1
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Xu X, Peng Q, Meng L, Yang H, Wang Y, Luo Y, Dong M, Wang C, Wang M. Quality assessment of clinical practice guidelines for adult obstructive sleep apnea: A systematic review. Sleep Med 2024; 118:16-28. [PMID: 38581804 DOI: 10.1016/j.sleep.2024.03.045] [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: 01/14/2024] [Revised: 03/03/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Clinical Practice Guidelines (CPGs) are crucial in standardizing the management of obstructive sleep apnea (OSA) in adults. However, there has been insufficient evaluation of the overall quality of CPGs for adult OSA. This review aimed to comprehensively assess the overall quality of CPGs in the field of adult OSA. METHODS A systematic search was conducted on various literature databases, guideline-related databases, and academic websites from January 2013 to December 2023 to select CPGs relevant to adult OSA. The methodological and reporting quality of the eligible CPGs were thoroughly appraised by three reviewers using the AGREE II instrument and RIGHT checklist, respectively. RESULTS This review included 44 CPGs, consisting of 42 CPGs in English and 2 CPGs in Chinese. The assessment of methodological quality revealed that four domains attained an average standardized score above 60%. Among the domains, "clarity of presentation" received the highest standardized score of 85.10%, while the lowest standardized score was observed in the "rigor of development" domain with the value of 56.77%. The evaluation of reporting quality indicated an overall reporting rate of 51.30% for the eligible CPGs, with only three domains achieving an average reporting rate higher than 50%. The domain with the highest reporting rate was "basic information" at 60.61%, while the domain with the lowest reporting rate was "review and quality assurance" at 15.91%. Furthermore, a significantly positive correlation was found between the AGREE II standardized scores and the RIGHT reporting rates (r = 0.808, P < 0.001). CONCLUSIONS The overall quality of the currently available guidelines for adult OSA demonstrated considerable variability. Researchers should prioritize the utilization of evidence-based methods and adhere to the items listed in the RIGHT checklist when developing CPGs to enhance efficient clinical decision-making and promote the translation of evidence into practice.
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Affiliation(s)
- Xiaopan Xu
- Department of Respiratory and Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, China
| | - Qianqian Peng
- Department of Graduate School, Wannan Medical College, Wuhu, China
| | - Ling Meng
- Department of Nursing, Jining NO.1 People's Hospital, Jining, China
| | - Hualu Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Regions, China; Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yingzhen Wang
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Luo
- School of Nursing, Zhuhai Campus of the Zunyi Medical University, Zhuhai, China
| | - Min Dong
- School of Nursing, Zhuhai Campus of the Zunyi Medical University, Zhuhai, China
| | - Changyu Wang
- Department of Respiratory and Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, China.
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Regions, China.
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2
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Degraeve M, Beij T, Lammens I, Vagenende T, De Meyer M, Aps J, Jacquet W. A systematic review on 4D images of the upper airway in patients with OSA. Sleep Breath 2024; 28:597-606. [PMID: 38127191 DOI: 10.1007/s11325-023-02948-4] [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: 05/11/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
AIM-BACKGROUND In the treatment of obstructive sleep apnoea (OSA), oral appliances are now being recognized as a valuable alternative to continuous positive airway pressure (CPAP). Various static imaging techniques of the upper airways allow for assessment of bone and soft tissue structures. However, static images do not capture dynamic airway characteristics. The aim of this paper was to review 4D imaging techniques in patients with OSA. METHODS PubMed/MEDLINE, Web of Science and Embase were systematically searched for studies published before June 2022. The review was compliant with the PRISMA guidelines. The quality of each eligible study was critically evaluated by all four authors independently. Four unique articles with qualitative analyses were retrieved. All included studies had a clear objective/aim, an appropriate endpoint and sufficiently described eligibility criteria. RESULTS With dynamic imaging (4D) evaluation of the upper airway, the incidence of upper airway collapsibility due to use of a mandibular advancement device (MAD) was reduced, extraluminal tissue pressure was decreased and the space in the upper airway was increased, notably in the retropalatal and retroglossal areas of the airway. These findings suggest that MADs may be effective for OSA regardless of whether or not the obstruction site is in the velopharynx or oropharynx. However, further investigation of dynamic changes in the upper airway is required to explain the efficacy of OSA treatment and the underlying mechanisms.
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Affiliation(s)
- Michiel Degraeve
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Ghent, Ghent, Belgium.
| | - Tessa Beij
- Department of Oral and Maxillofacial Surgery, RadboudUMC, Nijmegen, The Netherlands
| | - Inés Lammens
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Tim Vagenende
- Department of Oral and Maxillofacial Surgery, Jan Palfijn General Hospital, Ghent, Belgium
| | - Miche De Meyer
- Department of Adult Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Dentistry, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Aps
- Department of Dentistry, Groningen University Medical Center, Groningen, the Netherlands
- OpiniDent BV, Marke, Belgium
| | - Wolfgang Jacquet
- Department of Adult Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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3
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Chang JL, Goldberg AN, Alt JA, Alzoubaidi M, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Boyd Gillespie M, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OM, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SY, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJ, Redline S, Rotenberg BW, Ryden A, Sarmiento KF, Sbeih F, Schell AE, Schmickl CN, Schotland HM, Schwab RJ, Seo J, Shah N, Shelgikar AV, Shochat I, Soose RJ, Steele TO, Stephens E, Stepnowsky C, Strohl KP, Sutherland K, Suurna MV, Thaler E, Thapa S, Vanderveken OM, de Vries N, Weaver EM, Weir ID, Wolfe LF, Tucker Woodson B, Won CH, Xu J, Yalamanchi P, Yaremchuk K, Yeghiazarians Y, Yu JL, Zeidler M, Rosen IM. International Consensus Statement on Obstructive Sleep Apnea. Int Forum Allergy Rhinol 2023; 13:1061-1482. [PMID: 36068685 PMCID: PMC10359192 DOI: 10.1002/alr.23079] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 08/12/2022] [Accepted: 08/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Evaluation and interpretation of the literature on obstructive sleep apnea (OSA) allows for consolidation and determination of the key factors important for clinical management of the adult OSA patient. Toward this goal, an international collaborative of multidisciplinary experts in sleep apnea evaluation and treatment have produced the International Consensus statement on Obstructive Sleep Apnea (ICS:OSA). METHODS Using previously defined methodology, focal topics in OSA were assigned as literature review (LR), evidence-based review (EBR), or evidence-based review with recommendations (EBR-R) formats. Each topic incorporated the available and relevant evidence which was summarized and graded on study quality. Each topic and section underwent iterative review and the ICS:OSA was created and reviewed by all authors for consensus. RESULTS The ICS:OSA addresses OSA syndrome definitions, pathophysiology, epidemiology, risk factors for disease, screening methods, diagnostic testing types, multiple treatment modalities, and effects of OSA treatment on multiple OSA-associated comorbidities. Specific focus on outcomes with positive airway pressure (PAP) and surgical treatments were evaluated. CONCLUSION This review of the literature consolidates the available knowledge and identifies the limitations of the current evidence on OSA. This effort aims to create a resource for OSA evidence-based practice and identify future research needs. Knowledge gaps and research opportunities include improving the metrics of OSA disease, determining the optimal OSA screening paradigms, developing strategies for PAP adherence and longitudinal care, enhancing selection of PAP alternatives and surgery, understanding health risk outcomes, and translating evidence into individualized approaches to therapy.
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Affiliation(s)
- Jolie L. Chang
- University of California, San Francisco, California, USA
| | | | | | | | - Liza Ashbrook
- University of California, San Francisco, California, USA
| | | | - Indu Ayappa
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | - Maurits S. Boon
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Pien Bosschieter
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | - Itzhak Braverman
- Hillel Yaffe Medical Center, Hadera Technion, Faculty of Medicine, Hadera, Israel
| | - Kara Brodie
- University of California, San Francisco, California, USA
| | | | - Ray Caesar
- Stone Oak Orthodontics, San Antonio, Texas, USA
| | | | - Yi Cai
- University of California, San Francisco, California, USA
| | | | | | | | | | | | | | | | | | - Susmita Chowdhuri
- Wayne State University and John D. Dingell VA Medical Center, Detroit, Michigan, USA
| | - Peter A. Cistulli
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - David Claman
- University of California, San Francisco, California, USA
| | - Jacob Collen
- Uniformed Services University, Bethesda, Maryland, USA
| | | | | | - Eric M. Davis
- University of Virginia, Charlottesville, Virginia, USA
| | | | | | - Mohan Dutt
- University of Michigan, Ann Arbor, Michigan, USA
| | - Mazen El Ali
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | | | | | | | - Kirat Gill
- Stanford University, Palo Alto, California, USA
| | | | - Lea Golisch
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | | | | | - Arushi Gulati
- University of California, San Francisco, California, USA
| | | | | | - Paul T. Hoff
- University of Michigan, Ann Arbor, Michigan, USA
| | - Oliver M.G. Hoffmann
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | | | - Jennifer Hsia
- University of Minnesota, Minneapolis, Minnesota, USA
| | - Colin Huntley
- Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Sanjana Inala
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | | | | | | | | | | | | | | | - Meena Khan
- Ohio State University, Columbus, Ohio, USA
| | | | - Alan Kominsky
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | - Meir Kryger
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Derek J. Lam
- Oregon Health and Science University, Portland, Oregon, USA
| | | | | | | | | | | | | | - Atul Malhotra
- University of California, San Diego, California, USA
| | | | - Joachim T. Maurer
- University Hospital Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany
| | - Anna M. May
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Ron B. Mitchell
- University of Texas, Southwestern and Children’s Medical Center Dallas, Texas, USA
| | | | | | | | | | - Brandon Nokes
- University of California, San Diego, California, USA
| | | | - Allan I. Pack
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | | | | | | | | | | | | | | | - Mark Quigg
- University of Virginia, Charlottesville, Virginia, USA
| | | | - Susan Redline
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Armand Ryden
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | | | - Firas Sbeih
- Cleveland Clinic Head and Neck Institute, Cleveland, Ohio, USA
| | | | | | | | | | - Jiyeon Seo
- University of California, Los Angeles, California, USA
| | - Neomi Shah
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | | | - Ryan J. Soose
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Erika Stephens
- University of California, San Francisco, California, USA
| | | | | | | | | | - Erica Thaler
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sritika Thapa
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nico de Vries
- Academic Centre for Dentistry Amsterdam, Amsterdam, The Netherlands
| | | | - Ian D. Weir
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Josie Xu
- University of Toronto, Ontario, Canada
| | | | | | | | | | | | - Ilene M. Rosen
- University of Pennsylvania, Philadelphia, Pennsylvania, USA
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4
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Gurgel M, Cevidanes L, Costa F, Pereira R, Cunali P, Bittencourt L, Ruellas A, Gonçalves J, Bianchi J, Chaves C. Three-dimensional comparison between the effects of mandibular advancement device and maxillomandibular advancement surgery on upper airway. BMC Oral Health 2023; 23:436. [PMID: 37391785 PMCID: PMC10314553 DOI: 10.1186/s12903-023-03125-5] [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: 03/21/2023] [Accepted: 06/10/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND The efficacy of mandibular advancement devices (MAD) and maxillomandibular advancement (MMA) in improving upper airway (UA) patency has been described as being comparable to continuous positive airway pressure (CPAP) outcomes. However, no previous study has compared MAD and MMA treatment outcomes for the upper airway enlargement. This study aimed to evaluate three-dimensionally the UA changes and mandibular rotation in patients after MAD compared to MMA. METHODS The sample consisted of 17 patients with treated with MAD and 17 patients treated with MMA matched by weight, height, body mass index. Cone-beam computed tomography from before and after both treatments were used to measure total UA, superior/inferior oropharynx volume and surface area; and mandibular rotation. RESULTS Both groups showed a significant increase in the superior oropharynx volume after the treatments (p = 0.003) and the MMA group showed greater increase (p = 0.010). No statistical difference was identified in the MAD group considering the inferior volume, while the MMA group showed a significantly gain (p = 0.010) and greater volume (p = 0.024). Both groups showed anterior mandibular displacement. However, the mandibular rotation were statistically different between the groups (p < 0.001). While the MAD group showed a clockwise rotation pattern (-3.97 ± 1.07 and - 4.08 ± 1.30), the MMA group demonstrated a counterclockwise (2.40 ± 3.43 and 3.41 ± 2.79). In the MAD group, the mandibular linear anterior displacement was correlated with superior [p = 0.002 (r=-0.697)] and inferior [p = 0.004 (r = 0.658)] oropharynx volume, suggesting that greater amounts of mandibular advancement are correlated to a decrease in the superior oropharynx and an increase in the inferior oropharynx. In the MMA group, the superior oropharynx volume was correlated to mandibular anteroposterior [p = 0.029 (r=-0.530)] and vertical displacement [p = 0.047 (r = 0.488)], indicating greater amounts of mandibular advancement may lead to a lowest gain in the superior oropharynx volume, while a great mandibular superior displacement is correlated with improvements in this region. CONCLUSIONS The MAD therapy led to a clockwise mandibular rotation, increasing the dimensions of the superior oropharynx; while a counterclockwise rotation with greater increases in all UA regions were showed in the MMA treatment.
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Affiliation(s)
- Marcela Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Lucia Cevidanes
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
| | - Fabio Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil.
| | - Rowdley Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Paulo Cunali
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Lia Bittencourt
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Antonio Ruellas
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Joao Gonçalves
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
| | - Jonas Bianchi
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, United States of America
- Department of Pediatric Dentistry, School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Brazil
- Department of Orthodontics, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, CA, United States of America
| | - Cauby Chaves
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, Fortaleza, 1273 Monsenhor Furtado St, CE, Brazil
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Musleh A, Abd El Maksoud WM, Dalboh A, Abbas KS, Alshehri S, Bawahab MA, Alqahtani AJ, Al-Malki AQ. Impact of Laparoscopic Sleeve Gastrectomy on Obstructive Sleep Apnea Symptoms Based on the STOP-BANG Questionnaire: A Prospective Study. Bariatr Surg Pract Patient Care 2023; 18:115-120. [DOI: 10.1089/bari.2022.0023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023] Open
Affiliation(s)
- Abdullah Musleh
- Otorhinolaryngology Division, Surgery Department, King Khalid University College of Medicine, Abha, Saudi Arabia
| | | | - Abdullah Dalboh
- Surgery Department, King Khalid University College of Medicine, Abha, Saudi Arabia
| | - Khaled S. Abbas
- Surgery Department, King Khalid University College of Medicine, Abha, Saudi Arabia
| | - Sarah Alshehri
- Otorhinolaryngology Division, Surgery Department, King Khalid University College of Medicine, Abha, Saudi Arabia
| | - Mohammed A. Bawahab
- Surgery Department, King Khalid University College of Medicine, Abha, Saudi Arabia
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Yu J, Li C, Chen J, Ran Q, Zhao Y, Cao Q, Chen X, Yu L, Li W, Zhao Z. Diagnosis and treatment of MN1 C-terminal truncation syndrome. Mol Genet Genomic Med 2022; 10:e1965. [PMID: 36124717 PMCID: PMC9651612 DOI: 10.1002/mgg3.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND MN1 C-terminal truncation (MCTT) is a rare syndrome; only 27 cases have been reported. We report the first case of an 8-year-old girl with MCTT syndrome complicated with moderate obstructive sleep apnea (OSA). METHODS MCTT syndrome was diagnosed by whole-exome sequencing (WES) and validated by Sanger sequencing. The patient received 2 years of treatment with continuous positive airway pressure (CPAP) to relieve sleep apnea and hypoxia, and a reverse sector fan-shaped expander for maxillary expansion. RESULTS WES revealed a de novo MN1 variant, c.3760C>T (p.[Q1254*]). An arachnoid cyst was found in the right occipital brain. The patient presented mild symptoms of classic MCTT syndrome. The patient did not experience hearing loss and only mild intellectual disability. Radiological examinations showed cleft secondary palate, narrow upper arch, narrow upper airway, and mandibular skeletal retrusion. Polysomnography indicated moderate OSA, with an apnea/hypopnea index of 6.8, which decreased to 1 after CPAP during the night. Two-year maxillary expansion widened the upper arch, and the cleft secondary palate became visible. The mandible moved forward spontaneously, resulting in the improvement of profile and upper airway widening. General physical conditions, such as motor delay, muscle weakness, and developmental delay, were significantly improved two years later. CONCLUSION In conclusion, we discovered a MN1 variant [NM_002430.2: c.3760C>T, p.Q1254*] that causes mild MCTT symptoms compared to other MN1 variants. For patients with MCTT complicated with OSA, multidisciplinary combination therapy can improve maxillofacial development, widen the upper airway and relieve sleep apnea, improving the general physical condition.
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Affiliation(s)
- Jingjia Yu
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Chen Li
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Jialin Chen
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Qiuchi Ran
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Yingya Zhao
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Qingxin Cao
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Ximeng Chen
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Linnan Yu
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
| | - Wenyang Li
- Institute of Respiratory Disease, The First Hospital of China Medical University, Shenyang, China
| | - Zhenjin Zhao
- The First Clinic, Orthodontic Department, School and Hospital of Stomatology, China Medical University, Liaoning Province Key Laboratory of Oral Disease, Shenyang, China
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7
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Barbosa DF, Meira E Cruz M, Alves MC, Zancanella E, Berzin F, Júnior AJM. Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study. Eur J Dent 2022; 16:564-572. [PMID: 35181870 PMCID: PMC9507576 DOI: 10.1055/s-0041-1735933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Objectives
Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OA
m
) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OA
m
is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OA
m
use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures.
Materials and Methods
A retrospective longitudinal study of 33 OSA patient treated with a different OA
m
, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance.
Results
Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters.
Conclusion
In this pilot study, DIORS OA
m
as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.
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Affiliation(s)
- Denise Fernandes Barbosa
- Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
| | - Miguel Meira E Cruz
- Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Lisbon, Portugal.,Research Laboratory on the Neuroimmune Interface of Pain São Leopoldo Mandic College, Campinas, São Paulo, Brazil
| | | | - Edilson Zancanella
- Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
| | - Fausto Berzin
- Department of Odontology, FOP - UNICAMP, Piracicaba, São Paulo, Brazil
| | - Almiro José Machado Júnior
- Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
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8
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Fernández-Sanjuán P, Arrieta JJ, Sanabria J, Alcaraz M, Bosco G, Pérez-Martín N, Pérez A, Carrasco-Llatas M, Moreno-Hay I, Ríos-Lago M, Lugo R, O’Connor-Reina C, Baptista P, Plaza G. Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol. J Clin Med 2022; 11:jcm11030658. [PMID: 35160107 PMCID: PMC8836970 DOI: 10.3390/jcm11030658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.
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Affiliation(s)
- Patricia Fernández-Sanjuán
- Department of Maxillofacial Surgery and Dentistry, Hospital Universitario San Francisco de Asís, Universidad Rey Juan Carlos, 28002 Madrid, Spain;
- Dental Sleep Medicine, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain
| | - Juan José Arrieta
- Department of Stomatology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Jaime Sanabria
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Marta Alcaraz
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
| | - Gabriela Bosco
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
| | - Nuria Pérez-Martín
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
| | - Adriana Pérez
- Department of Otolaryngology Head and Neck Surgery, Hospital La Milagrosa, 28010 Madrid, Spain;
| | - Marina Carrasco-Llatas
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Dr. Peset., 46017 Valencia, Spain;
| | - Isabel Moreno-Hay
- Division of Orofacial Pain, Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, KY 40536, USA;
| | - Marcos Ríos-Lago
- Department of Basic Psychology II, Faculty of Psychology, UNED, 28040 Madrid, Spain;
| | - Rodolfo Lugo
- Department of Otolaryngology Head and Neck Surgery, Hospital San José, Monterrey 64718, Mexico;
| | - Carlos O’Connor-Reina
- Department of Otolaryngology Head and Neck Surgery, Hospital Quironsalud Marbella, 29603 Marbella, Spain;
- Department of Otolaryngology Head and Neck Surgery, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Peter Baptista
- Department of Otolaryngology Head and Neck Surgery, Clínica Universitaria de Navarra, 31008 Pamplona, Spain;
| | - Guillermo Plaza
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Correspondence:
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9
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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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10
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Fichera G, Ronsivalle V, Zappalà G, Campagna P, Quinzi V, Lo Giudice A. Mandibular Advancement Devices (MAD) as a Treatment Alternative for Obstructive Sleep Apnea Syndrome (OSAS). Open Dent J 2021. [DOI: 10.2174/1874210602115010120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Continuous Positive Airways Pressure therapy (CPAP) is the gold standard treatment of the Obstructive Sleep Apnea Syndrome (OSAS), however, the scarce adherence to the therapy requires the evaluation of other therapeutic alternatives.
Objective:
The aim of the present study was to assess the effectiveness of Mandibular Advancement Devices (MAD) in subjects affected by OSAS who had interrupted the treatment with CPAP and to make comparative evaluations.
Methods:
Eighteen subjects (15 males and 3 females), aged between 27 and 60 years, with a diagnosis of moderate to severe OSAS were included. Inclusion criteria: polysomnographic examination before treatment (T0) and after 1 month from the beginning of the therapy with CPAP(T1), interruption of the treatment due to loss of compliance, Epworth Sleepiness Scale (ESS) questionnaire filled out at T0 and T1. Subjects started the treatment with MAD and polysonnographic examination was prospectively executed after 3 months (T2) and 1 year (T3). One-way analysis of the variance (ANOVA) was used to compare data of polysonnographic examination performed at T0, T1, T2 and T3 as well as the differences of ESS scores recorded at different timing.
Results:
Compared to baseline (T0), all functional parameters tested showed statistically significant differences at T1, T2 and T3 (p < 0.001), meanwhile no differences were found between data recorded after therapy with MAD (T2 and T3) and with CPAP (T1). Similar results were also found with the score of ESS among different timelines (p < 0.001).
Conclusion:
These findings suggest that MAD could be a valid alternative for the treatment of OSAS in those patients with scarce adherence to the CPAP therapy.
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11
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Sideris AW, Wallace G, Lam ME, Kitipornchai L, Lewis R, Jones A, Jeiranikhameneh A, Beirne S, Hingley L, Mackay S. Smart polymer implants as an emerging technology for treating airway collapse in obstructive sleep apnea: a pilot (proof of concept) study. J Clin Sleep Med 2021; 17:315-324. [PMID: 33118930 DOI: 10.5664/jcsm.8946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To assess the use of a novel magnetic polymer implant in reversing airway collapse and identify potential anatomical targets for airway implant surgery in an in vivo porcine model. METHODS Target sites of airway collapse were genioglossus muscle, hyoid bone, and middle constrictor muscle. Magnetic polymer implants were sutured to these sites, and external magnetic forces, through magnets with pull forces rated at 102 kg and 294 kg, were applied at the skin. The resultant airway movement was assessed via nasendoscopy. Pharyngeal plexus branches to the middle constrictor muscle were stimulated at 0.5 mA, 1.0 mA, and 2.0 mA and airway movement assessed via nasendoscopy. RESULTS At the genioglossus muscles, large magnetic forces were required to produce airway movement. At the hyoid bone, anterior movement of the airway was noted when using a 294 kg rated magnet. At the middle constrictor muscle, an anterolateral (or rotatory) pattern of airway movement was noted when using the same magnet. Stimulation of pharyngeal plexus branches to the middle constrictor revealed contraction and increasing rigidity of the lateral walls of the airway as stimulation amplitude increased. The resultant effect was prevention of collapse as opposed to typical airway dilation, a previously unidentified pattern of airway movement. CONCLUSIONS Surgically implanted smart polymers are an emerging technology showing promise in the treatment of airway collapse in obstructive sleep apnea. Future research should investigate their biomechanical role as an adjunct to treatment of airway collapse through nerve stimulation.
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Affiliation(s)
- Anders William Sideris
- Department of Otolaryngology Head and Neck Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra ENT Head and Neck Clinic, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District Wollongong, New South Wales, Australia
| | - Gordon Wallace
- ARC Centre of Excellence for Electromaterials Science (ACES), Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong, New South Wales, Australia
| | - Matthew Eugene Lam
- Department of Otolaryngology Head and Neck Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra ENT Head and Neck Clinic, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District Wollongong, New South Wales, Australia
| | - Leon Kitipornchai
- Department of Otolaryngology Head and Neck Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra ENT Head and Neck Clinic, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District Wollongong, New South Wales, Australia
| | - Richard Lewis
- Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Andrew Jones
- Illawarra ENT Head and Neck Clinic, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District Wollongong, New South Wales, Australia
| | - Ali Jeiranikhameneh
- ARC Centre of Excellence for Electromaterials Science (ACES), Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong, New South Wales, Australia
| | - Stephen Beirne
- ARC Centre of Excellence for Electromaterials Science (ACES), Intelligent Polymer Research Institute, AIIM Facility, Innovation Campus, University of Wollongong, New South Wales, Australia
| | - Lachlan Hingley
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Stuart Mackay
- Department of Otolaryngology Head and Neck Surgery, The Wollongong Hospital, Wollongong, New South Wales, Australia.,Illawarra ENT Head and Neck Clinic, Wollongong, New South Wales, Australia.,Illawarra Shoalhaven Local Health District Wollongong, New South Wales, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
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12
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MacKay SG, Lewis R, McEvoy D, Joosten S, Holt NR. Surgical management of obstructive sleep apnoea: A position statement of the Australasian Sleep Association . Respirology 2020; 25:1292-1308. [PMID: 33190389 PMCID: PMC7839593 DOI: 10.1111/resp.13967] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 09/15/2020] [Accepted: 09/20/2020] [Indexed: 12/11/2022]
Abstract
Surgery for adult obstructive sleep apnoea (OSA) plays a key role in contemporary management paradigms, most frequently as either a second‐line treatment or in a facilitatory capacity. This committee, comprising two sleep surgeons and three sleep physicians, was established to give clarity to that role and expand upon its appropriate use in Australasia. This position statement has been reviewed and approved by the Australasian Sleep Association (ASA) Clinical Committee.
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Affiliation(s)
- Stuart G MacKay
- University of Wollongong, Wollongong, NSW, Australia.,Illawarra ENT Head and Neck Clinic, Wollongong, NSW, Australia.,Department of Otolaryngology Head and Neck Surgery, The Wollongong Hospital, Wollongong, NSW, Australia
| | - Richard Lewis
- Hollywood Medical Centre, Perth, WA, Australia.,Department of Otolaryngology Head and Neck Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Doug McEvoy
- Adelaide Institute for Sleep Health, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.,Respiratory and Sleep Service, Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Simon Joosten
- Monash Lung and Sleep, Monash Health, Monash Medical Centre, Melbourne, VIC, Australia.,School of Clinical Sciences, Melbourne, VIC, Australia
| | - Nicolette R Holt
- The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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13
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Francis CE, Quinnell T. Mandibular Advancement Devices for OSA: An Alternative to CPAP? Pulm Ther 2020; 7:25-36. [PMID: 33170490 PMCID: PMC8137783 DOI: 10.1007/s41030-020-00137-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/19/2020] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnea (OSA) is a prevalent condition causing unrefreshing sleep and excessive daytime sleepiness. It has individual socioeconomic impacts and, through association with increased risk of road traffic accidents, diabetes, and cardiovascular disease, OSA is a public health issue. Continuous positive airway pressure (CPAP) is the first-line treatment for moderate-to-severe OSA. It is effective in improving excessive daytime sleepiness and quality of life. There is also evidence that CPAP therapy has cardiovascular benefits although nature and extent remain uncertain. Despite its benefits, a significant proportion of patients are unable to tolerate CPAP. There are also patients with mild but symptomatic disease, for whom CPAP is usually not available or appropriate, so there is a need for other treatment options. Mandibular advancement devices (MADs) offer an effective alternative to CPAP and can improve daytime symptoms and quality of life. There are many devices available, representing a range of complexity and cost. It is challenging to properly evaluate the effectiveness of this ever-evolving range. The more basic MADs are cheaper and more accessible but are less well tolerated. More complex devices are better tolerated and may be more effective. However, they are more expensive and often require dental expertise, so access is more limited. Efforts continue to try to improve accessibility to effective MAD therapy. Alongside increasing awareness, this may be facilitated by developing and refining devices that could be fitted by non-dental clinicians, and potentially by patients themselves. Research efforts need to focus on determining how to efficiently identify patients who are likely to respond to MAD therapy, so as to improve clinical and cost-effectiveness of OSA therapy overall.
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Affiliation(s)
| | - Tim Quinnell
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK.
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14
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Barbosa DF, Giannasi LC, Ferreira LMDB, Cruz MME, Alves MC, Berzin F. A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients. Dental Press J Orthod 2020; 25:44-50. [PMID: 33206828 PMCID: PMC7668058 DOI: 10.1590/2177-6709.25.5.044-050.oar] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/30/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper's plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. OBJECTIVE This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. METHODS Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. RESULTS Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. CONCLUSION Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.
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Affiliation(s)
- Denise Fernandes Barbosa
- Private practice (Jundiaí/SP, Brazil)
- Universidade de Campinas, Faculdade de Odontologia de Piracicaba (Piracicaba/SP, Brazil)
| | - Lilian Chrystiane Giannasi
- Universidade Estadual Paulista Júlio Mesquita Filho, Instituto de Ciência e Tecnologia (São José dos Campos/SP, Brazil)
| | | | - Miguel Meira e Cruz
- Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Lisbon, Portugal
- Neuroimune Interface Research Lab, Faculdade São Leopoldo Mandic, Campinas-SP, Brazil
| | - Marcelo Corrêa Alves
- Universidade de São Paulo, Escola Superior de Agricultura Luiz de Queiroz (Piracicaba/SP, Brazil)
| | - Fausto Berzin
- Universidade de Campinas, Faculdade de Odontologia de Piracicaba (Piracicaba/SP, Brazil)
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15
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Flores-Orozco EI, Tiznado-Orozco GE, Díaz-Peña R, Orozco EIF, Galletti C, Gazia F, Galletti F. Effect of a Mandibular Advancement Device on the Upper Airway in a Patient With Obstructive Sleep Apnea. J Craniofac Surg 2020; 31:e32-e35. [PMID: 31449205 DOI: 10.1097/scs.0000000000005838] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The authors present a case of a 33-year-old male patient with obstructive sleep apnea syndrome who was treated with a mandibular advancement device with excellent results. The aim of this study is to underline the importance of new instruments that allow evaluating the upper airway with greater precision, such as cone beam tomography. Given the diagnosis and treatment, the upper airway was assessed using cone beam tomography; an increase in UA volume of 22% was observed (initial volume 22,962 mm), along with a 28% increase in area (initial area 971 mm). The evaluation of the UA using teleradiography also showed an increase in the points evaluated, with the midpoint of the soft palate presenting the greatest increase.
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Affiliation(s)
| | | | - Rogelio Díaz-Peña
- Department of Prosthodontics, Faculty of Dentistry, Autonomous University of Nayarit, Tepic, Mexico
| | - Esteban Isaí Flores Orozco
- Department of Restorative Dentistry, Endodontic Division, São Paulo State University (UNESP), São José dos Campos, Brazil
| | - Cosimo Galletti
- Comprehensive Dentistry Department, Faculty of Dentistry, Universitat de Barcelona, L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain
| | - Francesco Gazia
- Department of Adult and Development Age Human Pathology "Gaetano Barresi," Unit of Otorhinolaryngology, University of Messina Via Consolare Valeria 1, Messina, Italy
| | - Francesco Galletti
- Department of Adult and Development Age Human Pathology "Gaetano Barresi," Unit of Otorhinolaryngology, University of Messina Via Consolare Valeria 1, Messina, Italy
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16
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Romano M, Karanxha L, Baj A, Giannì A, Taschieri S, Del Fabbro M, Rossi D. Maxillomandibular advancement for the treatment of obstructive sleep apnoea syndrome: a long-term follow-up. Br J Oral Maxillofac Surg 2020; 58:319-323. [DOI: 10.1016/j.bjoms.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 12/26/2019] [Indexed: 10/24/2022]
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17
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Chen A, Burger MS, Rietdijk-Smulders MA, Smeenk FW. Mandibular advancement device: Effectiveness and dental side effects. A real-life study. Cranio 2020; 40:97-106. [DOI: 10.1080/08869634.2019.1708610] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Aoben Chen
- Department of Pulmonology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | - Maud S. Burger
- Department of Oral and Maxillofacial Surgery, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
| | | | - Frank W.J.M. Smeenk
- Department of Pulmonology, Catharina Hospital Eindhoven, Eindhoven, the Netherlands
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18
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Alessandri-Bonetti A, Bortolotti F, Moreno-Hay I, Michelotti A, Cordaro M, Alessandri-Bonetti G, Okeson JP. Effects of mandibular advancement device for obstructive sleep apnea on temporomandibular disorders: A systematic review and meta-analysis. Sleep Med Rev 2019; 48:101211. [DOI: 10.1016/j.smrv.2019.101211] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/30/2019] [Accepted: 09/09/2019] [Indexed: 12/18/2022]
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19
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Viviano J, Klauer D, Olmos S, Viviano JD. Retrospective comparison of the George Gauge™ registration and the sibilant phoneme registration for constructing OSA oral appliances. Cranio 2019; 40:5-13. [PMID: 31770076 DOI: 10.1080/08869634.2019.1694776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To compare outcomes for appliances manufactured utilizing the George Gauge™ Registration (GGR) and the Sibilant Phoneme Registration (SPR). It was hypothesized that there would be no difference in outcomes.Methods: This study is a retrospective analysis of two groups. Each group consisted of 20 oral appliances manufactured utilizing the GGR and 20 utilizing the SPR.Results: For the two-site data, no difference in outcomes was demonstrated (p = .24). The SPR method required fewer calibrations (p = 5.6 × 10-3) and less jaw movement (p = 3.33 × 10-4). Both bite methods resulted in similarly variable post-AHI scores (p = .52). For the eight-site data, no difference in outcomes was demonstrated (p = .76). The SPR required less movement of the jaw (p = 4.52 × 10-5); however, outcome variance was larger for the SPR (p = .036).Conclusion: The study null hypothesis of no difference in outcomes was supported.Abbreviations: AHI: Apnea-Hypopnea Index; GGR: George Gauge Registration; SPR: Sibilant Phoneme Registration; OSA: Obstructive Sleep Apnea; OA: Oral Appliance; OAT: Oral Appliance Therapy; MA: Mandibular Advancement; VDO: Vertical Dimensional Opening; AADSM: American Academy of Dental Sleep Medicine; ABDSM: American Board of Dental Sleep Medicine; BMI: Body Mass Index.
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Affiliation(s)
- John Viviano
- Private Practice, Sleep Disorders Dentistry RLC, Mississauga, ON, Canada
| | | | | | - Joseph D Viviano
- Private Practice, Sleep Disorders Dentistry RLC, Mississauga, ON, Canada
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20
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Ilea A, Timuș D, Höpken J, Andrei V, Băbțan AM, Petrescu NB, Câmpian RS, Boșca AB, Șovrea AS, Negucioiu M, Mesaros AȘ. Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development. Cranio 2019; 39:472-483. [PMID: 31588866 DOI: 10.1080/08869634.2019.1673285] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: Oral appliance therapy is a non-invasive treatment that offers a wide variety of oral devices for the treatment of obstructive sleep apnea (OSA). The present review focuses on the effectiveness of mandibular advancement devices for the treatment of OSA. Methods: A systematic review based on the PRISMA checklist was carried out. A detailed electronic database search was conducted using "Obstructive sleep apnea" AND "Oral appliance" AND "Dentistry" as keywords. Results: The initial search in the electronic databases resulted in a total of 262 papers. After the title and abstract analysis and full-text review, the number of eligible papers was reduced to 15. Conclusion: The mandibular advancement device is an effective treatment, improving the Apnea Hypopnea Index and the symptoms of patients with OSA in 92% of the subjects from all the investigated studies. The future may include the integration of a biosensor for the diagnosis and follow-up. Abbreviations: OSA: Obstructive sleep apnea; MADs: Mandibular advancement devices; CPAP: Continuous positive airway pressure; OAT: Oral appliance therapy; MRD: Mandibular repositioning devices; MAS: Mandibular advancement splints; MAA: Mandibular advancement appliances; OA: Oral appliances; AASM: American Academy of Sleep Medicine; AHI: Apnea-hypopnea index; EEG: Sleep-related breathing disorder SRBD; Electroencephalogram; EOG: Electrooculogram; ECG: Electrocardiogram; QOL: Quality of life; TMJ: Temporomandibular joint.
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Affiliation(s)
- Aranka Ilea
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Daniela Timuș
- Faculty of Dentistry, Student in the 6th year of "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Julian Höpken
- Faculty of Dentistry, Postgraduate student of "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Vlad Andrei
- Department of Periodontology, Clinical County Hospital of Târgu Mureș , Romania
| | - Anida-Maria Băbțan
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Nausica Bianca Petrescu
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Radu Septimiu Câmpian
- Department of Oral Rehabilitation, Oral Health and Dental Office Management, Faculty of Dentistry, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Adina Bianca Boșca
- Department of Histology, Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Alina Simona Șovrea
- Department of Histology, Faculty of Medicine, "Iuliu Haţieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Marius Negucioiu
- Department of Prosthodontics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
| | - Anca Ștefania Mesaros
- Department of Dental Propedeutics and Esthetics, Faculty of Dentistry, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca , Cluj-Napoca , Romania
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Chuang LC, Hwang YJ, Lian YC, Hervy-Auboiron M, Pirelli P, Huang YS, Guilleminault C. Changes in craniofacial and airway morphology as well as quality of life after passive myofunctional therapy in children with obstructive sleep apnea: a comparative cohort study. Sleep Breath 2019; 23:1359-1369. [DOI: 10.1007/s11325-019-01929-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 11/28/2022]
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22
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S3-Leitlinie „Diagnostik und Therapie des Schnarchens des Erwachsenen“. SOMNOLOGIE 2019. [DOI: 10.1007/s11818-019-0211-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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23
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Sutherland K, Dalci O. Fake it till you custom-make it: a non-inferior thermoplastic mandibular advancement device? Thorax 2019; 74:629-630. [PMID: 31053620 DOI: 10.1136/thoraxjnl-2019-213366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Kate Sutherland
- Department of Respiratory and Sleep Medicine, Center for Sleep Health and Research, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Oyku Dalci
- Discipline of Orthodontics and Paediatric Dentistry, School of Dentistry, University of Sydney, Dental Hospital, Sydney Local Health District, Sydney, New South Wales, Australia
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Alqahtani ND, Algowaifly MI, Almehizia FA, Alraddadi ZA, Al-Sehaibany FS, Almosa NA, Albarakati SF, Bahammam AS. The characteristics of dental occlusion in patients with moderate to severe obstructive sleep apnea in Saudi Arabia. Saudi Med J 2018; 39:928-934. [PMID: 30251737 PMCID: PMC6200999 DOI: 10.15537/smj.2018.9.22750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objectives: To evaluate characteristics of dental occlusion among non-obese Saudi adult patients suffering from moderate to severe obstructive sleep apnea(OSA). Methods: Following ethical approval, a cross-sectional study was conducted at Sleep Disorders Center, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia, between January and March 2017. Non-obese adult Saudi patients with moderate/severe OSA (apnea-hypopnea index>15) and without history of malocclusion or edentulism were included with an estimated sample size of 50. Demographic details and severity of OSA as diagnosed by polysomnography were recorded. Characteristics of dental occlusion, namely molar, canine and incisor relationship, overjet, overbite, crossbite and arch form were obtained through calibrated examiners (kappa 0.81). Descriptive statistical analysis and Chi-square test, with 95% significance level (p<0.05), were used to identify relationships between the severity of OSA and characteristics of dental occlusion. Results: A total of 51 patients (31 males, 20 females; mean age 49.45±10.35 years), were enrolled in the study. Severity of OSA was moderate in 17 patients and severe in 34 patients. Severe form of OSA was more among males (64.7%) and in patients with Class-II division-1 incisor relationship (94.1%). Neither the demographic characteristics, nor characteristics of dental occlusion showed statistically significant relationship with the severity of OSA. Conclusion: The results of the present cross-sectional study indicate that the characteristics of dental occlusion are not related to the severity of OSA among non-obese adult Saudi patients.
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Affiliation(s)
- Nasser D Alqahtani
- Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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25
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Knappe SW, Sonnesen L. Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives. Nat Sci Sleep 2018; 10:65-72. [PMID: 29440942 PMCID: PMC5800493 DOI: 10.2147/nss.s135760] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The purpose of this article is to review 1) mandibular advancement device (MAD) - indication, treatment success, and side effects; 2) maxillomandibular advancement (MMA) surgery of the jaws - indication, treatment success, and side effects; and 3) current perspectives. Both MAD and MMA are administered to increase the upper airway volume and reduce the collapsibility of the upper airway. MAD is noninvasive and is indicated as a first-stage treatment in adult patients with mild-to-moderate obstructive sleep apnea (OSA) and in patients with severe OSA unable to adhere to continuous positive airway pressure (CPAP). MAD remains inferior to CPAP in reducing the apnea-hypopnea index (AHI) with a treatment success ranging between 24% and 72%. However, patient compliance to MAD is greater, and with regard to subjective sleepiness and health outcomes, MAD and CPAP have been found to be similarly effective. Short-term side effects of MAD are minor and often transient. Long-term side effects primarily appear as changes in the dental occlusion related to decreases in overjet and overbite. MMA is efficacious but highly invasive and indicated as a second-stage treatment in patients with moderate-to-severe OSA, with prior failure to other treatment modalities or with craniofacial abnormalities. The surgical success and cure rates are found to be 86.0% and 43.2%, respectively. Side effects may appear as postsurgical complications such as temporary facial paresthesia and compromised facial esthetics. However, most patients report satisfaction with their postsurgical appearance. Both treatment modalities require experienced clinicians and multidisciplinary approaches in order to efficaciously treat OSA patients. Some researchers do propose possible predictors of treatment success, but clear patient selection criteria and clinical predictive values for treatment success are still needed in both treatment modalities.
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Affiliation(s)
- Sofie Wilkens Knappe
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Liselotte Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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26
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Basyuni S, Barabas M, Quinnell T. An update on mandibular advancement devices for the treatment of obstructive sleep apnoea hypopnoea syndrome. J Thorac Dis 2018; 10:S48-S56. [PMID: 29445528 DOI: 10.21037/jtd.2017.12.18] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Continuous positive airway pressure (CPAP) remains the gold standard treatment for obstructive sleep apnoea hypopnoea syndrome (OSAHS). However, the high efficacy of CPAP is offset by intolerance and poor compliance, which can undermine effectiveness. This means that alternatives to CPAP are also necessary. In recent years, oral appliances have emerged as the leading alternative to CPAP. There is now a strong body of evidence supporting their use in OSAHS and clinical guidelines now recommend their use in mild OSAHS and in more severe cases when CPAP fails. These devices are by no means a homogenous group as they differ greatly in both design and action. The most commonly used appliances are mandibular advancement devices (MAD) that increase airway diameter with soft tissue displacement achieved by mandibular protrusion. Despite the growing evidence, there are still barriers to MAD provision. Their effectiveness can be difficult to predict and there is debate about the required level of design sophistication. These uncertainties prevent more widespread inclusion of MAD within clinical sleep services. This review will focus on the efficacy, effectiveness, design features, side-effects of and patient selection for MAD therapy. Comparison will also be made between MAD and CPAP therapy.
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Affiliation(s)
- Shadi Basyuni
- Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
| | - Michal Barabas
- Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
| | - Tim Quinnell
- Respiratory Support and Sleep Centre, Papworth Hospital, Cambridge, UK
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27
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Teixeira AODB, Andrade ALL, Almeida RCDC, Almeida MADO. Side effects of intraoral devices for OSAS treatment. Braz J Otorhinolaryngol 2017; 84:772-780. [PMID: 29102398 PMCID: PMC9442828 DOI: 10.1016/j.bjorl.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/28/2017] [Accepted: 09/23/2017] [Indexed: 11/28/2022] Open
Abstract
Introduction Intraoral devices have increasingly assumed a key role in the treatment of obstructive sleep apnea syndrome, but there are limitations to their indication and side effects that result from their continuous use, as well as the use of the continuous positive airway pressure device. Objectives To evaluate the changes in dental positioning caused by the continuous use of mandibular advancement devices. Methods A prospective longitudinal study with a sample of 15 patients, with evaluation of complete documentation after a mean time of 6.47 months, assessed changes in dental positioning due to the use of the Twin Block oral device for the treatment of patients with apnea. The following variables were evaluated: overjet, overbite, upper and lower intermolar distances, upper and lower intercanine distances, Little's irregularity index and the incisor mandibular plane angle. An intraclass correlation test was performed and a correlation index > 0.08 was accepted. After verifying the normal sample distribution (Shapiro-Wilks), a parametric test was used (t test), with a significance level set at 5%. Results There was a decrease in the values of overjet, overbite and Little's irregularity index, whereas there was an increase in the lower intercanine distance and IMPA values. All these variables are influenced, at different levels, by the forward inclination of the lower incisors, an action that can be expected due to the force applied by the device on the dentition. The other variables did not show statistically significant differences. Conclusion After a mean time of 6.47 months of use of the mandibular advancement device, there were statistically significant changes in the dental positioning, but they were not clinically relevant. However, it is relevant that this device is commonly in use over long periods of time, making the monitoring of these patients of the utmost importance for the duration of their therapy.
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Affiliation(s)
| | - Ana Luiza Ladeia Andrade
- Universidade do Estado do Rio de Janeiro (Uerj), Faculdade de Odontologia, Ortodontia, Rio de Janeiro, RJ, Brazil
| | | | - Marco Antonio de Oliveira Almeida
- Universidade do Estado do Rio de Janeiro (Uerj), Faculdade de Odontologia, Ortodontia, Rio de Janeiro, RJ, Brazil; North Carolina State University, Chapel Hill, United States
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28
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Güneri P, İlhan B, Çal E, Epstein JB, Klasser GD. Obstructive sleep apnoea and the need for its introduction into dental curricula. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2017; 21:121-129. [PMID: 26895614 DOI: 10.1111/eje.12190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2016] [Indexed: 06/05/2023]
Abstract
Obstructive sleep apnoea (OSA) is a major health problem which causes blood oxygen desaturation that may initiate a cascade of events via inflammatory cytokines and adrenocorticotrophic hormone that may have impact upon quality of life and lead to potential life-threatening events. Even though OSA affects an increasing number of individuals, the role of dental practitioners in recognition, screening and management has not developed accordingly. The goal of this article was to provide updated information to dental practitioners on pathophysiology, consequences and treatment options of OSA with a focused discussion on oral appliance (OA) therapy, as this topic is not routinely included in current dental curricula of many dental schools. Additionally, we present a template dental curriculum for predoctoral and/or postdoctoral students in education regarding sleep disordered breathing.
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Affiliation(s)
- P Güneri
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, Turkey
| | - B İlhan
- Department of Oral and Maxillofacial Radiology, Ege University School of Dentistry, Izmir, Turkey
| | - E Çal
- Department of Prosthetic Dentistry, Ege University School of Dentistry, Izmir, Turkey
| | - J B Epstein
- Division of Otolaryngology and Head and Neck Surgery City of Hope National Medical Center, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - G D Klasser
- Department of Diagnostic Sciences, School of Dentistry, Louisiana State University, New Orleans, LA, USA
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29
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Knappe SW, Bakke M, Svanholt P, Petersson A, Sonnesen L. Long-term side effects on the temporomandibular joints and oro-facial function in patients with obstructive sleep apnoea treated with a mandibular advancement device. J Oral Rehabil 2017; 44:354-362. [PMID: 28094865 DOI: 10.1111/joor.12485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2017] [Indexed: 11/27/2022]
Abstract
Patients with obstructive sleep apnoea (OSA) in long-term treatment with a mandibular advancement device (MAD) to increase the upper airway space may develop changes in the temporomandibular joint (TMJ) and the oro-facial function due to the protruded jaw position during sleep. The aim was to investigate the influence of long-term MAD treatment on the TMJs, oro-facial function and occlusion. This prospective study included 30 men and 13 women (median age 54) with OSA [Apnoea-Hypopnoea Index (AHI): 7-57]. They were examined with the Nordic Orofacial Test Screening (NOT-S), the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and cone beam computed tomography (CBCT) of the TMJs. The examination was performed before MAD treatment (T0), and 3-6 months (T1, no CBCT), 1 year (T2) and 3 years (T3) after treatment start. The results were analysed as long term (T0-T3, n = 14) and short term (T0-T2, n = 24) by t-test, Fisher's exact test and anova. Both long- and short-term analyses revealed a reduction in AHI (P < 0·002). Significant long term were increased scores in the NOT-S Interview (P < 0·045), reduced vertical overbite (P < 0·031) and increased jaw protrusive movement (P < 0·027). TMJ changes were found as joint sounds in terms of reciprocal clicking and crepitus, short term as a decrease and subsequent recurrence (P < 0·053; P < 0·037). No significant radiological changes were found. In conclusion, MAD treatment is beneficial to some OSA patients, but might induce changes in the TMJs, the oro-facial function and the occlusion. However, these changes seemed to be less harmful than previously reported with careful adaptation, control and follow-ups.
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Affiliation(s)
- S W Knappe
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - M Bakke
- Section of Oral Medicine (Clinical Oral Physiology), Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - P Svanholt
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - A Petersson
- Section of Radiology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - L Sonnesen
- Section of Orthodontics, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen – Kapitel „Schlafbezogene Atmungsstörungen“. SOMNOLOGIE 2016. [DOI: 10.1007/s11818-016-0093-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Abstract
Purpose of review Obstructive sleep apnea (OSA) is a global problem with implications for general health and quality of life, and is often encountered in patients with neurologic disease. This review outlines treatment modalities to consider for management of OSA in patients with neurologic disease. Recent findings New advances in positive airway pressure (PAP) devices, oral appliances, and surgical interventions offer a wide range of treatment options for patients with OSA. Summary PAP therapy remains the gold standard treatment for OSA. Other treatment modalities may be considered for OSA patients who decline or cannot tolerate PAP therapy. Some OSA patients may benefit from multimodal treatment.
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Affiliation(s)
- Patrick Pavwoski
- Garden City Hospital (PP); and University of Michigan (AVS), Ann Arbor
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32
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Al-Jewair TS, Gaffar BO, Flores-Mir C. Quality Assessment of Systematic Reviews on the Efficacy of Oral Appliance Therapy for Adult and Pediatric Sleep-Disordered Breathing. J Clin Sleep Med 2016; 12:1175-83. [PMID: 27397656 PMCID: PMC4957196 DOI: 10.5664/jcsm.6062] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/06/2016] [Indexed: 01/08/2023]
Abstract
STUDY OBJECTIVES To assess the methodological quality of published systematic reviews (SRs) and meta-analyses (MAs) about the efficacy of oral appliances (OA) in the management of adult and pediatric sleep-disordered breathing (SDB). METHODS SRs/MAs that evaluated the efficacy of OA therapy on the treatment of SDB in human subjects of all age groups were sought. Multiple electronic databases were searched for articles published in any language from the database's inception until January 2016. Two reviewers independently selected and then assessed the methodological quality of the studies using the Assessment of Multiple Systematic Reviews (AMSTAR) measurement tool. RESULTS Thirteen reviews on adult SDB were included (2 SRs and 11 SRs with MAs). Of those, seven were medium quality and six were high quality. Only four reviews were included on pediatric SDB (3 SRs and 1 SR with MA). Three of these were of high quality and one was medium quality. The identified limitations in the included reviews were failing to reference the excluded studies or describe reasons for exclusion, lack of applying valid criteria to assess the quality of included studies, lack of publication bias assessment, and absence of conflicts of interest reporting. CONCLUSIONS Overall, SRs/MAs on OA therapy for adult and pediatric SDB were conducted with acceptable methodological quality. High AMSTAR scores should not be extrapolated as a proxy of the methodological quality of the included evidence. There is a need for more primary studies and then that information can be used to be synthesized through SRs on pediatric SDB.
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Affiliation(s)
- Thikriat S. Al-Jewair
- Clinical Assistant Professor and Program Director, Department of Orthodontics, State University of New York at Buffalo, Buffalo, NY
| | - Balgis O. Gaffar
- Lecturer, Department of Preventive Dental Sciences, College of Dentistry, University of Dammam, Saudi Arabia
| | - Carlos Flores-Mir
- Professor, Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, University of Alberta, Edmonton, Alberta Canada
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Bartolucci ML, Bortolotti F, Raffaelli E, D'Antò V, Michelotti A, Alessandri Bonetti G. The effectiveness of different mandibular advancement amounts in OSA patients: a systematic review and meta-regression analysis. Sleep Breath 2016; 20:911-9. [PMID: 26779903 DOI: 10.1007/s11325-015-1307-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/20/2015] [Accepted: 12/29/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE The therapy with mandibular advancement devices (MADs) represents a treatment option for patients with obstructive sleep apnea (OSA). The literature does not provide evidence regarding the most effective mandibular advancement; therefore, the aim of this systematic review with meta-regression was to investigate the effectiveness of different mandibular advancement amounts in reducing apnea-hypopnea index (AHI) in OSA patients. METHODS An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, ISI Web of Knowledge, Scopus, and LILACS to select randomized controlled trials (RCTs) investigating the efficacy of MADs in reducing AHI in adult OSA patients. Inclusion criteria were the diagnosis of OSA and success evaluation performed with a polysomnography, follow-up of maximum 12 months, and protrusion amount reported as a percentage of the maximum mandibular advancement. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The success rate of each study was computed: [(mean AHI at baseline-mean AHI after treatment)/mean AHI at baseline]. RESULTS Thirteen RCTs performing advancements from 50 to 89 % of maximum mandibular protrusion were included. The meta-regression analysis showed that advancement amounts higher than 50 % do not significantly influence the success rate (Q = 0.373, p = 0.541). According to the GRADE score system, the quality of evidence resulted to be moderate. CONCLUSION The AHI improvement resulted to be not proportional to the mandibular advancement increase. It is plausible that the success of the therapy is influenced by a combination of variables that need closer study.
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Affiliation(s)
- Maria Lavinia Bartolucci
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy.
| | - Francesco Bortolotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy
| | - Eugenia Raffaelli
- Department of Biomedical Sciences, Section of Orthodontics, University of Bologna, via san Vitale, 59, 40125, Bologna, Italy
| | - Vincenzo D'Antò
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy
| | - Ambra Michelotti
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", via Pansini, 5, 80131, Naples, Italy
| | - Giulio Alessandri Bonetti
- Department of Biomedical Sciences, Section of Orthodontics, University of Bologna, via san Vitale, 59, 40125, Bologna, Italy
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Gjerde K, Lehmann S, Berge ME, Johansson AK, Johansson A. Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to CPAP. J Oral Rehabil 2015; 43:249-58. [PMID: 26707632 PMCID: PMC4834725 DOI: 10.1111/joor.12376] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 12/13/2022]
Abstract
The aim of this retrospective study was to evaluate the effect of individually adjusted custom‐made mandibular advancement device/oral appliance (OA) in treatment of patients with moderate and severe obstructive sleep apnoea (OSA), who were non‐adherent to continuous positive airway pressure (CPAP) therapy. During 2007‐2013, 116 patients with moderate (n = 82) and severe (n = 34) OSA non‐adherent to CPAP treatment were referred for dental management with an individually adjusted OA at a specialist sleep clinic. Ten of the participants (8·6%) were lost to follow‐up, leaving the data set to consist of 106 patients (71 men/35 women, mean age 57 year, range 28‐90). Nocturnal respiratory polygraphic recordings were performed at baseline and follow‐up. Average time between baseline polygraphy and follow‐up was 12 months. A successful OA treatment outcome was based on polygraphy at the follow‐up and divided into three groups: 1 = AHI <5; 2 = 5 ≤ AHI <10 and >50% reduction in baseline AHI; and 3. >50% reduction in baseline AHI. If there was a ≤ 50% reduction in baseline AHI at the follow‐up, the treatment was considered as a failure. The overall treatment success rate was 75%. There was no significant difference in success rates between patients in the moderate and severe categories (69% and 77%, respectively). Low oxygen saturation (SpO2 nadir) had a high predictive value for OA treatment failure. OA treatment of patients non‐adherent to CPAP is efficient and especially promising for the severe OSA group who are at greatest risks for developing serious comorbidities, if left untreated.
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Affiliation(s)
- K Gjerde
- Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway
| | - S Lehmann
- Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, Section for Thoracic Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - M E Berge
- Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - A-K Johansson
- Department of Clinical Dentistry - Cariology, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - A Johansson
- Department of Thoracic Medicine, Center for Sleep Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Cantore S, Ballini A, Farronato D, Malcangi G, Dipalma G, Assandri F, Garagiola U, Inchingolo F, De Vito D, Cirulli N. Evaluation of an oral appliance in patients with mild to moderate obstructive sleep apnea syndrome intolerant to continuous positive airway pressure use: Preliminary results. Int J Immunopathol Pharmacol 2015; 29:267-73. [PMID: 26684627 DOI: 10.1177/0394632015590949] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 05/20/2015] [Indexed: 11/15/2022] Open
Abstract
Obstructive sleep apnea syndrome (OSAS) is a phenomenon of repeated, episodic reduction, or cessation of airflow (hypopnea/apnea) as a result of upper airways obstruction. First-line treatment in younger children is adenotonsillectomy, although other available treatment options in middle-aged adults include continuous positive airways pressure (CPAP) and airway adjuncts. Oral appliances (OA) are a viable treatment alternative in patients with OSAS.The objective of this study was to assess, in a 1-year follow-up study, an OA in OSAS patients. The participants were subjected to polysomnographic examination with a validated device (MicroMESAM). Eight participants were fitted with a Thornton Adjustable Positioner (TAP). The participants were asked to wear the test appliance for 7 nights, and in case of compliance, for 6 months. The selected patients record their usage of the appliance and any adverse effects in a treatment journal. The research focused on the following outcomes: sleep apnea (i.e. reduction in the apnea/hypopnea index) and the effect of oral appliances on daytime function.In conclusion, the results suggest that OA have a definite role in the treatment of snoring and sleep apnea.
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Affiliation(s)
- S Cantore
- Department of Basic Medical Science, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - A Ballini
- Department of Basic Medical Science, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - D Farronato
- Department of Morphologic and Surgical Sciences, Insubria University, Varese, Italy
| | - G Malcangi
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - G Dipalma
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - F Assandri
- Department of Biomedical, Surgical and Dental Sciences, Unit of Orthodontics and Paediatric Dentistry, University of Milan, Milan, Italy
| | - U Garagiola
- Department of Biomedical, Surgical and Dental Sciences, Unit of Orthodontics and Paediatric Dentistry, University of Milan, Milan, Italy
| | - F Inchingolo
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, Bari, Italy
| | - D De Vito
- Department of Basic Medical Science, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - N Cirulli
- Department of Basic Medical Science, Neurosciences and Sense Organs, University of Bari Aldo Moro, Bari, Italy
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Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. Sleep Breath 2015; 20:635-46. [PMID: 26463420 PMCID: PMC4850173 DOI: 10.1007/s11325-015-1265-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 09/07/2015] [Accepted: 09/21/2015] [Indexed: 10/26/2022]
Abstract
PURPOSE The present study compared the effects of mandibular advancement therapy (MAD) with continuous positive airway pressure therapy (CPAP) on daytime cardiac autonomic modulation in a wide range of obstructive sleep apnea (OSA) patients under controlled conditions in a randomized, two-period crossover trial. METHODS Forty OSA patients underwent treatment with MAD and with CPAP for 12 weeks each. At baseline and after each treatment period, patients were assessed by polysomnography as well as by a daytime cardiac autonomic function test that measured heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under conditions of spontaneous breathing, with breathing at 6, 12, and 15/min. RESULTS Both CPAP and MAD therapy substantially eliminated apneas and hypopneas. CPAP had a greater effect. During daytime with all four conditions of controlled breathing, three-minute mean values of continuous diastolic BP were significantly reduced for both MAD and CPAP therapy. At the same time, selective increases due to therapy with MAD were found for HRV high frequency (HF) values. No changes were observed for BRS in either therapy mode. CONCLUSIONS These findings indicate that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure. CPAP is more effective than MAD in eliminating respiratory events.
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Spicuzza L, Caruso D, Di Maria G. Obstructive sleep apnoea syndrome and its management. Ther Adv Chronic Dis 2015; 6:273-85. [PMID: 26336596 DOI: 10.1177/2040622315590318] [Citation(s) in RCA: 136] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Obstructive sleep apnoea (OSA) is a common disorder characterized by repetitive episodes of nocturnal breathing cessation due to upper airway collapse. OSA causes severe symptoms, such as excessive daytime somnolence, and is associated with a significant cardiovascular morbidity and mortality. Different treatment options are now available for an effective management of this disease. After more than three decades from its first use, continuous positive airway pressure (CPAP) is still recognized as the gold standard treatment. Nasal CPAP (nCPAP) is highly effective in controlling symptoms, improving quality of life and reducing the clinical sequelae of sleep apnoea. Other positive airway pressure modalities are available for patients intolerant to CPAP or requiring high levels of positive pressure. Mandibular advancement devices, particularly if custom made, are effective in mild to moderate OSA and provide a viable alternative for patients intolerant to CPAP therapy. The role of surgery remains controversial. Uvulopalatopharyngoplasty is a well established procedure and can be considered when treatment with CPAP has failed, whereas maxillar-mandibular surgery can be suggested to patients with a craniofacial malformation. A number of minimally invasive procedures to treat snoring are currently under evaluation. Weight loss improves symptoms and morbidity in all patients with obesity and bariatric surgery is an option in severe obesity. A multidisciplinary approach is necessary for an accurate management of the disease.
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Affiliation(s)
- Lucia Spicuzza
- UO Pneumologia, Azienda Policlinico, Via Santa Sofia 187, 95123 Catania, Italy
| | - Daniela Caruso
- Respiratory Unit, AOU Policlinico, University of Catania, Catania, Italy
| | - Giuseppe Di Maria
- Respiratory Unit, AOU Policlinico, University of Catania, Catania, Italy
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Abstract
Paediatric obstructive sleep apnea (OSA) is common and its prevalence is expected to increase due to the rise in childhood obesity. Recent research has shown that many children, both syndromic and non-syndromic, who exhibit mouth breathing as a result of upper airway obstruction, may also exhibit dentofacial anomalies. Although adenotonsillectomy and continuous positive airway pressure have been classically proposed as the primary treatment modalities for paediatric OSA, there are significant limitations to both therapies. Therefore newer treatment modalities are needed. Current research has focused on emerging dental treatment options for paediatric OSA, such as rapid maxillary expansion, oral appliances and distraction osteogenesis. However, there are few randomized trials assessing the effectiveness of these novel dental therapies for paediatric OSA, and hence further research is required to advance the field.
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Upadhyay R, Dubey A, Kant S, Singh BP. Management of severe obstructive sleep apnea using mandibular advancement devices with auto continuous positive airway pressures. Lung India 2015; 32:158-61. [PMID: 25814802 PMCID: PMC4372871 DOI: 10.4103/0970-2113.152632] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The use of continuous positive airway pressures (CPAP) is considered standard treatment of moderate to severe obstructive sleep apnea (OSA). Treatment of the disease poses a great challenge not only for its diagnostic purpose but also for its treatment part. In about 29-83% of the patients, treatment is difficult because of non-compliance resulting due to high pressures, air leaks and other related issues. In such situations, alternative methods of treatment need to be looked for so as to ascertain better management. Mandibular advancement devices along with CPAP may show better treatment outcome in specific situations.
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Affiliation(s)
- Rashmi Upadhyay
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Abhishek Dubey
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Surya Kant
- Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Balendra Pratap Singh
- Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
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Horner K, O'Malley L, Taylor K, Glenny AM. Guidelines for clinical use of CBCT: a review. Dentomaxillofac Radiol 2015; 44:20140225. [PMID: 25270063 PMCID: PMC4277440 DOI: 10.1259/dmfr.20140225] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 09/25/2014] [Accepted: 09/29/2014] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To identify guidelines on the clinical use of CBCT in dental and maxillofacial radiology, in particular selection criteria, to consider how they were produced, to appraise their quality objectively and to compare their recommendations. METHODS A literature search using MEDLINE (Ovid(®)) was undertaken prospectively from 1 January 2000 to identify published material classifiable as "guidelines" pertaining to the use of CBCT in dentistry. This was supplemented by searches on websites, an internet search engine, hand searching of theses and by information from personal contacts. Quality assessment of publications was performed using the AGREE II instrument. Publications were examined for areas of agreement and disagreement. RESULTS 26 publications were identified, 11 of which were specifically written to give guidelines on the clinical use of CBCT and contained sections on selection criteria. The remainder were a heterogeneous mixture of publications that included guidelines relating to CBCT. Two had used a formal evidence-based approach for guideline development and two used consensus methods. The quality of publications was frequently low as assessed using AGREE II, with many lacking evidence of adequate methodology. There was broad agreement between publications on clinical use, apart from treatment planning, in implant dentistry. CONCLUSIONS Reporting of guideline development is often poorly presented. Guideline development panels should aim to perform and report their work using the AGREE II instrument as a template to raise standards and avoid the risk of suspicions of bias.
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Affiliation(s)
- K Horner
- School of Dentistry, University of Manchester, Manchester, UK
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Abstract
The prevalence of sleep disturbances and their symptomatic manifestations may be different in men and women. Women with obstructive sleep apnea are less likely to be diagnosed with sleep apnea compared to men, probably due to atypical symptoms such as morning headaches, symptoms of depression and daytime fatigue. There is a great importance of diagnosis and treatment of sleep disorders regarding quality of life, co-morbidity and mortality in both genders.
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Affiliation(s)
- Csilla Zita Turányi
- Semmelweis Egyetem, Általános Orvostudományi Kar Alvásmedicina Munkacsoport, Magatartástudományi Intézet Budapest Nagyvárad tér 4. 1089
| | - Nóra Pintér
- Semmelweis Egyetem, Általános Orvostudományi Kar Alvásmedicina Munkacsoport, Magatartástudományi Intézet Budapest Nagyvárad tér 4. 1089
| | - Andrea Dunai
- Semmelweis Egyetem, Általános Orvostudományi Kar Alvásmedicina Munkacsoport, Magatartástudományi Intézet Budapest Nagyvárad tér 4. 1089 RWTH Aachen Hochschulärztliche Einrichtung Aachen Németország
| | - Márta Novák
- Semmelweis Egyetem, Általános Orvostudományi Kar Alvásmedicina Munkacsoport, Magatartástudományi Intézet Budapest Nagyvárad tér 4. 1089 University Health Network, University of Toronto Department of Psychiatry Toronto Kanada
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