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Guichaoua C, Dugast S, Derrien A, Boudaud P, Chaux AG, Bertin H, Corre P. Evaluation of the efficacy of a custom-made monoblock mandibular advancement device in treatment of obstructive sleep apnea hypopnea syndrome. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2024; 125:101743. [PMID: 38128880 DOI: 10.1016/j.jormas.2023.101743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Mandibular advancement devices (MAD) are an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS). We aimed to evaluate the efficiency of a custom-made monoblock MAD for the treatment of OSAHS. MATERIALS AND METHODS We carried out a monocentric retrospective observational study including patients with OSAHS (mild, moderate or severe) or isolated ronchopathy from January 2005 to March 2023. The primary objective was to evaluate the overall efficiency of the MAD assessed by the percentage of patients successfully treated. The secondary objectives included the global efficiency of the device in the treatment of snoring, the report of side effects, and the identification of predictive factors for efficacy or failure. RESULTS The medical records of 586 patients were collected, and 293 patients (229 OSAHS and 64 isolated ronchopathy) were included in the analysis. After a mean 2.9 years follow-up, 72.5 % of patients were successfully treated by MAD. We observed a significant improvement in ronchopathy, both in terms of intensity and percentage of time per night. Regarding patients with isolated ronchopathy, 87.5 % reported an improvement in their symptoms and satisfaction with their treatment. Finally, 14.0 % of the patients declared side-effects, the dentoskeletal modifications being the most frequent (6.1 % of the patients). CONCLUSION This study confirmed the long-term efficacy and good tolerance of a custom-made monoblock orthosis in OSAHS.
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Affiliation(s)
- Camille Guichaoua
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France; Nantes Université, CHU Nantes, Service de chirurgie orale, 1, place Alexis Ricordeau, F-44000, Nantes, France.
| | - Sophie Dugast
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France
| | - Anthony Derrien
- Cabinet libéral PISB, 6, rue de Gouédic, F-22000, Saint-Brieuc, France
| | - Pascale Boudaud
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France
| | - Anne Gaelle Chaux
- Nantes Université, CHU Nantes, Service de chirurgie orale, 1, place Alexis Ricordeau, F-44000, Nantes, France
| | - Hélios Bertin
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France; Nantes Université, UnivAngers, CHU Nantes, INSERM, CNRS, CRCI2NA, 8, quai Moncousu, F-44000, Nantes, France
| | - Pierre Corre
- Nantes Université, CHU Nantes, Service de chirurgie maxillo-faciale et stomatologie, 1, place Alexis Ricordeau, F-44000, Nantes, France; Nantes Université, Oniris, UnivAngers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, 1, place Alexis Ricordeau, F-44000, Nantes, France
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Becek KC, Piskin B, Yılmaz Savaş T, Sahin N, Uyar A. Fabricating a custom monoblock mandibular advancement device by using an open-source nondental CAD software program and additive manufacturing: A dental technique. J Prosthet Dent 2022:S0022-3913(22)00639-4. [PMID: 36379725 DOI: 10.1016/j.prosdent.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/13/2022]
Abstract
Custom mandibular advancement devices (MADs) can be fabricated by using either conventional processes or computer-aided design and computer-aided manufacturing (CAD-CAM). The CAD-CAM technique involves digitizing the dental arches of the patients, designing by using a dental CAD software program, and additive manufacturing with a suitable material. This article describes the steps of the design of a custom MAD by using an open-source nondental CAD software program and of the fabrication with additive manufacturing.
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Affiliation(s)
| | - Bulent Piskin
- Professor, Department of Prosthodontics, Faculty of Dentistry, Cappadocia University, Nevşehir, Turkey
| | - Tuba Yılmaz Savaş
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Selçuk University, Konya, Turkey.
| | - Nesrin Sahin
- Assistant Professor, Cappadocia University, Cappadocia Vocational College, Center of Dental Technologies, Urgup, Turkey
| | - Alper Uyar
- Researcher, Department of Prosthodontics, Gulhane Faculty of Dentistry, Health Sciences University, Ankara, Turkey
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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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Mohammadieh AM, Sutherland K, Chan ASL, Cistulli PA. Mandibular Advancement Splint Therapy. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1384:373-385. [PMID: 36217096 DOI: 10.1007/978-3-031-06413-5_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Mandibular advancement splint (MAS) therapy is the leading alternative to continuous positive airway pressure (CPAP) therapy for the treatment of obstructive sleep apnoea. A MAS is an oral appliance which advances the mandible in relation to the maxilla, thus increasing airway calibre and reducing collapsibility. Although it is less effective than CPAP in reducing the apnoea-hypopnoea index (AHI), it has demonstrated equivalence to CPAP in a number of key neurobehavioural and cardiovascular health outcomes, perhaps due to increased tolerability and patient adherence when compared to CPAP. However, response to MAS is variable, and reliable prediction tools for patients who respond best to MAS therapy have thus far been elusive; this is one of the key clinical barriers to wider uptake of MAS therapy. In addition, the most effective MAS devices are custom-made by a dentist specialising in the treatment of sleep disorders, which may present financial or accessibility barriers for some patients. MAS devices are generally well tolerated but may have side effects including temporomandibular joint (TMJ) dysfunction, hypersalivation, tooth pain and migration as well as occlusal changes. A patient-centred approach to treatment from a multidisciplinary team perspective is recommended. Evidence-based clinical practice points and areas of future research are summarised at the conclusion of the chapter.
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Affiliation(s)
- Anna M Mohammadieh
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia.
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia.
| | - Kate Sutherland
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Andrew S L Chan
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Peter A Cistulli
- Department of Respiratory & Sleep Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
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Dissanayake HU, Colpani JT, Sutherland K, Loke W, Mohammadieh A, Ou YH, de Chazal P, Cistulli PA, Lee CH. Obstructive sleep apnea therapy for cardiovascular risk reduction-Time for a rethink? Clin Cardiol 2021; 44:1729-1738. [PMID: 34791676 PMCID: PMC8715402 DOI: 10.1002/clc.23747] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 01/14/2023] Open
Abstract
Obstructive sleep apnea (OSA) is a highly prevalent and underdiagnosed medical condition, which is associated with various cardiovascular and metabolic diseases. The current mainstay of therapy is continuous positive airway pressure (CPAP); however, CPAP is known to be poorly accepted and tolerated by patients. In randomized controlled trials evaluating CPAP in cardiovascular outcomes, the average usage was less than 3.5 hours, which is below the 4 hours per night recommended to achieve a clinical benefit. This low adherence may have resulted in poor effectiveness and failure to show cardiovascular risk reduction. The mandibular advancement device (MAD) is an intraoral device designed to advance the mandible during sleep. It functions primarily through alteration of the jaw and/or tongue position, which results in improved upper airway patency and reduced upper airway collapsibility. The MAD is an approved alternative therapy that has been consistently shown to be the preferred option by patients who are affected by OSA. Although the MAD is less efficacious than CPAP in abolishing apnea and hypopnea events in some patients, its greater usage results in comparable improvements in quality-of-life and cardiovascular measures, including blood pressure reduction. This review summarizes the impact of OSA on cardiovascular health, the limitations of CPAP, and the potential of OSA treatment using MADs in cardiovascular risk reduction.
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Affiliation(s)
- Hasthi U Dissanayake
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Juliana T Colpani
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Kate Sutherland
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Weiqiang Loke
- Faculty of Dentistry, National University of Singapore, Singapore
| | - Anna Mohammadieh
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Yi-Hui Ou
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Philip de Chazal
- Sleep Research Group, Charles Perkins Centre, Faculty of Engineering, University of Sydney, Camperdown, New South Wales, Australia
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre & Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.,Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Chi-Hang Lee
- Department of Cardiology, National University Heart Centre Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Clinical and Research Solutions to Manage Obstructive Sleep Apnea: A Review. SENSORS 2021; 21:s21051784. [PMID: 33806496 PMCID: PMC7961570 DOI: 10.3390/s21051784] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 02/24/2021] [Accepted: 02/26/2021] [Indexed: 12/13/2022]
Abstract
Obstructive sleep apnea (OSA), a common sleep disorder disease, affects millions of people. Without appropriate treatment, this disease can provoke several health-related risks including stroke and sudden death. A variety of treatments have been introduced to relieve OSA. The main present clinical treatments and undertaken research activities to improve the success rate of OSA were covered in this paper. Additionally, guidelines on choosing a suitable treatment based on scientific evidence and objective comparison were provided. This review paper specifically elaborated the clinically offered managements as well as the research activities to better treat OSA. We analyzed the methodology of each diagnostic and treatment method, the success rate, and the economic burden on the world. This review paper provided an evidence-based comparison of each treatment to guide patients and physicians, but there are some limitations that would affect the comparison result. Future research should consider the consistent follow-up period and a sufficient number of samples. With the development of implantable medical devices, hypoglossal nerve stimulation systems will be designed to be smart and miniature and one of the potential upcoming research topics. The transcutaneous electrical stimulation as a non-invasive potential treatment would be further investigated in a clinical setting. Meanwhile, no treatment can cure OSA due to the complicated etiology. To maximize the treatment success of OSA, a multidisciplinary and integrated management would be considered in the future.
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Dauvilliers Y, Verbraecken J, Partinen M, Hedner J, Saaresranta T, Georgiev O, Tiholov R, Lecomte I, Tamisier R, Lévy P, Scart-Gres C, Lecomte JM, Schwartz JC, Pépin JL. Pitolisant for Daytime Sleepiness in Patients with Obstructive Sleep Apnea Who Refuse Continuous Positive Airway Pressure Treatment. A Randomized Trial. Am J Respir Crit Care Med 2020; 201:1135-1145. [PMID: 31917607 PMCID: PMC7193861 DOI: 10.1164/rccm.201907-1284oc] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Excessive daytime sleepiness is a common disabling symptom in obstructive sleep apnea syndrome. Objectives: To evaluate the efficacy and safety of pitolisant, a selective histamine H3 receptor antagonist with wake-promoting effects, for the treatment of daytime sleepiness in patients with moderate to severe obstructive sleep apnea refusing continuous positive airway pressure treatment. Methods: In an international, multicenter, double-blind, randomized (3:1), placebo-controlled, parallel-design trial, pitolisant was individually titrated at up to 20 mg/d over 12 weeks. The primary endpoint was the change in the Epworth Sleepiness Scale score. Key secondary endpoints were maintenance of wakefulness assessed on the basis of the Oxford Sleep Resistance test, safety, Clinical Global Impression of severity, patient’s global opinion, EuroQol quality-of-life questionnaire, and Pichot fatigue questionnaire. Measurements and Main Results: A total of 268 patients with obstructive sleep apnea (75% male; mean age, 52 yr; apnea–hypopnea index, 49/h; baseline sleepiness score, 15.7) were randomized (200 to pitolisant and 68 to placebo) and analyzed on an intention-to-treat basis. The Epworth Sleepiness Scale score was reduced more with pitolisant than with placebo (−2.8; 95% confidence interval, −4.0 to −1.5; P < 0.001). Wake maintenance tests were not improved. The Pichot fatigue score was reduced with pitolisant. The overall impact of pitolisant was confirmed by both physicians’ and patients’ questionnaires. Adverse event incidence, mainly headache, insomnia, nausea, and vertigo, was similar in the pitolisant and placebo groups (29.5% and 25.4%, respectively), with no cardiovascular or other significant safety concerns. Conclusions: Pitolisant significantly reduced self-reported daytime sleepiness and fatigue and improved patient-reported outcomes and physician disease severity assessment in sleepy patients with obstructive sleep apnea refusing or nonadherent to continuous positive airway pressure. Clinical trial registered with www.clinicaltrials.gov (NCT01072968) and EU Clinical Trials Register (EudraCT 2009-017251-94).
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Affiliation(s)
- Yves Dauvilliers
- National Reference Center for Narcolepsy, Sleep and Wake Unit, Department of Neurology, Gui-de-Chauliac Hospital, Montpellier University Hospital, Montpellier, France.,INSERM U1061, Montpellier University, Montpellier, France
| | - Johan Verbraecken
- Multidisciplinary Sleep Disorders Center, Antwerp University Hospital and University of Antwerp, Antwerp, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Markku Partinen
- Helsinki Sleep Clinic, Vitalmed Research Center, Helsinki, Finland.,Department of Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Jan Hedner
- Sleep and Vigilance Laboratory, Department of Internal Medicine, University of Göteborg, Sahlgrenska University Hospital, University of Göteborg, Göteborg, Sweden
| | - Tarja Saaresranta
- Sleep Research Center, Department of Pulmonary Diseases and Clinical Allergology, University of Turku, Turku, Finland.,Department of Pulmonary Diseases, Turku University Hospital, Turku, Finland
| | - Ognian Georgiev
- Pulmonology Unit, Department of Internal Medicine, Alexandrovska Hospital Medical University, Sofia, Bulgaria
| | - Rumen Tiholov
- Department of Internal Diseases, Sveti Ivan Rilski Multiprofile Hospital for Active Treatment, Kozloduy, Bulgaria
| | | | - Renaud Tamisier
- Hypoxia-Physiopathology (HP2) Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France; and.,Cardio-Respiratory Functional Exploration Laboratory (EFCR), Grenoble Alpes University Hospital, Grenoble, France
| | - Patrick Lévy
- Hypoxia-Physiopathology (HP2) Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France; and.,Cardio-Respiratory Functional Exploration Laboratory (EFCR), Grenoble Alpes University Hospital, Grenoble, France
| | | | | | | | - Jean-Louis Pépin
- Hypoxia-Physiopathology (HP2) Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France; and.,Cardio-Respiratory Functional Exploration Laboratory (EFCR), Grenoble Alpes University Hospital, Grenoble, France
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