Oral Appliances in Obstructive Sleep Apnea

Dentoskeletal changes of long-term oral appliance treatment in patients with obstructive sleep apnea: A systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to evaluate the dental and skeletal effects of the long-term oral appliance (OA) treatment in patients with obstructive sleep apnea (OSA) and provide insights for clinicians in treatment planning and decision-making for OSA patients undergoing OA treatment.

MATERIALS AND METHODS

A comprehensive literature search was conducted in major databases up to April 2024. Studies were included if they assessed long-term OA treatment (≥6 months) in adults with OSA using any type of mandibular advancement device (MADs) or tongue retaining device (TRD). Dental and skeletal changes, measured by dental cast and cephalometric analysis, were the primary outcomes.

RESULTS

A total of 42 studies were included in the systematic review, with 23 included in the meta-analysis. Long-term OA treatment was associated with a significant decrease in overbite (0.87 mm, 95% CI: 0.69-1.05) and overjet (0.86 mm, 95% CI: 0.69-1.03). Subgroup analyses showed the decrease of overbite and overjet progressively changed over the years intervals. There was a significant retroclination of the upper incisors (U1-SN, 2.58°, 95% CI: 1.07-4.08) and proclination of the lower incisors (L1-MP, -2.67° (95% CI: -3.78-1.56). Skeletal changes were not significant.

CONCLUSION

Overbite and overjet gradually decreased in the long-term OA treatment, which might predominantly result from the retroclination of the upper incisors and the proclination of the lower incisors. The skeletal patterns in the anteroposterior and vertical direction might remain relatively stable over time. There was a tendency for the clockwise rotation of the mandible.

The development of a novel bidirectional fine-tuning mandibular advancement device

OBJECTIVE

To develop a novel mandibular advancement device (MAD) with high comfort, good compliance, and bidirectional fine-tuning capability for patients with obstructive sleep apnea hypopnea syndrome (OSAHS), and to evaluate the therapeutic efficacy of the new MAD.

METHODS

The MAD, featuring upper and lower dental splints with a fine-tuning mechanism for mandibular adjustment, incorporates improved design elements such as partial dental coverage, shortened baffles, and memory resin lining. The novel MAD was used to treat 30 OSAHS patients in the study, comparing pre- and post-treatment scores on the Epworth Sleepiness Scale (ESS), the Apnea-Hypopnea Index (AHI), and the lowest oxygen saturation (LSO2).

RESULTS

The novel MAD reduced size and side effects, enhancing comfort. All patients complied well, using it for an average of 95% over 30 days and ≥ 5 h nightly. After treatment, significant improvements were observed in ESS, AHI, and LSO2 (P < 0.05).

CONCLUSIONS

This novel bidirectional adjustable MAD provides high comfort and compliance, improving treatment precision. It is an effective choice for mild to moderate OSAHS patients and an alternative for those intolerant to CPAP or averse to surgery.

Hypoglossal Nerve Stimulation Therapy in a Belgian Cohort of Obstructive Sleep Apnea Patients

Hypoglossal nerve stimulation (HGNS) has emerged as a widespread and innovative treatment option for selected moderate-to-severe obstructive sleep apnea (OSA) patients who cannot be treated effectively with traditional treatment modalities. In this observational cohort study, the objective and subjective outcomes of Belgian OSA patients treated with HGNS therapy were analyzed at 6 and 12 months post-implantation. Thirty-nine patients implanted with a respiration-synchronized HGNS device at the Antwerp University Hospital w ere included in this study. Patients underwent baseline in-laboratory polysomnography and a follow-up sleep study 6 and 12 months post-implantation. Questionnaires on patient experience and daytime sleepiness were filled out and data on objective therapy usage were collected. All 39 patients completed the 6-month follow-up and 21 patients (54%) completed the 12-month follow-up. Median AHI decreased from 33.8 [26.1;45.0] to 10.2 [4.8;16.4] at the 6-month follow-up, and to 9.6 [4.1;16.4] at the 12-month follow-up (p < 0.001). The surgical success rate, according to the Sher20 criteria, was 80% and 76% at the 6- and 12-month follow-ups, respectively. Median ESS improved from 12.0 [7.0;18.0] at baseline to 6.0 [2.5;11.0] at 6 months (p < 0.001) and to 6.5 [2.8;11.5] at 12 months (p = 0.012). Objective therapy usage was 7.4 [6.6;8.0] and 7.0 [5.9:8.2] h/night at the 6- and 12-month follow-ups, respectively. A high overall clinical effectiveness of HGNS therapy, as shown by a mean disease alleviation of 58%, was demonstrated at 12 months post-implantation. Overall, HGNS therapy using respiration-synchronized neurostimulation of the XII cranial nerve resulted in a significant improvement in both objective and subjective OSA outcomes, with a high level of patient satisfaction and high treatment adherence.

Effect of mandibular advancement appliance use on oral and periodontal health in patients with OSA: a systematic review

STUDY OBJECTIVES

Use of a mandibular advancement appliance (MAA) is an effective treatment option for mild-to-moderate obstructive sleep apnea (OSA). MAA is well-tolerated but undesirable effects may be observed over time. The present systematic review aimed to assess the effect of MAA use on oral and periodontal health in patients with OSA.

METHODS

MEDLINE (PubMed), Cochrane, and Scopus were searched for randomized and non-randomized controlled trials (RCTs, NRCTs), cohorts, and case-control studies reporting on side effects of MAA treatment in OSA patients during a follow-up of at least 6 months.

RESULTS

From a total of 169 articles screened, 28 were selected. The most frequently reported MAA-related effects on oral health were: hypersalivation (weighted mean prevalence, 33.3%), occlusal changes (30.2%), muscle pain (22.9%), tooth discomfort or pain (20.2%), and xerostomia (18.3%). No MAA-related periodontal effect was reported. The periodontal status prior to MAA treatment was rarely assessed and described, but 5 studies (17.8%) stated that periodontitis was an exclusion criterion for MAA. Only one retrospective study specifically evaluated periodontal parameters and reported no significant changes in periodontally healthy patients with OSA using MAA for over 7 years.

CONCLUSION

MAA use is associated with a number of clinical consequences on oral health, but there is no evidence to conclude whether or not MAA affects periodontal health in patients with OSA. This aspect appears to be under-evaluated and should be further investigated in relation to the type of MAA, the duration of treatment, and prior history of periodontitis.

Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea

PURPOSE

The purpose of this study was to compare objective and self-reported outcomes of two treatments for managing mild, moderate, and severe obstructive sleep apnea (OSA) in adults: a mandibular advancement device (MAD) and continuous positive airway pressure (CPAP).

METHODS

Patients diagnosed with OSA by means of polysomnography (PSG) included one group treated with a custom-made, two-piece, adjustable MAD and a second group treated with CPAP for 8 weeks. Before the initiation of the treatment, all patients assigned to MAD underwent drug-induced sleep endoscopy (DISE), and all CPAP group patients underwent manual titration of CPAP after PSG. Objective (PSG) and self-reported (Epworth Sleepiness Scale [ESS] and Short Form Health Survey [SF-36]) data were used to assess outcomes. Collected data included apnea-hypopnea index (AHI), mean capillary oxygen saturation (SpO2), oxygen desaturation index (ODI), arousal index (AI), degree of daytime sleepiness, and quality of life. A PSG follow-up after 8 weeks with MAD in situ, and data from the CPAP data card were used to assess the effect of the two treatments.

RESULTS

A total of 59 patients included 30 treated with MAD and 29 treated with CPAP. Between baseline and the 8-week follow-up, the mean AHI score decreased significantly from 35.1 to 6.8 episodes/h (p < 0.001) in patients treated with MAD and from 35.2 to 3.0 episodes/h (p < 0.001) in patients treated with CPAP. The mean AHI score at the 8-week follow-up was significantly lower in CPAP group than in MAD group (p = 0.003). The two groups did not differ significantly at follow-up regarding SpO2 (p = 0.571), ODI (p = 0.273), AI (p = 0.100), ESS score (p = 0.648), and SF-36 score (p = 0.237).

CONCLUSION

In the short term, patients on CPAP attained better PSG outcomes in terms of AHI reduction. Both MAD after DISE evaluation and CPAP resulted in similar improvements in clinical symptoms and health-related quality of life, even in patients with severe OSA.

Revisiting the Role of Serotonin in Sleep-Disordered Breathing

Serotonin or 5-hydroxytryptamine (5-HT) is a ubiquitous neuro-modulator-transmitter that acts in the central nervous system, playing a major role in the control of breathing and other physiological functions. The midbrain, pons, and medulla regions contain several serotonergic nuclei with distinct physiological roles, including regulating the hypercapnic ventilatory response, upper airway patency, and sleep-wake states. Obesity is a major risk factor in the development of sleep-disordered breathing (SDB), such as obstructive sleep apnea (OSA), recurrent closure of the upper airway during sleep, and obesity hypoventilation syndrome (OHS), a condition characterized by daytime hypercapnia and hypoventilation during sleep. Approximately 936 million adults have OSA, and 32 million have OHS worldwide. 5-HT acts on 5-HT receptor subtypes that modulate neural control of breathing and upper airway patency. This article reviews the role of 5-HT in SDB and the current advances in 5-HT-targeted treatments for SDB.

Computed Tomography versus Sleep Endoscopy (DISE) to Predict the Effectiveness of Mandibular Advancement Devices in Adult Patients with Obstructive Sleep Apnea: A Protocol for Systematic Review

Obstructive sleep apnea is a sleep disorder with a high prevalence in the world population. The mandibular advancement device is one of the options for treating obstructive sleep apnea. Neck computed tomography and drug-induced sleep endoscopy are complementary diagnostic tests that may help predict the effectiveness of mandibular advancement devices. This study aims to analyze the best method for predicting the effectiveness of mandibular advancement devices in the therapeutic approach to obstructive sleep apnea. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science Core Collection databases will be comprehensively searched. We will include randomized clinical trials, non-randomized prospective or retrospective clinical studies, case controls, cohort studies, and case series. Two authors will independently conduct data extraction and assess the literature quality of the studies. The analysis of the included literature will be conducted by Revman 5.3 software. The outcomes that will be analyzed are craniofacial characteristics, cephalometric assessments, site and type of obstruction of the upper airway, mean values of the apnea-hypopnea index, and SaO2 verified in the initial and follow-up polysomnography. This study will provide reliable, evidence-based support for the clinical application of mandibular advancement devices for obstructive sleep apnea.

Equal effect of a noncustom vs a custom mandibular advancement device in treatment of obstructive sleep apnea

STUDY OBJECTIVES

Numerous types of mandibular advancement devices (MADs) are available to treat patients with obstructive sleep apnea, varying from noncustom to custom devices. Only a limited number of studies have been performed to determine whether a noncustom MAD could be used to predict treatment success of a custom MAD. In this study, we investigated the potential of a new-generation noncustom MAD, by comparing its effectiveness with a custom MAD. We hypothesized that the effectiveness of the devices is similar with regard to both objective (polysomnography) and self-reported (questionnaires, adherence, and patient satisfaction) outcomes.

METHODS

This was a single-center prospective randomized crossover study including a consecutive series of patients with obstructive sleep apnea. Patients were randomized to start either with the noncustom or custom MAD. Both MADs were applied for 12 weeks, followed by polysomnography with MAD in situ and questionnaires. After the first 12 weeks of follow-up, a washout period of 1 week was applied. Equal effectiveness was defined as no significant differences in both objective and self-reported outcomes between both devices.

RESULTS

Fifty-eight patients were included; 40 completed the full follow-up. The median apnea-hypopnea index significantly decreased from 16.3 (7.7, 24.8) events/h to 10.7 (5.6, 16.6) events/h with the custom MAD (P = .010) and to 7.8 (2.9, 16.1) events/h with the noncustom MAD (P < .001). Self-reported outcomes significantly improved in both groups. No significant differences were found between both devices.

CONCLUSIONS

The effectiveness of a noncustom and custom MAD is comparable, which suggests that a noncustom MAD can be used as a selection tool for MAD treatment eligibility to improve MAD treatment outcome.

CLINICAL TRIAL REGISTRATION

Registry: Netherlands Trial Register; Name: The Use of a Boil and Bite Mandibular Advancement Device vs a Custom Mandibular Advancement Device in Obstructive Sleep Apnea Management; URL: https://www.trialregister.nl/trial/7249; Identifier: NL64738.100.18.

CITATION

Bosschieter PFN, Uniken Venema JAM, Vonk PE, et al. Equal effect of a noncustom vs a custom mandibular advancement device in treatment of obstructive sleep apnea. J Clin Sleep Med. 2022;18(9):2155-2165.

Effectiveness of Titratable Oral Appliance in Management of Moderate to Severe Obstructive Sleep Apnea-A Prospective Clinical Study with Acoustic Pharyngometry

To assess effectiveness of titratable Oral Appliance (OA) in management of moderate to severe cases of Obstructive Sleep Apnea (OSA). Thirty Polysomnography (PSG) diagnosed cases of moderate to severe OSA were subjected to a thorough cranio-facial-dental evaluation, a detailed sleep history and three dimensional assessment of upper airway geometry utilising Acoustic Pharyngometry (AP) (Eccovision, sleep group solutions). A titratable OA was delivered to all patients for mandibular advancement. Apnea Hypopnea Index (AHI), Oxygen Saturation (SPO2), Epworth's Sleepiness Scale (ESS), Mean area and volume of upper airway were recorded at Baseline (T0) and after 08 weeks of appliance delivery (T1). The mean AHI & ESS scores were significantly lower and SPO2 was significantly higher at T1 compared to T0 (P-value < 0.05 for all). The mean area and volume of upper airway at T1 were significantly higher compared to values at T0 (P-value < 0.05 for both). The mean area showed 19.51% increase at T1 whereas mean volume increased by 18.55%. OA therapy is highly efficacious in cases with moderate to severe OSA, especially, in those with retrognathic mandible. This modality should be considered as an effective alternate to Continuous Positive Airway Pressure (CPAP) therapy in non-compliant patients rather than no treatment. AP is an effective modality to predict airway changes after advancement with OA, to ascertain follow up changes and is highly recommended in routine clinical practice. Large scale, multicenter studies are recommended to elaborate the findings of the present study and to add better quality evidence in this regard.

In-home mandibular repositioning during sleep using MATRx plus predicts outcome and efficacious positioning for oral appliance treatment of obstructive sleep apnea

STUDY OBJECTIVES

Oral appliance therapy is not commonly used to treat obstructive sleep apnea due to inconsistent efficacy and lack of established configuration procedures. Both problems may be overcome by information gathered while repositioning the mandible during sleep. The purpose of this investigation was to determine if an unattended sleep study with a mandibular positioner can predict therapeutic success and efficacious mandibular position, assess the contribution of artificial intelligence analytics to such a system, and evaluate symptom resolution using an objective titration approach.

METHODS

Fifty-eight individuals with obstructive sleep apnea underwent an unattended sleep study with an auto-adjusting mandibular positioner followed by fitting of a custom oral appliance. Therapeutic outcome was assessed by the 4% oxygen desaturation index with therapeutic success defined as oxygen desaturation index < 10 h^-1. Outcome was prospectively predicted by an artificial intelligence system and a heuristic, rule-based method. An efficacious mandibular position was also prospectively predicted by the test. Data on obstructive sleep apnea symptom resolution were collected 6 months following initiation of oral appliance therapy.

RESULTS

The artificial intelligence method had significantly higher predictive accuracy (sensitivity: 0.91, specificity: 1.00) than the heuristic method (P = .016). The predicted efficacious mandibular position was associated with therapeutic success in 83% of responders. Appliances titrated based on oxygen desaturation index effectively resolved obstructive sleep apnea symptoms.

CONCLUSIONS

The MATRx plus device provides an accurate means for predicting outcome to oral appliance therapy in the home environment and offers a replacement to blind titration of oral appliances.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Predictive Accuracy of MATRx plus in Identifying Favorable Candidates for Oral Appliance Therapy; Identifier: NCT03217383; URL: https://clinicaltrials.gov/ct2/show/NCT03217383.

CITATION

Mosca EV, Bruehlmann S, Zouboules SM, et al. In-home mandibular repositioning during sleep using MATRx plus predicts outcome and efficacious positioning for oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):911-919.

Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing: a prospective study

STUDY OBJECTIVES

Mandibular advancement devices (MADs) are a noninvasive treatment option for patients with obstructive sleep apnea (OSA) and act by increasing the upper airway volume. However, the exact therapeutic mechanism of action remains unclear. The aim of this study was to assess MAD mechanisms using functional imaging that combines imaging techniques and computational fluid dynamics and assess associations with treatment outcome.

METHODS

One hundred patients with OSA were prospectively included and treated with a custom-made MAD at a fixed 75% protrusion. A low-dose computed tomography scan was made with and without MADs for computational fluid dynamics analysis. Patients underwent a baseline and 3-month follow-up polysomnography to evaluate treatment efficacy. A reduction in apnea-hypopnea index ≥ 50% defined treatment response.

RESULTS

Overall, 71 patients completed both 3-month follow-up polysomnography and low-dose computed tomography scan with computational fluid dynamics analysis. MAD treatment significantly reduced the apnea-hypopnea index (16.5 [10.4-23.6] events/h to 9.1 [3.9-16.4] events/h; P < .001, median [quartile 1-quartile 3]) and significantly increased the total upper airway volume (8.6 [5.4-12.8] cm³ vs 10.7 [6.4-15.4] cm³; P = .003), especially the velopharyngeal volume (2.1 [0.5-4.1] cm³ vs 3.3 [1.8-6.0] cm³; P < .001). However, subanalyses in responders and nonresponders only showed a significant increase in the total upper airway volume in responders, not in nonresponders.

CONCLUSIONS

MAD acts by increasing the total upper airway volume, predominantly due to an increase in the velopharyngeal volume. Responders showed a significant increase in the total upper airway volume with MAD treatment, while there was no significant increase in nonresponders. Findings add evidence to implement functional imaging using computational fluid dynamics in routine MAD outcome prediction.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050.

CITATION

Van Gaver H, Op de Beeck S, Dieltjens M, et al. Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing: a prospective study. J Clin Sleep Med. 2022;18(3):739-750.

Implications of Obstructive Sleep-related Breathing Disorder in Dentistry: Focus on Snoring and Obstructive Sleep Apnea

Obstructive sleep-related breathing disorder (SRBD) is an umbrella term that encompasses various types of upper airway dysfunctions during sleep characterized by increased respiratory effort secondary to snoring and/or increased upper airway resistance and pharyngeal collapse. Obstructive sleep apnea (OSA) is a representative SRBD that involves a significant decrease in or cessation of airflow despite the presence of respiratory effort. While snoring is considered a normal condition, it can cause serious noise disturbance to sleep partners and is considered a predictor of OSA. Snoring and OSA are highly correlated with obesity. SRBDs can lead to cardiovascular disease, hypertension, decreased quality of life, decreased work efficiency, daytime sleepiness, decreased neurocognitive activity, and psychological impairments. In dentistry, research on sleep problems has focused on temporomandibular disorder (TMD)/orofacial pain. The relationship between OSA and TMD/orofacial pain has been reported, but it is not clear whether it is a simple correlation or a causal relationship. Therefore, we aimed to review the causes of SRBDs including snoring and OSA and to review and infer the relationship between these SRBDs and TMD/orofacial pain. The effects of snoring and OSA extend beyond sleep disturbances and are worthy of future research, especially with regard to TMD.

Myofunctional therapy for OSA: a meta-analysis

INTRODUCTION

Myofunctional therapy (MT) improves obstructive sleep apnea (OSA) in patients.

AREAS COVERED

We systematically reviewed publications to evaluate MT as a treatment for OSA. We identified relevant articles and performed a meta-analysis on apnea-hypopnea index (AHI) scores, lowest oxygen saturation (LSAT), and Epworth Sleepiness Scale (ESS). Search databases were retained as primary data sources with the search performed through 18 June 2021.

EXPERT OPINION

Fifteen studies with 237 patients provided OSA outcomes before and after MT, which were analyzed for this meta-analysis. The mean AHI scores decreased from 28.0 ± 16.2/h to 18.6 ± 13.1/h. The AHI standard mean difference (SMD) is -1.34 (large effect) [95% CI -0.84, -1.85], (P < 0.00001). LSAT (197 patients) improved from 83.18 ± 6.10% to 85.13 ± 7.01%. The LSAT SMD is 0.44 [95% CI 0.75, 0.12], (P < 0.007). Sleepiness measured via ESS (156 patients) demonstrated a decrease from 12.71 ± 5.73 to 8.78 ± 5.80. The ESS SMD is -1.0 [95% CI -0.50, -1.50], (P < 0.0001).

Partner perceptions are associated with objective sensor-measured adherence to oral appliance therapy in obstructive sleep apnea

The aims of the present prospective clinical study were to determine objective, sensor-measured adherence to a mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA) and to identify partner-specific adherence-related factors. A total of 77 eligible participants with mild, moderate, or severe OSA and who were non-adherent to continuous positive airway pressure (mean age 56.2 years) participated in the study (32.5% women). The mean (range) observation time between MAD delivery and final follow-up was 8.3 (3.4-16.5) months. The mean apnea-hypopnea index (AHI) was 26.6 events/hr at baseline and 12.5 events/hr at the 8-month follow-up (both p < 0.001). The mean sensor-measured adherence at the 8-month follow-up was 60.1% for ≥4 hr/night of appliance use for ≥5 days/week. Average usage was 6.4 hr/night, when worn. The mean reduction in the AHI was significantly greater in the "good adherence" (Δ 17.4) than the "poor adherence" group (Δ11.0; p < 0.05). From the partner's perspective, the appliance had a positive effect on sharing a bedroom in the good- (55%) compared to the poor-adherence group (25%; p < 0.05) and on their relationship (51.7% versus 17.9%, respectively; p < 0.05). Regression analyses identified the partner's snoring and apneas to be the most significant factor predicting good adherence to MAD (odds ratio 4.4, 95% confidence interval 1.4-14.0). In conclusion, social factors, like partner perceptions, were positively associated with adherence, which indicate that partner's attitudes and support may be a resource that can be utilised to improve adherence in oral appliance treatment of OSA.

Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data

STUDY OBJECTIVES

Mandibular advancement devices (MADs) are an alternative to continuous positive airway pressure for the management of obstructive sleep apnea (OSA). The ORthèse d'avanCée mAndibulaire dans le traitement en DEuxième intention du SAHOS sévère (ORCADES) study is investigating the long-term effectiveness of MAD therapy in patients with OSA who refused or were intolerant of continuous positive airway pressure. Five-year follow-up data are presented.

METHODS

Data were available in 172 of 331 patients treated with a custom-made computer-aided design/computer-aided manufacturing biblock MAD (Narval CC; ResMed, Saint-Priest, France). The primary end point was treatment success (≥50% decrease in apnea-hypopnea index from baseline).

RESULTS

Five-year treatment success rates were 52% overall and 25%, 52%, and 63%, respectively, in patients with mild, moderate, or severe OSA. This reflects a decline over time vs 3-6 months (79% overall) and 2 years (68%). Rates declined in all patient subgroups but to the greatest extent in patients with mild OSA. The slight worsening of respiratory parameters over time was not associated with any relevant changes in sleepiness and symptoms. Moderate or severe OSA at baseline, treatment success at 3-6 months, and no previous continuous positive airway pressure use were significant independent predictors of 5-year treatment success on multivariate analysis. No new safety signals emerged during long-term follow-up. The proportion of patients using their MAD for ≥4 h/night on ≥4 days/wk was 93.3%; 91.3% of patients reported device use of ≥6 h/night at 5 years. At 5-year follow-up, 96.5% of patients reported that they wanted to continue MAD therapy.

CONCLUSIONS

Long-term MAD therapy remained effective after 5 years in >50% of patients, with good levels of patient satisfaction and adherence.

CITATION

Vecchierini MF, Attali V, Collet JM, et al. Mandibular advancement device use in obstructive sleep apnea: ORCADES study 5-year follow-up data. J Clin Sleep Med. 2021;17(8):1695-1705.

Telemedicine in Sleep-Disordered Breathing: Expanding the Horizons

Interest in telemedicine has increased exponentially. There is a growing body of published evidence on the use of telemedicine for patients using continuous positive airway pressure. Telemedicine-ready devices can support the transmission on use time, apnea-hypopnea index, and leakage. This approach enables early activation of troubleshooting. Automated, personalized feedback for patients and patient access to their own data provide unprecedented opportunities for integrating comanagement approaches, multiactor interactions, and patient empowerment. Telemedicine is likely cost effective, but requires better evidence. Notwithstanding barriers for implementation that remain, telemedicine has to be embraced, leaving the physician and patient to accept it or not.

Resolution of fibromyalgia by controlling obstructive sleep apnea with a mandibular advancement device

Fibromyalgia (FM) is a chronic, often disabling disorder characterized by multisite pain along with sleep problems and fatigue. Pain and sleep exhibit a reciprocal relationship. When FM and obstructive sleep apnea/hypopnea (OSA) co-exist, treatment options include continuous positive airway pressure or mandibular advancement device. We present a patient experiencing fibromyalgia and OSA whose symptoms vanished wearing a Mandibular Advancement Device (MAD) during sleep. To our knowledge, this is the first documented case of FM symptom resolution by MAD treatment.