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Mayoral Sanz P, Lagravère Vich M. Oral Appliances for Obstructive Sleep Apnea. Dent Clin North Am 2024; 68:495-515. [PMID: 38879283 DOI: 10.1016/j.cden.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
The use of mandibular repositioning devices (MRDs) in the management of patients with obstructive sleep apnea (OSA) has gained extensive recognition with relevant clinical evidence of its effectiveness. MRDs are designed to advance and hold the mandible in a protrusive position to widen the upper airway and promote air circulation. This review of the MRD aims to provide an evidence-based update on the optimal design features of an MRD, an analysis of the variety of appliances available, and the current understanding of the action mechanism.
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Affiliation(s)
- Pedro Mayoral Sanz
- Catholic University of Murcia UCAM, Calle Conde de Peñalver 61 - 1º, Madrid 28029, Spain.
| | - Manuel Lagravère Vich
- School of Dentistry, 5-488 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada
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Parthasarathy S, Ayas NT, Bogan R, Hwang D, Kushida C, Lown JS, Ojile JM, Patel I, Prasad B, Rapoport DM, Strollo P, Vanderveken OM, Viviano J. Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae035. [PMID: 38966620 PMCID: PMC11223066 DOI: 10.1093/sleepadvances/zpae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Indexed: 07/06/2024]
Abstract
This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify-from an implementation science standpoint-the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events-such as a large-scale PAP device recall compounded by supply chain woes of the pandemic-and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.
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Affiliation(s)
- Sairam Parthasarathy
- Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA
| | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Bogan
- Department of Psychaiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Dennis Hwang
- Division of Sleep Medicine, Kaiser Permanente Southern California, Fontana, CA, USA
| | - Clete Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | | | - Imran Patel
- Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA
- Dental Sleep Service Line, Banner University Medical Center - Tucson, Tucson, AZ, USA
| | - Bharati Prasad
- Department of Medicine, University of Illinois at Chicago and Jesse Brown VA Medical Center, Chicago, IL, USA
| | - David M Rapoport
- Mount Sinai Health System Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Oliver M Vanderveken
- Department of ENT-HNS, Antwerp University Hospital, Edegem, Belgium and Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - John Viviano
- Sleep Disorders Dentistry Research and Learning Center, Mississauga, ON, Canada
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Ou YH, Colpani JT, Cheong CS, Loke W, Thant AT, Shih EC, Lee F, Chan SP, Sia CH, Koo CY, Wong S, Chua A, Khoo CM, Kong W, Chin CW, Kojodjojo P, Wong PE, Chan MY, Richards AM, Cistulli PA, Lee CH. Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea. J Am Coll Cardiol 2024; 83:1760-1772. [PMID: 38588926 DOI: 10.1016/j.jacc.2024.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Hypertension guidelines recommend diagnosis and treatment of obstructive sleep apnea (OSA) in patients with hypertension. The mandibular advancement device (MAD) is an oral appliance therapy for patients who decline or cannot tolerate continuous positive airway pressure (CPAP). OBJECTIVES We compared the relative effectiveness of MAD vs CPAP in reducing 24-hour ambulatory blood pressure (BP). METHODS In an investigator-initiated, randomized, noninferiority trial (prespecified margin 1.5 mm Hg), 321 participants aged ≥40 years with hypertension and increased cardiovascular risk were recruited at 3 public hospitals for polysomnography. Of these, 220 participants with moderate-to-severe OSA (apnea-hypopnea index ≥15 events per hour) were randomized to either MAD or CPAP (1:1). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and 6 months. RESULTS Compared with baseline, the 24-hour mean arterial BP decreased by 2.5 mm Hg (P = 0.003) at 6 months in the MAD group, whereas no change was observed in the CPAP group (P = 0.374). The between-group difference was -1.6 mm Hg (95% CI: -3.51 to 0.24, noninferiority P < 0.001). The MAD group demonstrated a larger between-group reduction in all secondary ambulatory BP parameters compared with the CPAP group, with the most pronounced effects observed in the asleep BP parameters. Both the MAD and CPAP improved daytime sleepiness, with the between-group difference similar (P = 0.384). There were no between-group differences in cardiovascular biomarkers. CONCLUSIONS MAD is noninferior to CPAP for reducing 24-hour mean arterial BP in participants with hypertension and increased cardiovascular risk. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling-Non-inferiority Trial [CRESCENT]; NCT04119999).
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Affiliation(s)
- Yi-Hui Ou
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Juliana Tereza Colpani
- Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - Crystal S Cheong
- Department of Otolaryngology-Head & Neck Surgery, National University Hospital, Singapore, Singapore
| | - Weiqiang Loke
- Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - As Tar Thant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E' Ching Shih
- Department of Otolaryngology-Head & Neck Surgery, National University Hospital, Singapore, Singapore
| | - Frank Lee
- Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - Siew-Pang Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Serene Wong
- Department of Medicine, Alexandra Hospital, Singapore
| | - Aiping Chua
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Chin-Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Calvin W Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | | | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - A Mark Richards
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore; Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre and 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 Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore.
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Pépin JL, Cistulli PA, Crespeigne E, Tamisier R, Bailly S, Bruwier A, Le-Dong NN, Lavigne G, Malhotra A, Martinot JB. Mandibular Jaw Movement Automated Analysis for Oral Appliance Monitoring in Obstructive Sleep Apnea: A Prospective Cohort Study. Ann Am Thorac Soc 2024; 21:814-822. [PMID: 38330168 PMCID: PMC11109906 DOI: 10.1513/annalsats.202312-1077oc] [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: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 02/10/2024] Open
Abstract
Rationale: Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. Objectives: To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA. Methods: This observational, prospective study included 135 patients with OSA eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. Additionally, MJM monitoring at home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was revaluated using Bland-Altman analysis. Changes in AHI during the home-based oral appliance titration process were evaluated using a generalized linear mixed model and a generalized estimating equation model. Results: The automated MJM analysis demonstrated strong agreement with PG in assessing AHI at the end of titration, with a median bias of 0.24/h (limits of agreement, -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across three evaluation conditions: in-laboratory PG (-59.6%; 95% confidence interval, -59.8% to -59.5%), in-laboratory automated MJM analysis (-59.2%; -65.2% to -52.2%), and at-home automated MJM analysis (-59.7%; -67.4% to -50.2%). Conclusions: Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.
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Affiliation(s)
- Jean-Louis Pépin
- Laboratoire HP2, Institut National de la Santé et de la Recherche Médicale, U1300, Université Grenoble Alpes, Grenoble, France
- Laboratoire Exploration Fonctionnelle Cardio-Respiratoire (EFCR), Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Etienne Crespeigne
- Laboratoire du sommeil, Centre Hospitalier Universitaire (CHU) Université catholique de Louvain (UCL), Site Sainte-Elisabeth, Namur, Belgium
| | - Renaud Tamisier
- Laboratoire HP2, Institut National de la Santé et de la Recherche Médicale, U1300, Université Grenoble Alpes, Grenoble, France
- Laboratoire Exploration Fonctionnelle Cardio-Respiratoire (EFCR), Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, Institut National de la Santé et de la Recherche Médicale, U1300, Université Grenoble Alpes, Grenoble, France
- Laboratoire Exploration Fonctionnelle Cardio-Respiratoire (EFCR), Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Annick Bruwier
- Département D’orthodontie et Orthopédie Dentofaciale, Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium
| | | | - Gilles Lavigne
- Department of Oral Health, Faculty of Dental Medicine, University of Montréal, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal (CIUSSS NIM) et Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Atul Malhotra
- University of California, San Diego, La Jolla, California; and
| | - Jean-Benoît Martinot
- Laboratoire du sommeil, Centre Hospitalier Universitaire (CHU) Université catholique de Louvain (UCL), Site Sainte-Elisabeth, Namur, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain Bruxelles Woluwe, Bruxelles, Belgium
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Leonhard AG, Donovan LM. Remote Titration of Mandibular Advancement Devices: What Outcomes Should We Target? Ann Am Thorac Soc 2024; 21:703-705. [PMID: 38691008 PMCID: PMC11109908 DOI: 10.1513/annalsats.202402-219ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Affiliation(s)
- Aristotle G Leonhard
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington; and
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington; and
- Division of Pulmonary and Critical Care Medicine and
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
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Anitua E, Mayoral P, Almeida GZ, Durán-Cantolla J, Alkhraisat MH. A Multicenter Prospective Study on the Use of a Mandibular Advancement Device in the Treatment of Obstructive Sleep Apnea. Dent J (Basel) 2023; 11:247. [PMID: 37999010 PMCID: PMC10670328 DOI: 10.3390/dj11110247] [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: 09/05/2023] [Revised: 10/06/2023] [Accepted: 10/20/2023] [Indexed: 11/25/2023] Open
Abstract
The main objective of this prospective study was the evaluation of 1 mm step titration of mandible advancement in the success of treating obstructive sleep apnea (OSA). For that, a multicenter prospective study was designed to recruit patients with OSA who were eligible to receive a mandibular advancement device. Gradual titration of mandibular advancement (steps of 1 mm) from maximum intercuspidation was performed to determine the optimal mandibular advancement (highest reduction in the apnea-hypopnea index (AHI)). The principal variable was the percentage of patients where a reduction ≥50% of the AHI was achieved at the end of the titration phase. A total of 102 patients participated in this study. Fifty-six percent of the participants were males and 67% had a BMI ≥ 25 kg/m2. Most of the patients (79%) had an age ≥ 50 years and the majority (74%) were either non-smokers or ex-smokers. Excessive daytime sleepiness was reported by 40% of the patients. The mean AHI at baseline was 20.6 ± 12.7 events/h. The mean advancement of the mandible was 3.1 ± 1.6 mm. The device achieved a reduction in the AHI in 93% of the patients and success (≥50% reduction in the AHI) in 69% of the patients. Success was achieved in 50%, 81.6%, and 73.3% of the patients with mild, moderate, and severe OSA, respectively. Decreasing the magnitude of mandibular advancement could be possible by controlling the vertical mouth opening and step-by-step titration.
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Affiliation(s)
- Eduardo Anitua
- Sleep Unit, Clínica Eduardo Anitua, 01007 Vitoria, Spain; (G.Z.A.); (J.D.-C.)
- Regenerative Medicine Department, BTI Biotechnology Institute, 01007 Vitoria, Spain;
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Turnbull CD, Stradling JR. Endotyping, phenotyping and personalised therapy in obstructive sleep apnoea: are we there yet? Thorax 2023; 78:726-732. [PMID: 37217289 DOI: 10.1136/thorax-2023-220037] [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: 02/27/2023] [Accepted: 05/02/2023] [Indexed: 05/24/2023]
Abstract
Obstructive sleep apnoea (OSA) was traditionally thought to be mainly caused by obesity and upper airway crowding, and hence OSA management was not personalised according to particular characteristics, with most symptomatic patients receiving continuous positive airway pressure therapy. Recent advances in our understanding have identified additional potential and distinct causes of OSA (endotypes), and subgroups of patients (phenotypes) with increased risk of cardiovascular complications. In this review, we discuss the evidence to date as to whether there are distinct clinically useful endotypes and phenotypes of OSA, and the challenges to the field in moving towards delivering personalised therapy in OSA.
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Affiliation(s)
- Chris D Turnbull
- Oxford Centre for Respiratory Medicine, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Oxford Centre for Respiratory Medicine, NIHR Oxford Biomedical Research Centre, Oxford, UK
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - John R Stradling
- NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
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Wojeck BS, Inzucchi SE, Qin L, Yaggi HK. Polysomnographic predictors of incident diabetes and pre-diabetes: an analysis of the DREAM study. J Clin Sleep Med 2023; 19:703-710. [PMID: 36689314 PMCID: PMC10071389 DOI: 10.5664/jcsm.10414] [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: 05/13/2022] [Revised: 11/19/2022] [Accepted: 11/22/2022] [Indexed: 01/24/2023]
Abstract
STUDY OBJECTIVES We sought to evaluate sleep measures that better predict incident diabetes and prediabetes in a large cohort of veterans. METHODS This secondary analysis included 650 patients without baseline diabetes from a multisite observational veterans' cohort. Participants underwent obstructive sleep apnea evaluation via laboratory-based polysomnography between 2000 and 2004 with follow-up through 2012. The primary outcomes were prediabetes and diabetes defined by fasting blood glucose, hemoglobin A1c, or use of glucose-lowering medication at study initiation. Exposure variables included respiratory event frequency, arousals, and oxygen desaturation. Cox models adjusted for body mass index, age, race, sex, change in body mass index, and continuous positive airway pressure device utilization. RESULTS The adjusted analysis revealed that time spent with oxygen saturation less than 90 [hazards ratio (HR) 1.009], confidence interval (CI) 1.001-1.017, P = .02), respiratory arousals (HR 1.009, CI 1.003-1.015, P < 0.01) and total arousals (HR 1.006 CI 1.001-1.011 P = .02) were associated with an increased incidence of diabetes. Increases in mean nocturnal oxygen saturation were associated with decreased incidence of diabetes (HR 0.914 CI 0.857-0.975, P < .01) and prediabetes (HR 0.914 CI 0.857-0.975, P < .01). No significant relationships were demonstrated for apnea-hypopnea index (AHI), measures related to central apnea, Cheyne-Stokes respiration, periodic limb movements, or Epworth Sleepiness Scale score. CONCLUSIONS There was no significant association of incident prediabetes or diabetes with AHI, the gold standard of sleep apnea severity. This study suggests that hypoxia may be a better predictor of glycemic outcomes than AHI in an obstructive sleep apnea population and may provide clues to the underlying mechanism(s) that link sleep-disordered breathing and its metabolic consequences. CITATION Wojeck BS, Inzucchi SE, Qin L, Yaggi HK. Polysomnographic predictors of incident diabetes and pre-diabetes: an analysis of the DREAM study. J Clin Sleep Med. 2023;19(4):703-710.
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Affiliation(s)
- Brian S. Wojeck
- Yale University Department of Internal Medicine, Section of Endocrinology, New Haven, Connecticut
| | - Silvio E. Inzucchi
- Yale University Department of Internal Medicine, Section of Endocrinology, New Haven, Connecticut
| | - Li Qin
- Yale University Department of Internal Medicine, Section of Cardiology, New Haven, Connecticut
| | - Henry Klar Yaggi
- Yale University Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, New Haven, Connecticut
- The Clinical Epidemiology Research Center (CERC), VA Connecticut Healthcare System, West Haven VA, West Haven, Connecticut
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Fagundes NCF, Minervini G, Furio Alonso B, Nucci L, Grassia V, d'Apuzzo F, Puigdollers A, Perillo L, Flores-Mir C. PATIENT-REPORTED OUTCOMES WHILE MANAGING OBSTRUCTIVE SLEEP APNEA WITH ORAL APPLIANCES: A SCOPING REVIEW. J Evid Based Dent Pract 2023; 23:101786. [PMID: 36707161 DOI: 10.1016/j.jebdp.2022.101786] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/21/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This scoping review aims to describe dental treatment-related patient-reported outcomes (dPROs) while using oral appliances (OAs) to manage obstructive sleep apnea (OSA) in children and adults. METHODS Available literature that assessed dPROs in children and adults with OSA managed through OAs. Any clinical studies were included without restrictions of year or country. The results were analyzed and reported using narrative text and tables accompanying a descriptive summary. RESULTS The searches identified 1718 citations, and of these, forty-five studies were finally included. A total of 3498 adults were included in all 42 primary studies included in this review, in which all the studies presented adults as participants. The dPROs assessed were quality of life (QoL), reported side effects after OA usage, patient satisfaction, and experience with treatment, and subjective perception of occlusal changes after treatment. CONCLUSION This scoping review suggests that dPROs are mostly investigated as a secondary outcome from major studies exploring the effects of OAs on OSA severity, and often, dPROs are not well discussed or displayed on their report. As no risk of bias or certainty level assessment was completed, findings need to be carefully considered. Although in general terms management with OAs among adults with OSA does not seem to be uncomfortable or causing major problems to their lives, some mild discomfort and endured occlusal disturbances was reported in some studies. QoL seems to improve but consistent agreement was elusive. Data does not include experiences among those that dropped OA use. No data seems to exist about dPROs in children.
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Affiliation(s)
| | - Giuseppe Minervini
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Berta Furio Alonso
- Department of Orthodontics and Craniofacial Orthopedics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Ludovica Nucci
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Grassia
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fabrizia d'Apuzzo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Andreu Puigdollers
- Department of Orthodontics and Craniofacial Orthopedics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Letizia Perillo
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, Orthodontic Program, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Carlos Flores-Mir
- School of Dentistry, Faculty of Medicine and Dentistry, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada.
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Pengo MF, Gozal D, Martinez-Garcia MA. Should we treat with continuous positive airway pressure severe non-sleepy obstructive sleep apnea individuals without underlying cardiovascular disease? Sleep 2022; 45:6677982. [PMID: 36029295 DOI: 10.1093/sleep/zsac208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/12/2022] [Indexed: 12/14/2022] Open
Abstract
The majority of the current international obstructive sleep apnea (OSA) guidelines base the recommendation to treat OSA with continuous positive airway pressure (CPAP) on the presence of symptoms (principally, albeit not exclusively on daytime hypersomnolence). In nonsleepy patients, even with severe OSA, controversies remain, as clear evidence supporting CPAP treatment of this subgroup of OSA patients is lacking. However, given the nonnegligible proportion of non-sleepy OSA patients, clinicians often face a serious dilemma since CPAP treatment in these patients may prove to be not cost-effective. Here, we propose a simple three-step-based algorithm that attempts to better phenotype non-sleepy OSA patients prior to reaching a CPAP treatment decision while also considering a series of clinically relevant elements in the process that may improve with CPAP therapy. Such algorithm focuses on the presence of several OSA symptoms that are susceptible to benefit from treatment and also relies on OSA phenotypes that need to be considered in an effort to achieve optimal cardiovascular prevention. Here, we attempt to establish a framework for clinicians who are evaluating severe nonsleepy OSA patients in their practices. However, the algorithm proposal needs to be extensively validated before being systematically implemented in clinical settings.
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Affiliation(s)
| | - David Gozal
- Department of Child Health and Child Health Research Institute, University of Missouri School of Medicine, Columbia, MO, USA.,Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Miguel Angel Martinez-Garcia
- Respiratory Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain.,Centro de Investigación Biomédica en Red (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
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Patients with Obstructive Sleep Apnea and Cardiovascular Diseases: What, When, and Why Is Mandibular Advancement Device Treatment Required? A Short Review. J Clin Med 2022; 11:jcm11226845. [PMID: 36431322 PMCID: PMC9696671 DOI: 10.3390/jcm11226845] [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: 09/29/2022] [Revised: 11/07/2022] [Accepted: 11/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obstructive sleep apnea is a potentially dangerous condition with significant risks of comorbidities if left untreated. It represents a cardiovascular risk factor in the general population, and a higher prevalence is observed in patients already suffering from cardiovascular diseases. The gold standard treatment, continuous positive airway pressure, is not always accepted or tolerated. The mandibular advancement device represents an alternative treatment that we propose to implement in our study. The objective here is to first present a brief review of the topic. Due to poor evidence in the field, we propose a pilot study to evaluate the effect of a mandibular advancement device in patients with cardiovascular disease who are not treated for their sleep pathology in order to improve their therapeutic management.
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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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Gambino F, Zammuto MM, Virzì A, Conti G, Bonsignore MR. Treatment options in obstructive sleep apnea. Intern Emerg Med 2022; 17:971-978. [PMID: 35460431 PMCID: PMC9135849 DOI: 10.1007/s11739-022-02983-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022]
Abstract
Treatment of OSA with CPAP is currently the recommended treatment and has the greatest evidence of efficacy on AHI, symptoms and comorbidities. Symptomatic patients with moderate-severe OSA generally have good adherence to CPAP therapy, while those with mild OSA, female, young and generally paucisymptomatic, have lower CPAP adherence, especially in the medium and long term. The recent identification of different clinical and pathophysiological phenotypes of OSA has paved the way for alternative treatments to CPAP, leading to an increasingly personalized therapy. Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients. Mandibular advancement devices (MAD), positional therapy (PT) and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies on which there is promising and encouraging data but with still little strong scientific evidence. The purpose of this review is to compare the efficacy, adherence and costs of various therapeutic options for OSA patients in the light of recent evidence and to provide useful guidance for specialists.
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Affiliation(s)
- Francesco Gambino
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Marta Maria Zammuto
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Alessandro Virzì
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Giosafat Conti
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy
| | - Maria Rosaria Bonsignore
- Division of Pulmonary Medicine, Ospedali Riuniti Villa Sofia-Cervello, Via Trabucco 180, 90146, Palermo, Italy.
- PROMISE Department, University of Palermo, Palermo, Italy.
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Berlin and Epworth Surveys to Predict Obstructive Sleep Apnea for Adults on Biomimetic Oral Appliance Therapy: A Nonrandomized Clinical Trial. Int J Dent 2022; 2022:5283406. [PMID: 35572355 PMCID: PMC9106488 DOI: 10.1155/2022/5283406] [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: 12/17/2021] [Accepted: 04/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Two questionnaires (Berlin Questionnaire (BQ) and Epworth Sleepiness Scale (ESS)) are the widely used screening instruments for subjects suffering from sleep disorders. Obstructive sleep apnea (OSA) is the most common form of sleep-disordered breathing. The biomimetic oral appliance therapy (BOAT) offers an alternative nonsurgical method, which can improve symptoms and indices of OSA on objective sleep testing. Aim To describe testing the ability of BQ and EES for prediction of BOAT outcomes during OSA. Methods Seventeen adults (9 males, 8 females; age, mean (SD): 45.76 (10.31), BMI mean (SD): 33.5(13.43)) who underwent an overnight sleep study were diagnosed by a sleep specialist physician. The BQ and EES were recorded before and after BOAT treatment. Subjects with mild-to-moderate OSA had 2 months of follow-up visits and underwent a final overnight sleep study to measure apnea-hypopnea index (AHI). The subjects were asked to wear the appliance for 10–12 hours/day and at night. Findings were analyzed statistically using paired t-tests. Result As per sleep test results, pre-BOAT AHI measures versus post-BOAT AHI measures showed significant improvement. Comparing the BQ before versus after treatment showed that at the pretreatment stage, 66.0% of patients had high-risk score, whereas 34% had low-risk score. After treatment, 66.0% of patient had low-risk scores, whereas 34% had high-risk scores. As for the ESS, treatment resulted in significant reduction of total score from 10.43 ± 6.32 to 5.00 ± 5.20 (P < 0.01, paired t-test). Finally, there was a mild negative correlation between AHI and each of the BQ and ESS scores that was not statistically significant (r = −0.420, N = 26, P > 0.05, and r = −0.41, N = 26, P > 0.05, respectively). Conclusion The BOAT device may provide a useful form of therapy to improve OSA-related PSG parameters such as AHI. Both BQ and ESS were predictive to improvements detected by the sleep study during BOAT device use.
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Mouth Closing to Improve the Efficacy of Mandibular Advancement Devices in Sleep Apnea. Ann Am Thorac Soc 2022; 19:1185-1192. [PMID: 35254967 DOI: 10.1513/annalsats.202109-1050oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Mouth breathing increases upper airway collapsibility, leading to decreased efficacy of obstructive sleep apnea (OSA) treatments. We hypothesized that the use of mandibular advancement devices (MAD) increases mouth breathing and, thus, using an adhesive mouthpiece (AMT), to prevent mouth breathing, in combination with MAD can improve the treatment efficacy. OBJECTIVES To evaluate the efficacy of MAD + AMT in comparison to MAD alone. METHODS A prospective crossover pilot study was designed to test this hypothesis. Briefly, adult participants with an apnea-hypopnea index (AHI) between 10-50 events/h at the screening visit were randomized to no treatment (baseline), MAD treatment, AMT treatment, and MAD+AMT treatment. As a primary analysis, absolute AHI was compared between MAD and MAD + AMT arms. Secondary analyses included quantifying the percent change in AHI, percentage of complete (AHI < 5 events/h) and incomplete (AHI 5 - 10 events/h) responders, and the efficacy of AMT alone in comparison with other treatment arms. RESULTS A total 21 of participants were included. (Baseline AHI= 24.3±9.9 event/h) The median AHI (Interquartile [IQR]) in the MAD and MAD+AMT arms were 10.5 [5.4-19.6] events/h and 5.6 [2.2-11.7] events/h (p-value= 0.02), respectively. A total of 76% of individuals achieved an AHI < 10 events/h in the MAD + AMT arm vs. 43% in the MAD arm (p-value<0.01). Finally, the observed effect was similar in moderate to severe OSA (AHI ≥15 events/h) in terms of absolute reduction and treatment responders, and AMT alone did not significantly reduce the AHI compared to baseline. CONCLUSION Combination of an adhesive mouthpiece and MAD is a more effective therapy than MAD alone. These findings may help improve clinical decision-making in sleep apnea.
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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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Schütz L, Sixel-Döring F, Hermann W. Management of Sleep Disturbances in Parkinson's Disease. JOURNAL OF PARKINSON'S DISEASE 2022; 12:2029-2058. [PMID: 35938257 PMCID: PMC9661340 DOI: 10.3233/jpd-212749] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 06/07/2023]
Abstract
Parkinson's disease (PD) is defined by its motor symptoms rigidity, tremor, and akinesia. However, non-motor symptoms, particularly autonomic disorders and sleep disturbances, occur frequently in PD causing equivalent or even greater discomfort than motor symptoms effectively decreasing quality of life in patients and caregivers. Most common sleep disturbances in PD are insomnia, sleep disordered breathing, excessive daytime sleepiness, REM sleep behavior disorder, and sleep-related movement disorders such as restless legs syndrome. Despite their high prevalence, therapeutic options in the in- and outpatient setting are limited, partly due to lack of scientific evidence. The importance of sleep disturbances in neurodegenerative diseases has been further emphasized by recent evidence indicating a bidirectional relationship between neurodegeneration and sleep. A more profound insight into the underlying pathophysiological mechanisms intertwining sleep and neurodegeneration might lead to unique and individually tailored disease modifying or even neuroprotective therapeutic options in the long run. Therefore, current evidence concerning the management of sleep disturbances in PD will be discussed with the aim of providing a substantiated scaffolding for clinical decisions in long-term PD therapy.
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Affiliation(s)
- Lukas Schütz
- Department of Neurology, University of Rostock, Rostock, Germany
| | | | - Wiebke Hermann
- Department of Neurology, University of Rostock, Rostock, Germany
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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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Pépin JL, Eastwood P, Eckert DJ. Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care. Eur Respir J 2021; 59:13993003.01788-2021. [PMID: 34824053 DOI: 10.1183/13993003.01788-2021] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 09/16/2021] [Indexed: 11/05/2022]
Abstract
Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, "one size fits all", trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.
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Affiliation(s)
- Jean-Louis Pépin
- HP2 Laboratory, INSERM U1042, University Grenoble Alpes, Grenoble, France .,EFCR Laboratory, Grenoble Alpes University Hospital, Grenoble, France
| | - Peter Eastwood
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Danny J Eckert
- Flinders Health and Medical Research Institute and Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, 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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