Oral appliances for obstructive sleep apnea: Emerging issues, upcoming challenges, and possible solutions

Assessment of emotional stress among patients suffering from obstructive sleep apnea: A cross-sectional study

Background

Obstructive sleep apnea (OSA) is a sleep disorder in which the upper airway is partially or completely blocked during sleep. As a result, sleep arousal and arterial oxygen saturation are reduced. According to the epidemiological survey, OAS is relatively common among people that may be associated with psychiatric illnesses.

Objectives

The primary objective was to evaluate the stress level among patients suffering from OSA. The secondary objective was to compare the gender preference for stress among patients suffering from OSA.

Materials and Methods

A cross-sectional study, approved by the Institutional Ethics Committee, was performed to assess emotional stress among patients suffering from OSA. The study involved 20 participants diagnosed with OSA and reported to the Respiratory Department. The stress levels of the study participants were evaluated with a validated, Perceived Stress Scale (PSS) questionnaire given by the American Sociological Association (ASA).

Result

The stress levels presented by the study participants showed that 40% (n = 8) subjects had moderate stress and 60% (n = 12) had severe stress and 30.3% of females depicted emotional stress and 26.2% of males for the same.

Conclusion

There is a high psychological stress level among patients suffering from OSA. The females had higher predictions when compared to males. Such patients should be offered an intervention program aimed at stress management to enhance their quality of life.

Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-a randomized controlled trial

BACKGROUND

Obstructive sleep apnea (OSA) is quite common among the adult population, according to recent epidemiological studies. The most frequently suggested alternate treatment for mild to moderate OSA is oral appliances (OA). The purpose of the present study was to assess as well as compare the effectiveness of custom-made maxillary oral appliances against mandibular advancement appliances in the care of individuals suffering from moderate obstructive sleep apnea.

METHODS

A prospective interventional research was carried out with 40 participants. Polysomnography (PSG) was done and the participants with an apnea-hypopnea index (AHI) >15-30 were involved in the research. Study participants were randomly split up into two test groups: group I was the "Control Group" (group treated with a mandibular advancement device (MAD), n=20), while group II was exposed to a "customized maxillary oral appliance" (CMOA, n=20). Both groups had reference measures for AHI, blood oxygen saturation (SpO2), oro-nasal airflow via respiratory disturbance index (RDI), and the Epworth Sleepiness Scale (ESS). Appliances were fabricated and delivered to the respective study group participants. PSG was again conducted after a period of 1 and 3 months of appliance delivery and re-evaluation was done for all the parameters and was compared with reference measurements. The facts were analyzed using descriptive and analytical statistical methods. The statistical program utilized in the study was "SPSS (Statistical Package for Social Sciences) Version 20.1." After 1 and 3 months, the statistical significance between the two study groups was assessed at P<0.05.

RESULTS

The analysis of mean AHI, SPO2, RDI, and ESS for both test groups manifested statistically significant measures (P<0.001). The study results revealed a statistically significant depletion in mean AHI scores, improvement in mean SPO2 scores, and reduction in mean RDI scores and ESS scores when compared with reference measurements to 1 month, 1 to 3 months, and between reference measurements and 3 months.

CONCLUSION

The CMOA was effective in managing moderate OSA and has great therapeutic potential. It can be an option for the MAD for treating patients suffering from moderate obstructive sleep apnea.

TRIAL REGISTRATION

The study was registered under Clinical Trials Registry-India and the registration number is CTRI/2020/07/026936 . Registered on 31 July 2020.

Oral findings as predictors of obstructive sleep apnea- A case-control study

Objective

To evaluate the role of dental parameters that may contribute to increasing apneic activity in patients with or without obstructive sleep apnea (OSA).

Materials and Method

The study comprises a total of 120 patients (60 diagnosed with sleep apnea visiting a sleep center at Delhi and 60 controls). Patients were assessed based on body mass index, age, neck circumference, and gender (BANG), which were recorded for both the patients and controls. Oral and general examination was carried out using predetermined criteria for Angle's class of malocclusion, maxillary arch constriction, facial profile, Mallampati score for uvula, tongue size, depth of palatal vault, mouth breathing, and periodontitis.

Results

Among 120 study subjects, 92 were males and 28 females, with a mean age of 49.08 + 13.13 years in the study group and 45.28 + 14.78 years in the control group. All the variables except Angle's class of malocclusion, periodontitis, mouth breathing, and hypertension showed significant differences in the study group. Multivariate analysis for patients with OSA revealed that obese patients were almost 1.5 times more possibly to report OSA symptoms than their non-obese counterparts. It was also found that patients with OSA were 4.12 times more likely to have neck circumference >40 cm, 2.25 times more likely to have maxillary arch constriction, 1.43 times deeper palatal vault, 8.7 times macroglossia, and 1.7 times class III & IV Mallampati score for uvula.

Conclusion

The oral structural findings appear to be more closely related with OSA.

Comparative evaluation of the efficacy of customized maxillary oral appliance with mandibular advancement appliance as a treatment modality for moderate obstructive sleep apnea patients-protocol for a randomized controlled trial

Background

Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option, i.e., mandibular advancement device (MAD), which is an oral appliance (OA), are the most preferred ones. This study aims to evaluate the efficacy of customized maxillary oral appliances with mandibular advancement devices in moderate OSA patients.

Methods

A prospective interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) > 15–30, recorded on polysomnography (PSG). Study participants will be randomly divided into the following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of the appliance, all the parameters, i.e., AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth Sleepiness Scale will be re-evaluated and compared with the baseline measurements. Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p< 0.05.

Discussion

We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a “gold standard” for managing moderate OSA.

Trial registration

CTRI/2020/07/026936 Registered 31 July 2020.