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Meazzini MC, Moretti M, Canzi G, Sozzi D, Novelli G, Mazzoleni F. Maxillary Hypoplasia and Non-Invasive Ventilation: Literature Review and Proposed New Treatment Protocol. CHILDREN (BASEL, SWITZERLAND) 2024; 11:720. [PMID: 38929299 PMCID: PMC11201370 DOI: 10.3390/children11060720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 05/28/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024]
Abstract
The impact of non-invasive ventilation (NIV) on pediatric maxillary growth is a subject of ongoing research considering its increased use in the pediatric population due to technological advancements and broader indications. This review examines the existing literature, encompassing original articles, case reports, and reviews, to evaluate the effects of NIV on maxillary development and explore potential treatment options. Although the majority of studies agree on the adverse effects of prolonged NIV on maxillary development, techniques for its correction remain understudied. Introducing a novel treatment protocol, we addressed the challenge of correcting severe midfacial hypoplasia in a child with congenital central hypoventilation syndrome (CCHS) undergoing NIV therapy, thus sidestepping the necessity for osteotomies. This proposed protocol holds promise in correcting the adverse impact of NIV on maxillary growth, emphasizing the need for further exploration into innovative treatment modalities.
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Affiliation(s)
- Maria Costanza Meazzini
- Pediatric Craniofacial Malformations Unit, Smile House Monza—Craniofacial Center, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (M.C.M.); (F.M.)
| | - Mattia Moretti
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
- Postgraduate School of Maxillo-Facial Surgery, University of Milan, 20122 Milan, Italy
| | - Gabriele Canzi
- Maxillo-Facial Surgery Unit, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy;
| | - Davide Sozzi
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
| | - Giorgio Novelli
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
- Department of Medicine and Surgery, School of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
| | - Fabio Mazzoleni
- Pediatric Craniofacial Malformations Unit, Smile House Monza—Craniofacial Center, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (M.C.M.); (F.M.)
- Operative Unit of Maxillo-Facial Surgery, Fondazione IRCCS San Gerardo dei Tintori, 20900 Monza, Italy; (D.S.); (G.N.)
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Jafarimehrabady N, Scribante A, Defabianis P, Merlati G, Vitale MC. A Systematic Review of Oral Modifications Caused by the Prolonged Application of Continuous Positive Airway Pressure (CPAP) and Intraoral Appliances in Patients with Obstructive Sleep Apnea (OSA). BIOMED RESEARCH INTERNATIONAL 2024; 2024:9361528. [PMID: 38435538 PMCID: PMC10907106 DOI: 10.1155/2024/9361528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024]
Abstract
Objective Prolonged use of oral devices as a substitute for traditional treatments has been studied in relation to the dental and skeletal changes associated with obstructive sleep apnea syndrome (OSA), which is a sleep-breathing disorder. Materials and Methods A review of articles indexed in PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, and CINHAL databases in September 2022 based on MeSH-based keywords with "dental and skeletal" and "oral appliance" and "obstructive sleep apnea" was examined to ensure that the keywords alone or cross-linked, depending on which base of the searched data, were used. 16 articles out of 289 articles were included in the research, and 273 articles were excluded due to lack of study. Conclusions CPAP treatment has limited dental or skeletal effects in short-term or long-term use. OAs and MADs show significant dental changes with prolonged use. MAS and TSD are more effective in short-term goals than CPAP. OAs' increase may cause dental and skeletal changes. MPD shows notable cephalometric alterations.
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Affiliation(s)
- Niloofar Jafarimehrabady
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Andrea Scribante
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Patrizia Defabianis
- Department of Surgical Sciences, C.I.R. Dental School-Section of Pediatric Dentistry, University of Turin, Turin, Italy
| | - Giuseppe Merlati
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
| | - Marina Consuelo Vitale
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, Section of Dentistry, Unit of Orthodontics and Pediatric Dentistry, University of Pavia, Pavia, Italy
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Cozzi-Machado C, Albertini FR, Silveira S, Machado-Júnior AJ. Mandibular Advancement Appliances in Pediatric Obstructive Sleep Apnea: An Umbrella Review. Sleep Sci 2023; 16:e468-e475. [PMID: 38197023 PMCID: PMC10773500 DOI: 10.1055/s-0043-1776747] [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: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is defined as intermittent partial or complete collapse of the upper airway during sleep. It is a common condition in childhood, with an incidence ranging from 1.2% to 5.7%, and it can harm several aspects of children's life, such as cognitive, metabolic and cardiovascular functions, among others. There are treatment options, such as adenotonsillectomy, myofunctional therapy, mandibular advancement appliances (MAAs), rapid maxillary expansion, and positive airway pressure devices, but there is still doubt about which method is more suitable for the treatment of OSA in children. Objective To analyze the effectiveness of MAAs in the treatment of pediatric OSA. Materials and Methods The search was conducted in August 2021 in different electronic databases, such as PubMed, EBSCO (Dentistry & Oral Sciences Source), LILACS, Ovid, SciELO, Web of Science, EMBASE BIREME, BBO BIREME, and the Cochrane Library. Results Only three systematic reviews and two meta-analyses were included in the present study. All studies showed improvement in the score on the apnea-hypopnea index after using MAAs in the treatment of pediatric OSA. Conclusion Although more randomized studies are needed, based on the present umbrella review, MAAs must be considered part of the multidisciplinary treatment for pediatric OSA.
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Affiliation(s)
- Carolina Cozzi-Machado
- Postgraduate Program in Surgical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Fátima Rosana Albertini
- Postgraduate Program in Child and Adolescent Health, Centro de Investigação em Pediatria (CIPED), Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Silvana Silveira
- Postgraduate Program in Surgical Sciences, Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil
| | - Almiro José Machado-Júnior
- Department of Otorhinolaryngology, Head and Neck Surgery, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil; Institute of Science and Technology, Universidade Estadual de São Paulo (UNESP), São José dos Campos, SP, Brazil
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Guimarães MDLR, Ribeiro MCT, Barbosa TADS, Costa LGDF, Bastos PS. Obstructive Sleep Apnea Treatment with Oral Appliance in a Myotonic Dystrophy Type I Subject: A Case Report. Sleep Sci 2023; 16:e375-e380. [PMID: 38196758 PMCID: PMC10773523 DOI: 10.1055/s-0043-1772817] [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: 10/18/2021] [Accepted: 12/05/2022] [Indexed: 01/11/2024] Open
Abstract
Objective to report a myotonic dystrophy type 1 (MD1) subject with obstructive sleep apnea syndrome treated with oral appliance. Methods A review of individual's history and records, associated with a photographic register of all diagnostic methods and literature research about the topic were done. Final Statements This case depicts the therapeutical choices disposable to treat subjects with obstructive sleep apnea and DM1. Although considered an uncommon treatment, the oral appliances, if well indicated in adequately selected cases, can satisfactorily improve respiratory parameters, symptoms and quality of life.
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Affiliation(s)
| | | | | | | | - Patricia Souza Bastos
- Rede Sarah de Hospitais de Reabilitação, Setor de Eletrodiagnósticos, Belo Horizonte, Minas Gerais, Brazil.
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Tyler G, Machaalani R, Waters KA. Three-dimensional orthodontic imaging in children across the age spectrum and correlations with obstructive sleep apnea. J Clin Sleep Med 2023; 19:275-282. [PMID: 36123956 PMCID: PMC9892738 DOI: 10.5664/jcsm.10312] [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: 03/17/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 02/04/2023]
Abstract
STUDY OBJECTIVES To determine baseline facial convexity measurements in children with obstructive sleep apnea (OSA) across the age spectrum. METHODS Polysomnogram, stereophotogrammetry, and biometric data were collected from children aged 0-18 years who were being investigated for OSA. Analyses evaluated differences in facial convexity according to OSA severity and other sleep parameters, while adjusting for age, ethnicity, and sex. RESULTS Ninety-one children, aged 0.05-16.02 years, met the inclusion criteria for this study. Initial analysis showed that the logarithm of age had a significant effect on facial convexity (P = 8.3·10-7) with significant effects of sex (P = 1.3·10-2), while excluding OSA. Ordinal logistic regression taking into consideration age, sex, weight, height, and ethnicity with OSA severity categorized as obstructive apnea-hypopnea index negative, mild, moderate, or severe showed that facial convexity was associated with OSA severity (P = 2.2·10-3); an increasing obtuse angle of convexity increased the tendency to be classified as having severe OSA. CONCLUSIONS Using three-dimensional imaging, we found an added impact of infancy on changes of facial convexity with age. While modeling could describe facial convexity without any OSA-associated sleep parameters, differences in facial convexity were present among groups with different levels of OSA severity adjusted for growth (age, weight, and height), sex, and ethnicity. The method provides a safer and cheaper alternative to other medical imaging techniques in children and holds potential for future use in studies of craniofacial structure. CITATION Tyler G, Machaalani R, Waters KA. Three-dimensional orthodontic imaging in children across the age spectrum and correlations with obstructive sleep apnea. J Clin Sleep Med. 2023;19(2):275-282.
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Affiliation(s)
- Gemma Tyler
- Faculty of Science, University of Sydney, Camperdown, New South Wales 2006, Australia
- Sleep Unit, The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia
| | - Rita Machaalani
- Sleep Unit, The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2050, Australia
| | - Karen A. Waters
- Sleep Unit, The Children’s Hospital at Westmead, Westmead, New South Wales 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales 2050, Australia
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Ahonen H, Broström A, Fransson EI, Neher M, Lindmark U. "The terrible dryness woke me up, I had some trouble breathing"-Critical situations related to oral health as described by CPAP-treated persons with obstructive sleep apnea. J Sleep Res 2022; 31:e13670. [PMID: 35765213 PMCID: PMC10909513 DOI: 10.1111/jsr.13670] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/04/2022] [Accepted: 05/24/2022] [Indexed: 11/30/2022]
Abstract
Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment.
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Affiliation(s)
- Hanna Ahonen
- Centre for Oral Health, School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Anders Broström
- A.D.U.L.T., School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Clinical NeurophysiologyUniversity Hospital LinköpingLinköpingSweden
| | | | - Margit Neher
- A.D.U.L.T., School of Health and WelfareJönköping UniversityJönköpingSweden
| | - Ulrika Lindmark
- Centre for Oral Health, School of Health and WelfareJönköping UniversityJönköpingSweden
- Department of Health SciencesKarlstad UniversityKarlstadSweden
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Savoldi F, Svanetti L, Tsoi JK, Gu M, Paganelli C, Genna F, Lopomo NF. Experimental determination of the contact pressures produced by a nasal continuous positive airway pressure mask: A case study. J Mech Behav Biomed Mater 2022; 132:105272. [DOI: 10.1016/j.jmbbm.2022.105272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
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8
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Li Y, Lu Y, Li X, Zhao L, Guo J, Yu L, Feng J, Li B, Li X, Liu Y. Efficacy of orthodontic treatment versus adenotonsillectomy in children with moderate obstructive sleep apnoea and mandibular retrognathia: study design and protocol for a non-inferiority randomised controlled trial. BMJ Open 2022; 12:e055964. [PMID: 35473736 PMCID: PMC9045055 DOI: 10.1136/bmjopen-2021-055964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Orthodontic treatment and adenotonsillectomy (AT) are both conventional treatments for paediatric obstructive sleep apnoea (OSA). Each approach has distinct treatment advantages; however, there is currently a lack of solid evidence to support their efficacy comparison. We hypothesise that the objective effect of orthodontic treatment is not inferior to AT in children with moderate OSA and mandibular retrognathia, but orthodontic treatment has the advantage of promoting dentofacial growth. METHODS AND ANALYSIS This is a randomised, open-label, parallel-group, active controlled trial that will study the efficacy of orthodontic treatment versus AT in children with moderate OSA accompanied by tonsillar adenoid hypertrophy and mandibular retrognathia. A total of 98 patients will be enrolled and randomised in a 2:1 ratio to either orthodontic treatment or AT group. Participants will be recruited at Shanghai Stomatological Hospital, Shanghai Children's Hospital of Shanghai Jiaotong University and Children's Hospital of Fudan University, which are all located in Shanghai, China. The primary endpoint is the per cent change in the obstructive apnoea-hypopnoea index from baseline (month 0) to the primary endpoint (month 7), and the mean reduction in A point, nasion and B point angle on cephalometric measurements by lateral X-ray films. Important secondary efficacy endpoints include sleep duration with oxygen saturation below 90% according to polysomnography and subjective symptoms (assessed by the OSA-20 questionnaire), etc. Safety endpoints will also be evaluated. ETHICS AND DISSEMINATION The study was approved by the ethics committees of Shanghai Stomatological Hospital (approval no. (2021)002), Shanghai Children's Hospital of Shanghai Jiaotong University (approval no. 2021R046-F01) and Children's Hospital of Fudan University (approval no. (2021)136). Before enrolment, a qualified clinical research assistant will obtain written informed consent from both the participants and their guardians after full explanation of this study. The results will be presented at national or international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER ChiCTR2000037288.
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Affiliation(s)
- Yuanyuan Li
- Shanghai Stomatological Hospital, Department of Pediatric Dentistry, Fudan University Affliated Stomatological Hospital, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Yun Lu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
| | - Xuan Li
- Children's National Medical Center, Department of Stomatology, Children's Hospital of Fudan University, Shanghai, China
| | - Limin Zhao
- Shanghai Children's Hospital, Department of Otolaryngology and Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghan Guo
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
| | - Liming Yu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
| | - Jinqiu Feng
- Shanghai Stomatological Hospital, Department of Pediatric Dentistry, Fudan University Affliated Stomatological Hospital, Shanghai, China
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
| | - Bing Li
- Children's National Medical Center, Department of Stomatology, Children's Hospital of Fudan University, Shanghai, China
| | - Xiaoyan Li
- Shanghai Children's Hospital, Department of Otolaryngology and Head and Neck Surgery, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuehua Liu
- Shanghai Key Laboratory of Craniomaxillofacial Development and Diseases, Fudan University, Shanghai, China
- Shanghai Stomatological Hospital, Department of Orthodontics, Fudan University Affliated Stomatological Hospital, Shanghai, China
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Jaruga A, Ksiazkiewicz J, Kuzniarz K, Tylzanowski P. Orofacial Cleft and Mandibular Prognathism-Human Genetics and Animal Models. Int J Mol Sci 2022; 23:ijms23020953. [PMID: 35055138 PMCID: PMC8779325 DOI: 10.3390/ijms23020953] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/24/2021] [Accepted: 01/13/2022] [Indexed: 12/12/2022] Open
Abstract
Many complex molecular interactions are involved in the process of craniofacial development. Consequently, the network is sensitive to genetic mutations that may result in congenital malformations of varying severity. The most common birth anomalies within the head and neck are orofacial clefts (OFCs) and prognathism. Orofacial clefts are disorders with a range of phenotypes such as the cleft of the lip with or without cleft palate and isolated form of cleft palate with unilateral and bilateral variations. They may occur as an isolated abnormality (nonsyndromic-NSCLP) or coexist with syndromic disorders. Another cause of malformations, prognathism or skeletal class III malocclusion, is characterized by the disproportionate overgrowth of the mandible with or without the hypoplasia of maxilla. Both syndromes may be caused by the presence of environmental factors, but the majority of them are hereditary. Several mutations are linked to those phenotypes. In this review, we summarize the current knowledge regarding the genetics of those phenotypes and describe genotype-phenotype correlations. We then present the animal models used to study these defects.
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Affiliation(s)
- Anna Jaruga
- Laboratory of Molecular Genetics, Department of Biomedical Sciences, Medical University of Lublin, Chodzki 1, 20-093 Lublin, Poland; (A.J.); (J.K.)
| | - Jakub Ksiazkiewicz
- Laboratory of Molecular Genetics, Department of Biomedical Sciences, Medical University of Lublin, Chodzki 1, 20-093 Lublin, Poland; (A.J.); (J.K.)
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Krystian Kuzniarz
- Department of Maxillofacial Surgery, Medical University of Lublin, Staszica 11, 20-081 Lublin, Poland;
| | - Przemko Tylzanowski
- Laboratory of Molecular Genetics, Department of Biomedical Sciences, Medical University of Lublin, Chodzki 1, 20-093 Lublin, Poland; (A.J.); (J.K.)
- Department of Development and Regeneration, University of Leuven, Herestraat 49, 3000 Leuven, Belgium
- Correspondence:
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Genna F, Lopomo NF, Savoldi F. Validation of a numerical model for the mechanical behavior of a continuous positive airway pressure mask. Comput Methods Biomech Biomed Engin 2021; 25:165-175. [PMID: 34525878 DOI: 10.1080/10255842.2021.1940975] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Finite Element models (FEM) are developed for the analysis of the contact pressures exerted by a Continuous Positive Airway Pressure (CPAP) mask applied to a dummy head. This is seen as a preliminary step in the analysis of the mechanical effects of CPAP masks applied to human faces, such as recently employed for the care of COVID-19 patients, or other purposes. These mechanical effects can range from negligible, in the case of correct positioning, sufficiently light tension in the headgear, correct mask design, etc., to the possible development of device-related pressure ulcers and/or dentofacial deformations, especially in children. The results of Finite Element analyses are compared, for their validation, with experimental ones. The numerical analysis tool appears able to predict, at an acceptable cost, both the intensity and the area distribution of the contact pressures, as well as the force-displacement relationship occurring in the headgear. This might help the design and the production of more effective and tolerable CPAP masks.
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Affiliation(s)
- Francesco Genna
- Department Civil Engineering, University of Brescia, Brescia, Italy
| | | | - Fabio Savoldi
- Department Medical Surgical Specialties, Radiological Sciences and Public Health, Dental School, University of Brescia, Brescia, Italy.,Orthodontics, Division of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, The University of Hong Kong, Prince Philip Dental Hospital, Sai Ying Pun, Hong Kong S.A.R
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11
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Silberthau K, Thaler E. Tonsillar Hypertrophy in a Patient With Obstructive Sleep Apnea. JAMA Otolaryngol Head Neck Surg 2021; 146:373-374. [PMID: 31917393 DOI: 10.1001/jamaoto.2019.4164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kara Silberthau
- Jordan Medical Education Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania
| | - Erica Thaler
- Jordan Medical Education Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia Pennsylvania.,Department of Otolaryngology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. Sleep Med Clin 2020; 15:227-240. [PMID: 32386697 DOI: 10.1016/j.jsmc.2020.02.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.
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13
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Li Y, Wu J, Guo J, Yu L, Wang J, Li X, Xu S, Zhu M, Feng J, Liu Y. The efficacy of different treatment approaches for pediatric OSAHS patients with mandibular retrognathia: study protocol for a multicenter randomized controlled trial. Trials 2020; 21:595. [PMID: 32605655 PMCID: PMC7329444 DOI: 10.1186/s13063-020-04398-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/08/2020] [Indexed: 02/07/2023] Open
Abstract
Background Pediatric obstructive sleep apnea/hypopnea syndrome (OSAHS) is a multifactorial syndrome caused by many risk factors, such as craniofacial anomalies, adenotonsillar hypertrophy, obesity, and airway inflammation. Although new treatment patterns have recently been proposed, treatment methods for children remain particularly challenging and controversial. This randomized controlled trial was designed to investigate the efficacy of adenotonsillectomy and/or orthodontic treatment for children who have mild OSAHS with mandibular retrognathia. Methods A sample of 352 children with mild OSAHS and mandibular retrognathia, who are aged between 7 and 10 years, will be enrolled in the study. They will be randomized into four groups: the drug treatment group, the surgical treatment group, the orthodontic treatment group, or the surgery and postoperative orthodontic group. After randomization the children will receive treatments within 4 weeks. Outcome assessment will take place at the following points: (1) baseline, (2) 7 months after the treatment starting point, (3) 12 months after the treatment starting point, and (4) 24 months after the treatment starting point. The primary endpoint of the trial is the mean change in obstructive apnea/hypopnea index. Other endpoints will consist of the lowest oxygen saturation, apnea index, and hypopnea index assessed by polysomnography, subjective symptoms (assessed by the OSA-20 questionnaire), cephalometric measurements, and morphologic analysis of the upper airway. Discussion The results of this study will provide valuable evidence for the merits and long-term efficacy of different treatment approaches and contribute to facilitating the multidisciplinary treatment of pediatric OSAHS. Trial registration ClinicalTrials.gov: NCT03451318. Registered on 2 March 2018 (last update posted 19 April 2018).
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Affiliation(s)
- Yuanyuan Li
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Jiali Wu
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinghan Guo
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Liming Yu
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Jing Wang
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoyan Li
- Department of Otolaryngology and Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shuhua Xu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Min Zhu
- Department of Oral and Craniomaxillofacial Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,National Clinical Research Center for Oral Diseases, Shanghai, China.,Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Shanghai, China
| | - Jinqiu Feng
- Department of Pediatric Dentistry, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.,Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China
| | - Yuehua Liu
- Oral Biomedical Engineering Laboratory, Shanghai Stomatological Hospital, Fudan University, Shanghai, China. .,Department of Orthodontics, Shanghai Stomatological Hospital, Fudan University, Shanghai, China.
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14
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Ghadiri M, Grunstein RR. Clinical side effects of continuous positive airway pressure in patients with obstructive sleep apnoea. Respirology 2020; 25:593-602. [PMID: 32212210 DOI: 10.1111/resp.13808] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/05/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
CPAP is considered the gold standard treatment in OSA and is highly efficacious in controlling OSA symptoms. However, treatment effectiveness is limited because of many factors including low adherence due to side effects. This review highlights the range of side effects associated with CPAP therapy in patients with OSA. This information is important for the initiation of patients onto CPAP as well as their continued care while on treatment, given the increase in non-medically supervised CPAP care models in use globally.
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Affiliation(s)
- Maliheh Ghadiri
- Woolcock Institute of Medical Research, Respiratory Technology Group, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,School of Biomedical Engineering, University of Technology Sydney, Sydney, NSW, Australia
| | - Ronald R Grunstein
- Woolcock Institute of Medical Research, Respiratory Technology Group, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Royal Prince Alfred Hospital, Sydney, NSW, Australia
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15
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Lobbezoo F, Li J, Koutris M, Warnsinck CJ, Wetselaar P, Visscher CM, Aarab G. Nasal CPAP therapy associated with masticatory muscle myalgia. J Clin Sleep Med 2020; 16:455-457. [DOI: 10.5664/jcsm.8230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Frank Lobbezoo
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jiayu Li
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Michail Koutris
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - C. Jan Warnsinck
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Peter Wetselaar
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Corine M. Visscher
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Ghizlane Aarab
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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16
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Breathing retraining in sleep apnoea: a review of approaches and potential mechanisms. Sleep Breath 2020; 24:1315-1325. [PMID: 31940122 DOI: 10.1007/s11325-020-02013-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 11/26/2019] [Accepted: 01/07/2020] [Indexed: 10/25/2022]
Abstract
PURPOSE Anatomically based treatments for obstructive sleep apnoea (OSA) may not completely resolve OSA. This has led to interest in exploring ways of addressing physiological risk factors. This review examines the literature for research reporting on the effects of various types of breathing training and breathing activities on sleep apnoea. It also reviews and discusses proposed therapeutic mechanisms. METHODS A search of electronic databases was performed using the search terms related to various breathing therapies or to activities requiring high levels of breath control such as singing and the playing of musical instruments and sleep apnoea. RESULTS A total of 14 suitable studies were reviewed. A diverse variety of breathing retraining approaches are reported to improve sleep apnoea, e.g., Buteyko method, inspiratory resistance training, and diaphragmatic breathing. There is also a reduced incidence of sleep apnoea with intensive and regular participation in activities that require high levels of breath control, e.g., singing and playing wind instruments. Improvements in sleep-disordered breathing are thought to be related to improvements in (1) muscle tone of the upper airway; (2) respiratory muscle strength; (3) neuroplasticity of breathing control; (4) oxygen levels; (5) hyperventilation/dysfunctional breathing; and (6) autonomic nervous system, metabolic, and inflammatory status. CONCLUSION Breathing retraining and regular practice of breath control activities such as singing and playing wind instruments are potentially helpful for sleep apnoea, particularly for individuals with minimal anatomical deficit and daytime breathing dysfunction. Research is needed to elucidate mechanisms, to inform patient selection, and to refine clinical protocols.
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17
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Uniken Venema JAM, Doff MHJ, Joffe-Sokolova DS, Wijkstra PJ, van der Hoeven JH, Stegenga B, Hoekema A. Dental side effects of long-term obstructive sleep apnea therapy: a 10-year follow-up study. Clin Oral Investig 2019; 24:3069-3076. [PMID: 31863188 DOI: 10.1007/s00784-019-03175-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 12/11/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Patients with obstructive sleep apnea (OSA) are usually treated with either mandibular advancement device (MAD) or continuous positive airway pressure (CPAP) therapy. The objective of this study is to evaluate changes in dental occlusion associated with long-term MAD and CPAP therapy. MATERIALS AND METHODS Data from 14 OSA patients using MAD and 17 OSA patients using CPAP therapy were evaluated at baseline, 2-year and 10-year follow-up. Changes in dental occlusion were analyzed from dental plaster casts with a digital sliding caliper. RESULTS At 2-year follow-up, MAD therapy resulted in significant dental changes when compared with baseline values. In MAD therapy, overjet and overbite decreased with 1.1 ± 1.8 mm and 1.1 ± 1.2 mm respectively. With CPAP therapy overjet and overbite decreased significantly with 0.2 ± 0.5 mm and 0.3 ± 0.5 mm, respectively. Both groups also showed significant changes in molar occlusion. After a 10-year follow-up, significant and more pronounced changes were seen in overjet and overbite. In MAD therapy, overjet and overbite decreased with 3.5 ± 1.5 mm and 2.9 ± 1.5 mm respectively when compared with baseline values. In CPAP therapy, overjet and overbite decreased with 0.7 ± 1.5 mm and 0.8 ± 1.4 mm respectively when compared with baseline values. CONCLUSIONS This study demonstrates that MAD and CPAP therapy result in significant changes in dental occlusion. These changes appear progressive and more pronounced with MAD compared to CPAP therapy. CLINICAL RELEVANCE Long-term OSA treatment results in significant dental side effects that may progress over time. Informed consent is fundamental before starting MAD treatment and individualized long-term follow-up is of eminent importance.
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Affiliation(s)
- Julia Anne Margarethe Uniken Venema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
| | - Michiel H J Doff
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, Nij Smellinghe Hospital, Drachten, The Netherlands
| | - Dilyana S Joffe-Sokolova
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter J Wijkstra
- Department of Pulmonary Diseases/Department of Home Mechanical Ventilation, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Johannes H van der Hoeven
- Department of Clinical Neurophysiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Boudewijn Stegenga
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Aarnoud Hoekema
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam, Amsterdam, The Netherlands
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18
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Practical Aspects of Interface Application in CPAP Treatment. Can Respir J 2019; 2019:7215258. [PMID: 31781315 PMCID: PMC6874967 DOI: 10.1155/2019/7215258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/01/2019] [Indexed: 02/07/2023] Open
Abstract
While continuous positive airway pressure (CPAP) is an effective first-line therapy for sleep apnea, CPAP fails in one third of patients mainly due to poor adherence to the CPAP device and masks. The role of the medical team is to guide the patient in choosing the best mask, thus insuring good CPAP therapy adherence. Once a suitable mask is found, the brand of the mask does not affect patient satisfaction or CPAP adherence. For the majority of patients, nasal masks are by far more suitable than oronasal masks. Orosanal masks are indicated in case of nasal stuffiness or when an air leak manifests through the mouth. Re-evaluation of the efficacy of CPAP therapy is recommended when switching to oronasal masks.
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19
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Hamoda MM, Almeida FR, Pliska BT. Long-term side effects of sleep apnea treatment with oral appliances: nature, magnitude and predictors of long-term changes. Sleep Med 2019; 56:184-191. [DOI: 10.1016/j.sleep.2018.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 11/24/2022]
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20
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Okuno K, Ono Minagi H, Ikai K, Matsumura Ai E, Takai E, Fukatsu H, Uchida Y, Sakai T. The efficacy of nasal airway stent (Nastent) on obstructive sleep apnoea and prediction of treatment outcomes. J Oral Rehabil 2018; 46:51-57. [PMID: 30281824 DOI: 10.1111/joor.12725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 09/26/2018] [Accepted: 09/26/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is characterised by recurrent episodes of partial or complete upper airway collapse during sleep and is highly prevalent in the general population. The nasopharyngeal airway stent (Nastent) is a specifically designed, preformed silicone tube that intends to maintain the upper airway patency during sleep and reduce snoring and sleep apnoea. OBJECTIVE(S) The purpose of this study was to determine the efficacy of Nastent treatment and examine predictors for Nastent treatment outcomes in patients with OSA. METHODS Consecutive thirty patients were enrolled in this study. Cephalometric radiographs were obtained to analyse the pharyngeal and craniofacial morphology. Before and after Nastent treatment, we evaluated OSA using a portable sleep study. RESULTS Twenty-nine subjects completed this study. There were significant decreases in the respiratory event index (REI) (22.4 ± 14.1 to 15.7 ± 10.4, P < 0.01) and a significant increase in the lowest SpO2 (81.9 ± 7.5 to 86.6 ± 4.8, P < 0.01) by Nastent treatment. Subjects were divided into responders and non-responders based on reduction in REI of >50% compared with baseline REI. We evaluated the ratio of inferior airway width and middle airway width (IAW/MAW) on cephalograms as the index of the narrowest airway site. The IAW/MAW was significantly higher in responders than in non-responders (1.4 ± 0.9 vs 0.9 ± 0.4, P < 0.01) and predicted treatment responders with high accuracy (sensitivity: 90.9%, specificity: 88.9%, when IAW/MAW was set at 1.10). CONCLUSIONS The Nastent device improved OSA, and a narrower velopharynx than hypopharynx predicted treatment response with a good sensitivity and specificity.
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Affiliation(s)
- Kentaro Okuno
- Department of Geriatric Dentistry, Osaka Dental University, Chuo-ku, Osaka, Japan.,Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Hitomi Ono Minagi
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Kazuki Ikai
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Erika Matsumura Ai
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Etsuko Takai
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Hikari Fukatsu
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Yurika Uchida
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
| | - Takayoshi Sakai
- Department of Oral-Facial Disorders, Osaka University Graduate School of Dentistry, Suita-city, Osaka, Japan
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21
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Jen R, Almeida FR, Brasher P, Doyle-Waters MM, Salzman J, Fleetham J. Oral appliances for obstructive sleep apnoea. Hippokratia 2018. [DOI: 10.1002/14651858.cd013131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rachel Jen
- Department of Medicine; Division of Respiratory Medicine, Vancouver Coastal Health; Vancouver Canada
| | | | - Penelope Brasher
- Centre for Clinical Epidemiology & Evaluation; VGH Research Pavillion, Vancouver Coastal Health Research Institute; Vancouver Canada
| | - Mary M Doyle-Waters
- Centre for Clinical Epidemiology & Evaluation; VGH Research Pavillion, Vancouver Coastal Health Research Institute; Vancouver Canada
| | - Jim Salzman
- Department of Family Practice; University of British Colombia; Vancouver Canada
| | - John Fleetham
- Department of Medicine (Respiratory Division); The University of British Columbia; Vancouver Canada
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22
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Müller-Hagedorn S, Wiechers C, Arand J, Buchenau W, Bacher M, Krimmel M, Reinert S, Poets CF. Less invasive treatment of sleep-disordered breathing in children with syndromic craniosynostosis. Orphanet J Rare Dis 2018; 13:63. [PMID: 29688857 PMCID: PMC5914055 DOI: 10.1186/s13023-018-0808-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infants and children with syndromic craniosynostosis (SCS), such as Apert-, Crouzon- or Pfeiffer syndrome, are prone to sleep disordered breathing (SDB) including obstructive sleep apnea and upper airway resistance syndrome (OSAS, UARS), potentially leading to tracheostomy. We modified the Tübingen Palatal Plate (TPP), an oral appliance with a velar extension effectively treating airway obstruction in Robin sequence, by attaching a tube to its velar extension to bridge the narrow pharyngeal airway in SCS patients. Here, we evaluated this treatment concept. METHODS Our hospital's electronic patient files were searched for all children with a diagnosis of SCS admitted between 01/01/2004 and 31/12/2016. Children with isolated craniosynostosis were excluded. OSAS was defined as a mixed-obstructive apnea-hypopnea index (MOAHI) > 1, and UARS as more than 1 episode with nasal flow limitation/h, but absent OSAS. Children with a diagnosis of OSAS received the TPP and fiberoptic nasopharyngoscopy to assess the type of obstruction and to adjust the plate. Growth and weight gain, determined as standard deviation scores, were also evaluated before and during treatment. RESULTS Of 34 patients included, 24 presented with SDB (19 OSAS, 5 UARS) and 27 had midface hypoplasia. Proportions of SDB were 78% in those with, and 22% in those without midface hypoplasia. In the OSAS group (n = 19), 13 patients were treated with palatal plates, with the remaining receiving continuous positive airway pressure, midface surgery or tracheal intubation. The MOAHI decreased across all children receiving palatal plate treatment from 14.6 (range 0.0-50.7) at admission to 0.9 (range 0.0-3.5) at discharge (p = 0.002). SDS for weight and body length also improved (p < 0.05 for weight and p = 0.05 for body length). Only one child required tracheostomy. CONCLUSION Treatment of upper airway obstruction by a modified TPP in these children with SCS was shown to be mostly effective and safe. If confirmed in larger prospective studies, it may help to avoid more invasive interventions.
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Affiliation(s)
- Silvia Müller-Hagedorn
- Department of Orthodontics, Rostock University Hospital, Rostock, Germany.,Department of Orthodontics, Tübingen University Hospital, Tübingen, Germany.,Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany
| | - Cornelia Wiechers
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Jörg Arand
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Wolfgang Buchenau
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany
| | | | - Michael Krimmel
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Siegmar Reinert
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany.,Department of Maxillofacial Surgery, Tübingen University Hospital, Tübingen, Germany
| | - Christian F Poets
- Center for Cleft Palate & Craniofacial Malformations, Tübingen University Hospital, Tübingen, Germany. .,Department of Neonatology, Tübingen University Hospital, Calwerstrasse 7, 72076, Tuebingen, Germany.
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23
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Pliska BT, Almeida FR. Tooth Movement Associated With CPAP Therapy. J Clin Sleep Med 2018; 14:701-702. [PMID: 29609723 DOI: 10.5664/jcsm.7080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 12/13/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT We report on a rarely documented side effect-tooth movement-associated with positive airway pressure therapy. A 64-year-old woman presented to an orthodontic practice for evaluation of unexplained tooth movement and spaces opening between her anterior teeth. The patient recently received a diagnosis of mild obstructive sleep apnea, for which she had been using continuous positive airway pressure (CPAP) delivered by a nasal pillows interface for the past 18 months. Follow-up questioning revealed that shifting of the teeth was first noticed in the months following the initiation of CPAP and the result of forward thrusting of the tongue during use. Following 12 months of orthodontic treatment, the malocclusion was corrected and teeth returned to their pretreatment positions. Unwanted tooth movement, although a minor sequela, can have a meaningful effect on quality of life. With improved awareness of this issue, the patient experience and ultimately adherence with CPAP treatment can be improved.
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Affiliation(s)
- Benjamin T Pliska
- Department of Oral Health Sciences, University of British Columbia Faculty of Dentistry, Vancouver, Canada
| | - Fernanda R Almeida
- Department of Oral Health Sciences, University of British Columbia Faculty of Dentistry, Vancouver, Canada
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24
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Brill AK, Pickersgill R, Moghal M, Morrell MJ, Simonds AK. Mask pressure effects on the nasal bridge during short-term noninvasive ventilation. ERJ Open Res 2018; 4:00168-2017. [PMID: 29637077 PMCID: PMC5890023 DOI: 10.1183/23120541.00168-2017] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/23/2018] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to assess the influence of different masks, ventilator settings and body positions on the pressure exerted on the nasal bridge by the mask and subjective comfort during noninvasive ventilation (NIV). We measured the pressure over the nasal bridge in 20 healthy participants receiving NIV via four different NIV masks (three oronasal masks, one nasal mask) at three different ventilator settings and in the seated or supine position. Objective pressure measurements were obtained with an I-Scan pressure-mapping system. Subjective comfort of the mask fit was assessed with a visual analogue scale. The masks exerted mean pressures between 47.6±29 mmHg and 91.9±42.4 mmHg on the nasal bridge. In the supine position, the pressure was lower in all masks (57.1±31.9 mmHg supine, 63.9±37.3 mmHg seated; p<0.001). With oronasal masks, a change of inspiratory positive airway pressure (IPAP) did not influence the objective pressure over the nasal bridge. Subjective discomfort was associated with higher IPAP and positively correlated with the pressure on the skin. Objective measurement of pressure on the skin during mask fitting might be helpful for mask selection. Mask fitting in the supine position should be considered in the clinical routine.
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Affiliation(s)
- Anne-Kathrin Brill
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,Dept of Pulmonary Medicine, University and University Hospital Bern, Bern, Switzerland
| | - Rachel Pickersgill
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK
| | - Mohammad Moghal
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust and Imperial College, London, UK
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust and Imperial College, London, UK
| | - Anita K Simonds
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield Foundation Trust and Imperial College, London, UK
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25
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Minagi HO, Okuno K, Nohara K, Sakai T. Predictors of Side Effects With Long-Term Oral Appliance Therapy for Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:119-125. [PMID: 29198303 DOI: 10.5664/jcsm.6896] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/05/2017] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The aim of this study was to investigate the predictors of dental changes associated with long-term treatment with oral appliances (OAs) in patients with obstructive sleep apnea (OSA). METHODS This was a retrospective study to investigate Japanese patients with OSA receiving long-term treatment with OAs. Comparisons of cephalometric analysis were carried out between the initial and follow-up assessments of dental and skeletal changes. Based on dental changes, predictors that may cause side effects were investigated. RESULTS A total of 64 patients (average age at start of treatment: 57.7 ± 14.2 years, 44 males) were included in this study. The average duration of treatment was 4.3 ± 2.1 years. Over the total treatment period, there was a significant reduction in overjet (OJ) (1.5 ± 1.3 mm) and overbite (0.90 ± 1.5 mm), and an increase in the lower incisor line to the mandibular plane (3.1 ± 5.4°). A larger reduction in OJ of ≥ 1 mm was associated with treatment duration, use frequency, and mandibular advancement of the OAs. In addition to these predictive factors, the number of teeth was correlated with the amount of OJ reduction. CONCLUSIONS For long-term treatment with OAs, the risk of dental side effects should be considered, such as a reduction in OJ. A small number of maxillary teeth, as well as the factors associated with OAs, including treatment duration, use frequency, and mandibular advancement of the OAs, was correlated with an increased rate of OJ reduction. COMMENTARY A commentary on this article appears in this issue on page 7.
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Affiliation(s)
- Hitomi Ono Minagi
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kentaro Okuno
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kanji Nohara
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Takayoshi Sakai
- Department of Oral-facial Disorders, Osaka University Graduate School of Dentistry, Osaka, Japan
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26
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Tsuda H, Wada N, Ando SI. Practical considerations for effective oral appliance use in the treatment of obstructive sleep apnea: a clinical review. SLEEP SCIENCE AND PRACTICE 2017. [DOI: 10.1186/s41606-017-0013-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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27
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Treatment of Obstructive Sleep Apnea: Achieving Adherence to Positive Airway Pressure Treatment and Dealing with Complications. Sleep Med Clin 2017; 12:551-564. [PMID: 29108610 DOI: 10.1016/j.jsmc.2017.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Obstructive sleep apnea is a common and treatable condition, but therapeutic adherence is limited by numerous factors. Despite advances in positive airway pressure (PAP) technology and a multitude of effective pharmacologic and behavioral therapeutic interventions to overcome the most common barriers to PAP, adherence has not increased significantly over the past 30 years. This review aims to identify the most important factors that impact adherence, common barriers to treatment, and evidence-based treatment strategies to maximize the effectiveness of PAP treatment. Complications of PAP treatment and mitigation techniques are also discussed.
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Haviv Y, Leibovitz S, Almoznino G, Sharav Y, Zilberman U. Maxillary deformity following CPAP treatment in myasthenia gravis. Cranio 2017; 36:404-407. [DOI: 10.1080/08869634.2017.1349026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Yaron Haviv
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Shirley Leibovitz
- Department of Pediatric Dentistry, Barzilai Medical Center, Ashkelon, Israel
| | - Galit Almoznino
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
- Department of Oral Medicine, Oral and Maxillofacial Center, Medical Corps, Israel Defense Forces, Tel-Hashomer, Israel
| | - Yair Sharav
- Department of Oral Medicine, Sedation & Maxillofacial Imaging, Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Uri Zilberman
- Department of Pediatric Dentistry, Barzilai Medical Center, Ashkelon, Israel
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Brill AK, Moghal M, Morrell MJ, Simonds AK. Randomized crossover trial of a pressure sensing visual feedback system to improve mask fitting in noninvasive ventilation. Respirology 2017; 22:1343-1349. [PMID: 28508568 DOI: 10.1111/resp.13074] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/30/2017] [Accepted: 04/06/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND OBJECTIVE A good mask fit, avoiding air leaks and pressure effects on the skin are key elements for a successful noninvasive ventilation (NIV). However, delivering practical training for NIV is challenging, and it takes time to build experience and competency. This study investigated whether a pressure sensing system with real-time visual feedback improved mask fitting. METHODS During an NIV training session, 30 healthcare professionals (14 trained in mask fitting and 16 untrained) performed two mask fittings on the same healthy volunteer in a randomized order: one using standard mask-fitting procedures and one with additional visual feedback on mask pressure on the nasal bridge. Participants were required to achieve a mask fit with low mask pressure and minimal air leak (<10 L/min). Pressure exerted on the nasal bridge, perceived comfort of mask fit and staff- confidence were measured. RESULTS Compared with standard mask fitting, a lower pressure was exerted on the nasal bridge using the feedback system (71.1 ± 17.6 mm Hg vs 63.2 ± 14.6 mm Hg, P < 0.001). Both untrained and trained healthcare professionals were able to reduce the pressure on the nasal bridge (74.5 ± 21.2 mm Hg vs 66.1 ± 17.4 mm Hg, P = 0.023 and 67 ± 12.1 mm Hg vs 60 ± 10.6 mm Hg, P = 0.002, respectively) using the feedback system and self-rated confidence increased in the untrained group. CONCLUSION Real-time visual feedback using pressure sensing technology supported healthcare professionals during mask-fitting training, resulted in a lower pressure on the skin and better mask fit for the volunteer, with increased staff confidence.
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Affiliation(s)
- Anne-Kathrin Brill
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,Department of Pulmonary Medicine, University Hospital Bern, Bern, Switzerland.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Mohammad Moghal
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Mary J Morrell
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
| | - Anita K Simonds
- Academic Unit of Sleep and Breathing, National Heart and Lung Institute, Imperial College, London, UK.,National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College, London, UK
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Cao MT, Sternbach JM, Guilleminault C. Continuous positive airway pressure therapy in obstuctive sleep apnea: benefits and alternatives. Expert Rev Respir Med 2017; 11:259-272. [PMID: 28287009 DOI: 10.1080/17476348.2017.1305893] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is a highly prevalent condition affecting persons of all age with an increasing public health burden. It is implicated in cardiovascular disease, metabolic syndrome, neurocognitive impairment, reductions in quality of life, and increased motor vehicle accidents. The goals of OSA treatment are to improve sleep and daytime symptoms, and minimize cardiovascular risks.Areas covered: Continuous positive airway pressure (CPAP) is considered the gold standard therapy that delivers pressurized air into the upper airway to relieve obstruction during sleep. Although CPAP is an effective modality of treatment for OSA, adherence to therapy is highly variable. This article highlights the benefits of CPAP therapy, along with alternative treatment options including oral appliance, implantable and wearable devices, and surgery. Expert commentary: CPAP therapy is the gold standard treatment option and should continue to be offered to those who suffer from OSA. Alternative options are available for those who are unable to adhere to CPAP or choose an alternative treatment modality. The most interesting advances have been incorporating orthodontic procedures in conjunction with myofunctional therapy in prepubertal children, raising the possibility of OSA prevention by initiating treatment early in life.
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Affiliation(s)
- Michelle T Cao
- a Division of Sleep Medicine , Stanford University , Redwood City , CA , USA
| | - Joshua M Sternbach
- a Division of Sleep Medicine , Stanford University , Redwood City , CA , USA
| | - C Guilleminault
- a Division of Sleep Medicine , Stanford University , Redwood City , CA , USA
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31
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Guilleminault C, Huang YS. A review of treatment options in paediatric sleep-disordered breathing. ACTA ACUST UNITED AC 2017. [DOI: 10.4103/prcm.prcm_5_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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32
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Little known but important aspect of long term dental stability. Cranio 2016; 34:218. [DOI: 10.1080/08869634.2016.1186886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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33
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Roberts SD, Kapadia H, Greenlee G, Chen ML. Midfacial and Dental Changes Associated with Nasal Positive Airway Pressure in Children with Obstructive Sleep Apnea and Craniofacial Conditions. J Clin Sleep Med 2016; 12:469-75. [PMID: 26715402 DOI: 10.5664/jcsm.5668] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/12/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Nasal positive airway pressure (nPAP) for treatment of pediatric obstructive sleep apnea (OSA) is a widespread therapy that currently lacks longitudinal data describing how mask pressure impacts the developing facial skeleton. This retrospective cohort study compared midfacial growth in pediatric patients with underlying craniofacial conditions diagnosed with OSA who were compliant vs. noncompliant with nPAP therapy, and explored correlations between demographic, medical, and sleep variables with annual rate of facial change. METHODS Records from Seattle Children's Hospital's Craniofacial Center and Sleep Disorders Center were reviewed to identify patients prescribed nPAP for OSA with serial cephalographic images obtained during routine clinical care for concomitant craniofacial diagnosis. Lateral cephalometric analysis was used to determine mean annual change in midfacial structures from T1 (pre-nPAP) to T2 (post-nPAP) in compliant vs. noncompliant subjects. Compliance was indicated by nPAP usage of > 20 h/week for > 6 months. RESULTS 50 subjects were compliant with nPAP therapy (mean age 10.42 years) for an average of 2.57 years, and 50 subjects were noncompliant (mean age 8.53 years). Compliant subjects experienced negative mean annual change (retrusion) of the midface compared to forward growth seen in noncompliant subjects (SNA: -0.57° vs. 0.56°), counterclockwise rotation of palatal plane (SN-PP: -1.15° vs. 0.09°), and upper incisor flaring (U1-SN: 2.41° vs. -0.51°). CONCLUSIONS Pressure to the midface from compliant nPAP use may alter normal facial growth. Cephalometric findings indicate a greater need for collaboration between sleep medicine physicians and orthodontists to monitor midfacial growth during nPAP treatment.
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Affiliation(s)
- Soleil D Roberts
- Craniofacial Orthodontics, Seattle Children's Hospital, Seattle, WA
| | - Hitesh Kapadia
- Craniofacial Orthodontics, Seattle Children's Hospital, Seattle, WA.,University of Washington Department of Orthodontics, Seattle, WA
| | - Geoff Greenlee
- Craniofacial Orthodontics, Seattle Children's Hospital, Seattle, WA.,University of Washington Department of Orthodontics, Seattle, WA
| | - Maida L Chen
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.,Pediatric Sleep Disorders Center, Seattle Children's Hospital, Seattle, WA
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Quo S, Guilleminault C. A lot is missing: the Orcade study. Sleep Med 2016; 19:126-7. [DOI: 10.1016/j.sleep.2015.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/23/2015] [Indexed: 10/22/2022]
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Troubleshooting Common Ventilator and Related Equipment Issues in the Home. Respir Med 2016. [DOI: 10.1007/978-1-4939-3749-3_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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36
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Rapid maxillary expansion (RME) for pediatric obstructive sleep apnea: a 12-year follow-up. Sleep Med 2015; 16:933-5. [DOI: 10.1016/j.sleep.2015.04.012] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 04/14/2015] [Accepted: 04/16/2015] [Indexed: 11/18/2022]
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Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD. Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015. J Clin Sleep Med 2015; 11:773-827. [PMID: 26094920 DOI: 10.5664/jcsm.4858] [Citation(s) in RCA: 432] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 05/11/2015] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientific literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. METHODS The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modified Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefit of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the final guideline recommendations. RECOMMENDATIONS 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualified dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualified dentists provide oversight—rather than no follow-up—of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dental-related side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confirm treatment efficacy, rather than conduct follow-up without sleep testing, for patients fitted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualified dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic office visits—as opposed to no follow-up—with a qualified dentist and a sleep physician. (GUIDELINE). CONCLUSIONS The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline reflects the state of knowledge at the time of publication and will require updates if new evidence warrants significant changes to the current recommendations.
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Sutherland K, Phillips CL, Davies A, Srinivasan VK, Dalci O, Yee BJ, Darendeliler MA, Grunstein RR, Cistulli PA. CPAP pressure for prediction of oral appliance treatment response in obstructive sleep apnea. J Clin Sleep Med 2014; 10:943-9. [PMID: 25142773 DOI: 10.5664/jcsm.4020] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Mandibular advancement splints (MAS) are often preferred to CPAP treatment for OSA but are not always equally efficacious. High therapeutic CPAP pressure has been associated with MAS treatment failure in a Japanese population. We sought to assess the relationship between CPAP pressure and MAS treatment response in an Australian population. METHODS Therapeutic CPAP pressure and MAS treatment response were obtained from a one-month crossover trial of both treatments. Predictive utility of CPAP pressure to identify MAS treatment response was assessed. RESULTS Seventy-eight OSA patients were included (age 49.3 ± 11.1 years, BMI 29.1 ± 5.8 kg/m(2)) with predominantly moderate-severe OSA (AHI 30.0 ± 12.7/h). CPAP pressure was lower in MAS responders (MAS AHI < 10/h) 9.7 ± 1.6 vs. 11.7 ± 2.4 cm H O, p < 0.01, with area under ROC curve of 0.74 (95% CI 0.63-0.86), p < 0.01. The best cutoff value of 10.5 cm H O useful for discriminating MAS responders and non-responders in the previous Japanese population, was inadequate for prediction in the current population (0.47 negative predictive value [NPV]). However a cutoff of 13 cm H O identified MAS non-responders (1.0 NPV). Multivariate regression identified CPAP pressure (odds ratio [95% confidence interval] 0.53 [0.33-0.87], age (0.93 [0.87-0.99]) and AHI (0.92 [0.86-0.97]) as predictors of MAS treatment response (model r(2) = 0.54, p < 0.001). CONCLUSIONS In Australian patients, the majority of whom are Caucasian, a higher therapeutic CPAP pressure requirement in conjunction with age and OSA severity characteristics may be useful to indicate likelihood of success with MAS as an alternative therapy.
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Unterkieferprotrusionsschienen zur Therapie der Schlafapnoe. SOMNOLOGIE 2013. [DOI: 10.1007/s11818-013-0631-z] [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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Zhang C, He H, Ngan P. Effects of twin block appliance on obstructive sleep apnea in children: a preliminary study. Sleep Breath 2013; 17:1309-14. [PMID: 23558604 DOI: 10.1007/s11325-013-0840-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/11/2013] [Accepted: 03/22/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND Oral appliances are increasingly advocated as a treatment option for obstructive sleep apnea (OSA). However, it is not clear how the different designs influence treatment efficacy in children. The aim of this study was to investigate the effects of twin block (TB) appliance on children with OSA and mandibular retrognathia. METHODS A total of 46 children (31 males, 15 females, aged 9.7 ± 1.5 years, BMI: 18.1 ± 1.04 kg/m(2)) diagnosed with mandibular retrognathia and OSA by polysomnography (PSG) and with no obesity or adenotonsillar hypertrophy were recruited for the study. Patients in the treatment group were instructed to wear the twin block oral appliance full time for an average of 10.8 months. The efficacy of treatment was determined by monitoring the PSG and cephalometric changes before and after appliance removal. Data were analyzed using paired t test. RESULTS Results showed an improvement in patient's facial profile after treatment with the TB appliance. The average AHI index decreased from 14.08 ± 4.25 to 3.39 ± 1.86 (p < 0.01), and the lowest SaO2 increased from 77.78 ± 3.38 to 93.63 ± 2.66 (p < 0.01). Cephalometric measurements showed a significant increase in the superior posterior airway space, middle airway space, SNB angle and facial convexity which indicate an enhancement in mandibular growth, and reduction in the soft palate length. CONCLUSIONS This preliminary study suggests that twin block appliance may improve the patient's facial profile and OSA symptoms in a group of carefully selected children presented with both OSA and mandibular retrognathia symptoms.
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Affiliation(s)
- Chen Zhang
- Department of Orthodontics, School and Hospital of Stomatology, and Key Lab for Oral Biomedical Engineering, Ministry of Education, Wuhan University, Wuhan, Hubei, People's Republic of China
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Lowe AA. Treating obstructive sleep apnea: The case for oral appliances. Am J Orthod Dentofacial Orthop 2012; 142:434, 436, 438, 440. [DOI: 10.1016/j.ajodo.2012.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Merrill RL. Temporomandibular disorder pain and dental treatment of obstructive sleep apnea. Dent Clin North Am 2012; 56:415-31. [PMID: 22480811 DOI: 10.1016/j.cden.2012.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment of sleep apnea with mandibular advancement devices (MADs) may be associated with the development of symptoms of temporomandibular disorder (TMD). This article discusses the different types of TMD and orofacial pain problems that may occur during treatment of obstructive sleep apnea (OSA) with a MAD. It is critical that the general dentist who is providing dental devices for OSA perform a thorough physical and neurologic assessment of the temporomandibular joint and associated structures before providing such a device so that preexisting problems are identified and discussed with the patient.
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Chen H, Lowe AA. Updates in oral appliance therapy for snoring and obstructive sleep apnea. Sleep Breath 2012; 17:473-86. [DOI: 10.1007/s11325-012-0712-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 01/27/2012] [Accepted: 04/16/2012] [Indexed: 10/28/2022]
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Doff MHJ, Finnema KJ, Hoekema A, Wijkstra PJ, de Bont LGM, Stegenga B. Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on dental side effects. Clin Oral Investig 2012; 17:475-82. [PMID: 22562077 PMCID: PMC3579417 DOI: 10.1007/s00784-012-0737-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2011] [Accepted: 04/10/2012] [Indexed: 11/28/2022]
Abstract
Objectives This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. Materials and methods As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. Results Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior–posterior change in the occlusion (−1.3 ± 1.5 mm) in the oral appliance group compared to the CPAP group (−0.1 ± 0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (β) = −0.02, 95 % confidence interval (−0.04 to −0.00)]. Conclusions Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. Clinical relevance Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.
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Affiliation(s)
- M H J Doff
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands.
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Abstract
Oral appliances (OAs) are a primary treatment option for snoring and mild to moderate obstructive sleep apnea (OSA) and are implemented as a noninvasive alternative for patients with severe OSA who are unwilling or unable to tolerate continuous positive airway pressure for the management of their disease. Studies have demonstrated the ability of OAs to eliminate or significantly reduce the symptoms of OSA and produce a measurable influence on the long-term health effects of the disease. Most studies have evaluated one type of OAs, the mandibular advancement splints. This article describes the effectiveness and outcomes of mandibular advancement splints.
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Affiliation(s)
- Benjamin T Pliska
- Department of Oral Health Sciences, University of British Columbia, 2199 Wesbrook Mall, Vancouver, British Columbia V6T 1Z3, Canada.
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49
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Current World Literature. Curr Opin Anaesthesiol 2012; 25:111-20. [DOI: 10.1097/aco.0b013e32834fd93c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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50
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Current World Literature. Curr Opin Anaesthesiol 2011; 24:705-12. [DOI: 10.1097/aco.0b013e32834e25f9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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