackson
- Department of Orthodontics (M/C 841), College of Dentistry, University of Illinois at Chicago, 801 S. Paulina Street, Chicago, IL 60612, USA
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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.
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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
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Prescinotto R, Haddad FLM, Fukuchi I, Gregório LC, Cunali PA, Tufik S, Bittencourt LRA. Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome. Braz J Otorhinolaryngol 2015; 81:663-70. [PMID: 26387988 PMCID: PMC9442756 DOI: 10.1016/j.bjorl.2015.08.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Accepted: 01/06/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS). Objective To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS. Methods Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared. Results 28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence. Conclusion MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.
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Affiliation(s)
- Renato Prescinotto
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Otorhinolaryngology, Faculdade de Medicina do ABC, Santo André, SP, Brazil.
| | | | - Ilana Fukuchi
- Department of Otorhinolaryngology, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Luiz Carlos Gregório
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Paulo Afonso Cunali
- Dentistry Course, Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil; Department of Medicine and Sleep Biology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Sérgio Tufik
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Lia Rita Azeredo Bittencourt
- Department of Psychobiology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil; Department of Medicine and Sleep Biology, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
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Bhalla G, Arya D, Chand P, Singh K, Tripathi S. Management of obstructive sleep apnea with a palatal lift prosthesis. INTERNATIONAL JOURNAL OF STOMATOLOGY & OCCLUSION MEDICINE 2013. [DOI: 10.1007/s12548-013-0088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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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]
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Negative association between self-reported jaw symptoms and apnea–hypopnea index in patients with symptoms of obstructive sleep apnea syndrome: a pilot study. Sleep Breath 2012; 17:373-9. [DOI: 10.1007/s11325-012-0704-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 03/09/2012] [Accepted: 04/03/2012] [Indexed: 02/07/2023]
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Abstract
INTRODUCTION Forward displacement of the tongue is a verified principle in the therapy of sleep disorders which prevents the tongue from sinking backwards thus avoiding obstruction of the upper respiratory tract during sleep. In this feasibility study a novel oral appliance which connects to a pin implanted within the tongue was investigated. METHODS A new tongue positioning system using previously implanted tongue piercings as a pivot was developed. By pulling the tongue forward the oral device prevents airway obstruction. In our study we fitted 10 subjects who already had the tongue pierced with the developed oral device. The subjects underwent two nights of polysomnography with and without using the tongue positioning system. Wearing comfort and side effects were evaluated using a questionnaire. Moderate alcohol consumption was used to provoke snoring or apnea in the subjects. Tongue positioning with and without the device was visualized with oropharyngeal MRI. RESULTS Subjects did not report any discomfort or side effects wearing the device. Subjects showed only moderate snoring or apnea after alcohol consumption and snoring after alcohol consumption was reduced with the device. The average apnea/hypopnea index (AHI) was 0.8/h without the device. Using the device led to an increase of apnea in the subjects. MRI visualization showed that the device did not keep the upper airway space opened by fixing the tongue. CONCLUSION The effectiveness of the tongue positioning system should be improved by a modification which should be investigated in patients with preexisting sleep disorders.
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Giannasi LC, Magini M, Costa MS, de Oliveira CS, de Oliveira LVF. Oral appliance treatment for obstructive sleep apnea in a partly edentulous patient. Am J Orthod Dentofacial Orthop 2010; 137:548-51. [DOI: 10.1016/j.ajodo.2008.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2007] [Revised: 03/01/2008] [Accepted: 03/01/2008] [Indexed: 12/01/2022]
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Dasheiff RM, Finn R. Clinical Foundation for Efficient Treatment of Obstructive Sleep Apnea. J Oral Maxillofac Surg 2009; 67:2171-82. [DOI: 10.1016/j.joms.2009.04.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 03/25/2009] [Accepted: 04/21/2009] [Indexed: 10/20/2022]
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A randomized, controlled, crossover study of a noncustomized tongue retaining device for sleep disordered breathing. Sleep Breath 2008; 12:369-73. [PMID: 18461376 DOI: 10.1007/s11325-008-0187-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Revised: 03/12/2008] [Accepted: 03/21/2008] [Indexed: 10/22/2022]
Abstract
Tongue retaining devices (TRDs) are one type of oral appliance used to treat sleep disordered breathing. Previous studies have evaluated customized TRDs in comparison to mandibular repositioner appliances. The purpose of this study was to evaluate a noncustomized TRD compared to a control device. A randomized, controlled, crossover design was utilized. The primary outcome was the difference in reduction of the respiratory disturbance index (RDI) between the active suction device (S) and the control, nonsuction device (NS). Secondary outcomes included snoring index, Epworth Sleepiness Scale as well as patient and partner quality-of-life index. Crossover analysis found that only the S device significantly reduced the RDI by 4.9 (95% confidence interval 0.85-8.9) events more than the NS device. This represented a reduction in mean RDI from baseline of 15.5 (+/-17.6) to 8.9 (+/-7.6) with the S device. Significant reduction in snoring index was also only found with the S device (214.7-132.9 per hour). Fifty-four percent of subjects indicated they would continue to use only the S device. The S device, with suction, showed better objective and subjective outcomes. Future studies are needed to evaluate these types of devices in larger populations with a wide range of disease severity.
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Abstract
Between 1982 and 2006, there were 89 distinct publications dealing with oral appliance therapy involving a total of 3,027 patients, which reported results of sleep studies performed with and without the appliance. These studies, which constitute a very heterogeneous group in terms of methodology and patient population, are reviewed and the results summarized. This review focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index or respiratory disturbance index), ability of oral appliances to reduce snoring, effect of oral appliances on daytime function, comparison of oral appliances with other treatments (continuous positive airway pressure and surgery), side effects, dental changes (overbite and overjet), and long-term compliance. We found that the success rate, defined as the ability of the oral appliances to reduce apnea/hypopnea index to less than 10, is 54%. The response rate, defined as at least 50% reduction in the initial apnea/hypopnea index (although it still remained above 10), is 21%. When only the results of randomized, crossover, placebo-controlled studies are considered, the success and response rates are 50% and 14%, respectively. Snoring was reduced by 45%. In the studies comparing oral appliances to continuous positive airway pressure (CPAP) or to uvulopalatopharyngoplasty (UPPP), an appliance reduced initial AHI by 42%, CPAP reduced it by 75%, and UPPP by 30%. The majority of patients prefer using oral appliance than CPAP. Use of oral appliances improves daytime function somewhat; the Epworth sleepiness score (ESS) dropped from 11.2 to 7.8 in 854 patients. A summary of the follow-up compliance data shows that at 30 months, 56–68% of patients continue to use oral appliance. Side effects are relatively minor but frequent. The most common ones are excessive salivation and teeth discomfort. Efficacy and side effects depend on the type of appliance, degree of protrusion, vertical opening, and other settings. We conclude that oral appliances, although not as effective as CPAP in reducing sleep apnea, snoring, and improving daytime function, have a definite role in the treatment of snoring and sleep apnea.
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Affiliation(s)
- Victor Hoffstein
- Department of Medicine, University of Toronto, St. Michael's Hospital, 30 Bond Street, Toronto, ON, Canada M5B 1W8.
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Giannasi LC, Magini M, de Oliveira CS, de Oliveira LVF. Treatment of obstructive sleep apnea using an adjustable mandibular repositioning appliance fitted to a total prosthesis in a maxillary edentulous patient. Sleep Breath 2007; 12:91-5. [PMID: 17874256 DOI: 10.1007/s11325-007-0134-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper reports on the case of an oral appliance used in the treatment of obstructive sleep apnea syndrome (OSAS) fitted to a superior total prosthesis. In this case, the chosen device was the adjustable PMPositioner, a mandibular repositioning appliance. A polysomnogram (PSG) both prior and with the oral appliance "in situ" was applied to evaluate the effect of the adaptation of the adjustable PMPositioner fixed onto a maxillary full denture in decreasing the apnea-hypopnea index from 18.0 to 2.2 as well as increasing the minimum oxygen saturation (SaO2 nadir) from 83 to 92%, proving that the device remained in position during sleep.
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Affiliation(s)
- Lílian Chrystiane Giannasi
- IP&D-Institute for Research and Development, University of Vale do Paraíba, São José dos Campos, São Paulo, Brazil.
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Bian H, Smith CL. Development of a questionnaire to assess dentists' knowledge, opinion, education resources, physician cooperation, and clinical practice regarding obstructive sleep apnea (OSAQ-D). Sleep Breath 2007; 10:76-82. [PMID: 16528577 DOI: 10.1007/s11325-005-0045-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This report describes the construction of a questionnaire to assess dentists' knowledge, opinion, education resources, clinical practice, and physician cooperation regarding obstructive sleep apnea (OSA) based on the PRECEDE-PROCEED model. The scale development included such steps as generating an item pool, expert review of initial item pool, pilot test, and final test. After the expert review, a total of 78 items made up the pilot test instrument including five demographic (age, year graduated from dental school, gender, years in practice dentistry, and membership of the Academy of Dental Sleep Medicine), 22 knowledge, 15 opinion, 11 education resources, 10 physician cooperation, and 15 clinical practice questions. The pilot test samples were third or fourth year dental school students and dentists from the University of Florida. Nineteen dentists and 26 students returned the survey. Based on the results of item analysis and content review, a total of 70 questions were remained for the final test. The final questionnaire was mailed to 450 dentists who were randomly selected from a list of 10,838 dentists with a Florida license and also delivered to 65 dental school students and postgraduates of the University of Florida. A total of 163 participants including 112 dentists and 51 students and postgraduates responded. The average age was 42.87 years, and most of them are males (77.8%). Only one dentist was a current member of the Academy of Dental Sleep Medicine. The item analysis was performed for five scales. 8 items with poor item difficulty, lower item discrimination, or having big effect on the item consistency were removed from the instrument, and 62 questions were kept for the further evaluation. The reliability coefficient alpha of knowledge, opinion, education resources, physician cooperation, and clinical practice scales was 0.77, 0.86, 0.67, 0.75, and 0.86, respectively. According to the standard from DeVellis (Scale development: theory and applications, Sage, Thousand Oaks, 2003), they were acceptable, or respectable, or even very good.
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Affiliation(s)
- Hui Bian
- Department of Health Education and Behavior, University of Florida, P.O. Box 118210,, Gainesville, FL, 32611-8210, USA.
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Hartenbaum N, Collop N, Rosen IM, Phillips B, George CFP, Rowley JA, Freedman N, Weaver TE, Gurubhagavatula I, Strohl K, Leaman HM, Moffitt GL, Rosekind MR. Sleep Apnea and Commercial Motor Vehicle Operators:. J Occup Environ Med 2006; 48:S4-37. [PMID: 16985410 DOI: 10.1097/01.jom.0000236404.96857.a2] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sam K, Lam B, Ooi CG, Cooke M, Ip MS. Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea. Respir Med 2005; 100:897-902. [PMID: 16219453 DOI: 10.1016/j.rmed.2005.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Revised: 06/01/2005] [Accepted: 08/10/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND To evaluate the effect of oral appliance (OA) on upper airway morphology and its relationship with treatment response in subjects with obstructive sleep apnoea (OSA). METHODS Symptomatic OSA subjects were recruited. Non-adjustable OA was custom made. Variables examined at baseline and while wearing the device at 2 months included polysomnographic data, computed tomographic measurements of upper airway cross sectional area at level of velopharynx (VA) and hypopharynx (HA), upper airway volume, and cephalometric parameters. Treatment outcome was based on post-treatment apnoea-hypopnoea index (AHI). RESULTS Forty patients were recruited and 23 (7 women) completed the study. They were middle-aged (49, 40-58 years) (median, interquartile range) and overweight (BMI 26, 23.3-29.5 kg/m2), with moderate OSA (AHI 26.4, 14.1-36). The overall post treatment AHI was 8.4 (2.4-12.5), with 14 (61%) patients showing good response (AHI<10), and the other 9 patients showing moderate response (>50% reduction in AHI but still 10). OA decreased the cross-sectional area of the HA (P=0.046), showed a trend of decreasing the ratio of cross-sectional area of the HA to cross-sectional area of the VA (P=0.053) and significantly increased the overall upper airway volume (P=0.006, n=11). No significant relationship between upper airway parameters and treatment outcome was identified. CONCLUSIONS OA altered upper airway morphometry towards a profile consistent with decreased propensity to collapse, which may thus have contributed to improvement of OSA.
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Affiliation(s)
- K Sam
- Orthodontics, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR, China
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Aarab G, Lobbezoo F, Wicks DJ, Hamburger HL, Naeije M. Short-term effects of a mandibular advancement device on obstructive sleep apnoea: an open-label pilot trial. J Oral Rehabil 2005; 32:564-70. [PMID: 16011634 DOI: 10.1111/j.1365-2842.2005.01467.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Obstructive sleep apnoea (OSA) is a common sleep disorder, which is, among others, associated with snoring. OSA has a considerable impact on a patient's general health and daily life. Nasal continuous positive airway pressure (nCPAP) is frequently used as a "gold standard" treatment for OSA. As an alternative, especially for mild/moderate cases, mandibular advancement devices (MADs) are prescribed increasingly. Their efficacy and effectiveness seem to be acceptable. Although some randomized clinical trials (RCTs) have been published recently, most studies so far are case studies. Therefore, our department is planning a controlled RCT, in which MADs are compared with both nCPAP and a control condition in a parallel design. As a first step, an adjustable MAD was developed with a small, more or less constant vertical dimension at different mandibular positions. To test the device and the experimental procedures, a pilot trial was performed with 10 OSA patients (six mild, four moderate; one women, nine men; mean age = 47.9 +/- 9.7 years). They all underwent a polysomnographic recording before as well as 2-14 weeks after insertion of the MAD (adjusted at 50% of the maximal protrusion). The apnoea-hypopnoea index (AHI) was significantly reduced with the MAD in situ (P = 0.017). When analysed as separate groups, the moderate cases showed a significantly larger decrease in AHI than the mild cases (P = 0.012). It was therefore concluded from this pilot study that this MAD might be an effective tool in the treatment of, especially, moderate OSA.
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Affiliation(s)
- G Aarab
- Department of Oral Function, Academic Centre for Dentistry Amsterdam (ACTA), Amsterdam, The Netherlands
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Abstract
OSAHS should be an expected condition in many patients encountered by primary care providers. The diagnosis may arise because of patient daytime dysfunction, partner prompting, or in the course of managing comorbidities adversely influenced by the hemodynamic, neural, humoral,and inflammatory consequences of repetitive desaturations and arousals.OSAHS should be suspected in patients who exhibit habitually loud snoring, witnessed apneas/choking/gasping during sleep, hypertension, neck circumferences of 17 inches or greater, obesity, and laterally narrowed oropharynxes. Diagnosis is established by polysomnography. CPAP is the treatment of choice for most patients. Education, follow-up, and heated humidification may help bolster compliance. Lifestyle modifications, oral appliances, and upper surgeries are additional treatment options.
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Affiliation(s)
- Eric J Olson
- Mayo Clinic College of Medicine, Division of Pulmonary and Critical Care Medicine, Mayo Sleep Disorders Center, 200 1st Street SW, Rochester, MN 55905, USA.
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Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 2004; 125:1270-8. [PMID: 15078734 DOI: 10.1378/chest.125.4.1270] [Citation(s) in RCA: 213] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
STUDY OBJECTIVE To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece mandibular advancement device in patients with snoring and obstructive sleep apnea. DESIGN Prospective study. SETTING Departments of Respiratory Medicine and Orthodontics, Umeå University. PATIENTS Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000, were followed up. They had a mean apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42). MEASUREMENTS Interviews, questionnaires, and overnight sleep apnea recordings. Patients with an apnea-hypopnea index of >or=10 in the supine and/or lateral position were considered to have obstructive sleep apnea. A lateral apnea-hypopnea index of < 10, together with a supine apnea-hypopnea index of >or= 10, defined supine-dependent sleep apneas. RESULTS One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p = 0.01). In the women, the odds ratios for treatment success were 12 for mild sleep apnea (p = 0.04), and 0.1 for complaints of nasal obstruction (p = 0.03). In the men, the odds ratios for treatment success were 6.0 for supine-dependent sleep apneas (p < 0.001), 2.5 for mild sleep apnea (p = 0.04), 1.3 for each millimeter of mandibular advancement (p = 0.03), and 0.8 for each kilogram of weight increase (p = 0.001). CONCLUSIONS The mandibular advancement device is recommended for women with sleep apnea, for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10, and for snorers without sleep apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device.
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