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Henning RJ, Anderson WM. SLEEP APNEA IS A COMMON AND DANGEROUS CARDIOVASCULAR RISK FACTOR. Curr Probl Cardiol 2024:102838. [PMID: 39242062 DOI: 10.1016/j.cpcardiol.2024.102838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
Sleep apnea involves almost one billion individuals throughout the world, including 40 million Americans. Of major medical concern is the fact that the prevalence of sleep apnea is significantly increasing due to the epidemic of obesity, physical inactivity, and diabetes mellitus which are important risk factors for the development and persistence of sleep apnea in individuals. Sleep apnea is characterized by multiple episodes of apnea or hypopnea during sleep, which cause nocturnal arousals, gasping for breath during the night, daytime sleepiness, irritability, forgetfulness, fatigue and recurrent headaches. Obstructive sleep apnea occurs when upper airway obstruction occurs in an individual during sleep with absent or markedly reduced airflow in the presence of continued activity of inspiratory thoracic and diaphragmatic muscles. Central sleep apnea is defined as the absence or the significant reduction of naso-oral airflow due to the withdrawal during sleep of ponto-medullary respiratory center stimulation of the nerves of the inspiratory thoracic and diaphragmatic muscles and absence of contraction of these muscles during apnea. Complex sleep apnea occurs when an individual exhibits characteristics of both obstructive and central sleep apnea. The severity of sleep apnea is measured by polysomnography and the apnea hypopnea index (AHI), which is the average number of apneas and hypopneas per hour of sleep measured by polysomnography. Sleep apnea is mild if the AHI is 5-14/hour with no or mild symptoms, moderate if the AHI is 15 to 30/hour with occasional daytime sleepiness, and severe if the AHI is >30/hour with frequent daytime sleepiness that interferes with the normal activities of daily life. Chronic sleep apneas and hypopneas followed by compensatory hyperpneas are associated with significant adverse cardiovascular consequences including: 1) recurrent hypoxemia and hypercarbia; 2) Increased sympathetic nerve activity and decreased parasympathetic nerve activity; 3) oxidative stress and vascular endothelial dysfunction; and 4) cardiac remodeling and cardiovascular disease. Moderate or severe sleep apnea significantly increases the risk of coronary artery disease, congestive heart failure, cerebral vascular events (strokes), and cardiac dysrhythmias, and also increase the morbidity and mortality of these diseases. Nevertheless, sleep apnea is currently underdiagnosed and untreated in many individuals due to the challenges in the prediction and detection of sleep apnea and a lack of well-defined optimal treatment guidelines. Chronic continuous positive airway pressure for ≥4 hours/night for >70% of nights is beneficial in the treatment of patients with sleep apnea. CPAP Improves sleep quality, reduces the AHI, augments cardiac output and increases oxygen delivery to brain and heart, reduces resistant hypertension, decreases cardiac dysrhythmias, and reduces daytime sleepiness. The present article discusses the diagnosis of obstructive sleep apnea, central sleep apnea, and complex apnea. Thereafter the important pathophysiologic mechanisms in sleep apnea and the relationship of these pathophysiologic mechanics to atherosclerotic vascular disease are reviewed. Guidelines are then provided for the treatment of mild, moderate and severe sleep apnea In order to reduce the cardiovascular morbidity and mortality caused by sleep apnea and facilitate the diagnosis and the long-term, effective treatment of sleep apnea in patients, the close cooperation is necessary of cardiovascular specialists, pulmonary specialists, and respiratory therapy/ rehabilitation specialists.
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Affiliation(s)
- Robert J Henning
- University of south florida college of public health and morsani college of medicine.
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Jobanputra AM, Kesavarapu K, Naik S, Ramagopal M, Scharf MT, Jagpal S. Overnutrition in persons with cystic fibrosis on modulator therapy and the relationship to obstructive sleep apnea. Pediatr Pulmonol 2024; 59 Suppl 1:S27-S35. [PMID: 39105350 DOI: 10.1002/ppul.27163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 06/10/2024] [Accepted: 06/25/2024] [Indexed: 08/07/2024]
Abstract
Cystic fibrosis (CF) care is evolving with the ubiquitous use of modulator therapy and resultant increase in lifespan. It is important for CF clinicians to monitor the pathologic weight gain that is concomitantly being seen as obesity is a known risk factor for multiple other diseases. In this review we focus on obesity in CF, discuss screening and lifestyle considerations, outline CF-specific concerns with weight loss medications, and describe the vicious cycle of obesity and obstructive sleep apnea (OSA). We discuss screening and treatment for OSA, as it directly correlates with weight fluctuation. We offer interim recommendations for CF teams as they continue to care for this population.
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Affiliation(s)
- Aesha M Jobanputra
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Division of Pulmonary, Critical Care, and Sleep Medicine, New Brunswick, New Jersey, USA
| | - Keerthana Kesavarapu
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Division of Gastroenterology and Hepatology, New Brunswick, New Jersey, USA
| | - Sreelatha Naik
- Department of Medicine, Geisinger Wyoming Valley Medical Center, Division of Pulmonary, Critical Care, and Sleep Medicine, Wilkes-Barre, Pennsylvania, USA
| | - Maya Ramagopal
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, Division of Pediatric Pulmonary Medicine and Cystic Fibrosis Center, New Brunswick, New Jersey, USA
| | - Matthew T Scharf
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Division of Pulmonary, Critical Care, and Sleep Medicine, New Brunswick, New Jersey, USA
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Sugeet Jagpal
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, Division of Pulmonary, Critical Care, and Sleep Medicine, New Brunswick, New Jersey, USA
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Yu M, Ma Y, Gong XU, Gao X. DENTAL AND SKELETAL CHANGES OF LONG-TERM USE OF MANDIBULAR ADVANCEMENT DEVICES FOR THE TREATMENT OF ADULT OBSTRUCTIVE SLEEP APNEA: A SYSTEMATIC REVIEW AND META-ANALYSIS. J Evid Based Dent Pract 2024; 24:101991. [PMID: 39174171 DOI: 10.1016/j.jebdp.2024.101991] [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: 12/15/2023] [Revised: 03/10/2024] [Accepted: 03/22/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Mandibular advancement devices (MADs) are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA). Long-term use of MADs has been found to be associated with dental and skeletal changes. This study aims to conduct a systematic review and meta-analysis to improve knowledge about the dental and skeletal changes of long-term (>1 year) use of MADs for the treatment of OSA. MATERIAL AND METHODS Electronic databases were systematically searched. Two reviewers conducted screening, quality assessment, and data extraction independently. Thirty-four studies were included in the systematic review and 23 in the meta-analysis. RESULTS The mean change of overjet and overbite was -0.77mm (95%CI -1.01 to -0.53, P < .00001) and -0.64mm (95%CI -0.85 to -0.43, P < .00001), with progressive change over the treatment duration. The inclination of the upper incisor (U1/SN) and the lower incisor (L1/MP) showed a mean change of retroclined -2.10° (95%CI -3.93 to -0.28, P = .02) and proclined 1.78° (95%CI 0.63 to 2.92, P = .002), respectively. The mean change of the anteroposterior position of the mandible (SNB) was -0.33° posteriorly (95%CI -0.65 to -0.02, P = .04). CONCLUSIONS The meta-analysis showed a gradual decrease in overjet and overbite with treatment duration with long-term use of MADs for the treatment of OSA. Upper and lower incisors retroclined and proclined, respectively. The skeletal changes might include the mandibular position. Patients treated with MADs need to be continuously monitored over time.
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Affiliation(s)
- Min Yu
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, Haidian District, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, PR China; National Center for Stomatology, Beijing, Haidian District, PR China
| | - Yanyan Ma
- Department of Stomatology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, Chaoyang District, PR China
| | - X U Gong
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, Haidian District, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, PR China; National Center for Stomatology, Beijing, Haidian District, PR China
| | - Xuemei Gao
- Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, Haidian District, PR China; Center for Oral Therapy of Sleep Apnea, Peking University Hospital of Stomatology, Beijing, Haidian District, PR China; National Center for Stomatology, Beijing, Haidian District, PR China.
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Singh A, Bhat A, Saroya J, Chang J, Durr ML. Sociodemographic and Healthcare System Barriers to PAP Alternatives for Adult OSA: A Scoping Review. Laryngoscope 2024; 134:3903-3909. [PMID: 38568079 DOI: 10.1002/lary.31429] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 03/03/2024] [Accepted: 03/18/2024] [Indexed: 08/09/2024]
Abstract
OBJECTIVE To investigate sociodemographic and healthcare system barriers to access and utilization of alternative treatments to positive airway pressure (PAP) in the management of adult obstructive sleep apnea (OSA). DATA SOURCES PubMed, Embase, and Web of Science databases were searched from 2003 to 2023 for English-language studies containing original data on sociodemographic and healthcare system barriers to PAP-alternative treatments for adult OSA. REVIEW METHODS Studies were assessed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. Title and abstract screening, full-text review, and data collection were conducted by two investigators independently. RESULTS Out of 1,615 studies screened, 13 studies met inclusion criteria and reported on a total of 1,206,115 patients who received PAP alternative treatments, including surgery (n = 9 studies), and oral appliances (OAs) (n = 3 studies). The chance of receiving a PAP-alternative treatment such as surgery was greater among patients aged 39 years or younger, had body mass index below 30 kg/m2, fewer comorbidities, private insurance, and a higher occupational and income status. The decision of individuals to receive PAP alternative treatments was influenced by increased patient education from providers, as well as improvements in daytime sleepiness and partner perception of snoring and apnea. CONCLUSION Cumulative evidence suggests that several sociodemographic and healthcare system factors are associated with decreased use of PAP alternatives when PAP therapy fails. Investigation of interventions to eliminate these potential barriers may improve access and treatment outcomes. Laryngoscope, 134:3903-3909, 2024.
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Affiliation(s)
- Amritpal Singh
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Amrita Bhat
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jasmeet Saroya
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jolie Chang
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
- Surgical Services, San Francisco Veterans Affairs Health Care System, San Francisco, California, U.S.A
| | - Megan L Durr
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, U.S.A
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Özköylü G, Saraç D, Sasany R, Umurca DG. Comparison of monoblock and twinblock mandibular advancement devices in patiens with obstructive sleep apnea and temporomandibular disorder: effects on airway volume, polysomnography parameters, and sleepiness scale scores. BMC Oral Health 2024; 24:1026. [PMID: 39215302 PMCID: PMC11365127 DOI: 10.1186/s12903-024-04653-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE This study aimed to compare the effects of two different mandibular advancement devices on the upper airway volume, polysomnographic parameters, and sleepiness scale scores in patients with obstructive sleep apnea and Temporomandibular disorders (TMD). MATERIALS AND METHODS Monoblock and twinblock mandibular advancement devices were applied to patients with obstructive sleep apnea syndrome for 3 months separated by a wash-out period of 2 weeks. Research Diagnostic Criteria for TMD (RDC/TMD), Polysomnographic parameters and cone-beam computed tomography findings were recorded before and after the use of the mandibular advancement devices. A three-dimensional analysis of the airway was then performed. RESULTS The use of the monoblock device significantly increased the upper airway volume compared with the use of the twinblock device (p = 0.032). The polysomnographic parameters similarly improved with the use of the twin-block and monoblock devices. The significant reduction in TMD symptoms was observed. CONCLUSION The use of the monoblock device increased the retropalatal airway volume. This volume increase may be attributed to the fact that the design of the monoblock device allows less mandibular movement than does that of the twinblock device. Indicates the potential benefits of MADS treatment in alleviating TMD-related issues. CLINICAL SIGNIFICANCE Monoblock MADs have improved effects on respiratory parameters and upper airway dimensions in patients with OSA and mild to moderate TMD.
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Affiliation(s)
| | - Duygu Saraç
- Department of Prosthodontics, Faculty of Dentistry, Ondokuz Mayıs University, Samsun, Turkey
| | - Rafat Sasany
- Department of Prosthodontics, Faculty of Dentistry, İstanbul Biruni University, İstanbul, Turkey.
| | - Dilara Gülhan Umurca
- Department of Othodontics, Faculty of Dentistry, İstanbul Biruni University, İstanbul, Turkey
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Ishiyama H, Liu S, Nishiyama A, Fueki K. Morning headache caused by obstructive sleep apnea misdiagnosed as temporomandibular disorders-related headache: A case report. J Prosthodont Res 2024:JPR_D_24_00050. [PMID: 39198201 DOI: 10.2186/jpr.jpr_d_24_00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2024]
Abstract
PATIENT A 67-year-old woman presented to our clinic with chief complaints of headache and mandibular heaviness. Physical examination revealed bilateral tenderness in the temporalis and masseter muscles, corresponding to the patient's chief complaint. Thus, a diagnosis of temporomandibular disorders (TMDs)-related headache was made. However, sleep disorders were identified after further consultation. Hence, sleep apnea-related headache was suspected due to a snoring habit with a Mallampati classification of Class IV. Out-of-center sleep testing (OCST) revealed a respiratory event index (REI) of 10.1/h and a low peripheral oxygen saturation (SpO2) of 76%. Consequently, a diagnosis of obstructive sleep apnea (OSA) was made, and treatment using the mandibular advancement device (MAD) was recommended. Following MAD treatment, the patient's sleep quality improved, and morning headaches ceased. Subsequent OCST performed while wearing the MAD showed a significant reduction in the REI to 1.6/h and an increase in the SpO2 to 86%, indicating the therapeutic efficacy of the MAD in treating OSA. DISCUSSION MAD treatment effectively alleviated the patient's morning headaches, suggesting that sleep bruxism should not be considered the only cause of headaches. OSA should also be considered and addressed when investigating the potential causes of morning headaches in patients. CONCLUSIONS In patients experiencing TMDs symptoms and morning headaches, TMDs should not be presumed as the sole cause. Dentists should discuss the likelihood of sleep disorders during consultations. If sleep disorders are suspected, the possibility of OSA should be considered, and sleep tests should be conducted when necessary.
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Affiliation(s)
- Hiroyuki Ishiyama
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shaoyuan Liu
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Akira Nishiyama
- Department of General Dentistry, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kenji Fueki
- Department of Masticatory Function and Health Science, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Attia AAMM, Awad SS, Mansour M, Baz H, Zahran KM, Saleh AM. Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial. BMC Oral Health 2024; 24:931. [PMID: 39129005 PMCID: PMC11317010 DOI: 10.1186/s12903-024-04623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024] Open
Abstract
BACKGROUND In recent years, obstructive sleep apnea (OSA) has been increasingly recognized as a significant health concern. No previous studies assessed the effect of recommended treatment modalities of patients with OSA on the temporomandibular joint (TMJ). The current study aimed to evaluate the effect of different treatment modalities of OSA, such as continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and oral myofunctional therapy (OMT) on subjective symptoms, clinical, and radiographic signs of temporomandibular disorders. PATIENTS & METHODS This hospital-based prospective randomized controlled clinical trial study was approved by the institutional review board and formal patient consent, 39 OSA patients, ranging in age from 19 to 56 after confirmation with full night Polysomnography (PSG) with healthy TMJ confirmed clinically and radiographically with magnetic resonance imaging (MRI) were randomly allocated into three treatment groups. Group 1: 13 patients were managed with CPAP after titration, group 2: 13 patients were managed with digitally fabricated MAD, and group 3: 13 patients were managed with OMT. The following parameters were evaluated before and 3 months after the intervention. Pain using a visual analogue scale (VAS), maximum inter-incisal opening (MIO), lateral movements, and clicking sound of TMJ. MRI was done before and 3 months after the intervention. RESULTS Out of the 83 patients enrolled, 39 patients completed the treatment. There were no statistically significant differences in lateral jaw movements or clicking, and no significant difference in MRI findings between the three studied groups before and after the intervention. The OMT group showed a statistically significant difference in pain (p = 0.001), and MIO (p = 0.043) where patients experienced mild pain and slight limitation in mouth opening after 3 months of follow-up in comparison to MAD and CPAP groups. CONCLUSION CPAP and MAD are better for preserving the health of TMJ in the treatment of OSA patients. While OMT showed mild pain and slight limitation of MIO (that is still within the normal range of mouth opening) compared to CPAP and MAD. TRIAL REGISTRATION The study was listed on www. CLINICALTRIALS gov with registration number (NCT05510882) on 22/08/2022.
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Affiliation(s)
- Amira A M M Attia
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Sally S Awad
- Oral and Maxillofacial Surgery, Faculty of Dentistry, Mansoura University, Mansoura, Egypt.
| | - Manar Mansour
- Diagnostic and Interventional Radiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hemmat Baz
- Phoniatrics Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Khaled M Zahran
- Fixed Prosthodontics, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Abdelbaset M Saleh
- Chest Medicine, Sleep Disorder Breathing Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Park MJ, Meghpara S, Niraula R, DelRosso LM. A 74-Year-Old Woman with Severe Obstructive Sleep Apnea Intolerant to Continuous Positive Airway Pressure. Ann Am Thorac Soc 2024; 21:1209-1213. [PMID: 39087891 DOI: 10.1513/annalsats.202308-720cc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 05/01/2024] [Indexed: 08/02/2024] Open
Affiliation(s)
- Moon J Park
- Saint Agnes Medical Center, Fresno, California; and
| | | | - Rijesh Niraula
- University of California, San Francisco, Fresno, California
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Serghani MM, Heiser C, Schwartz AR, Amatoury J. Exploring hypoglossal nerve stimulation therapy for obstructive sleep apnea: A comprehensive review of clinical and physiological upper airway outcomes. Sleep Med Rev 2024; 76:101947. [PMID: 38788518 DOI: 10.1016/j.smrv.2024.101947] [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: 11/06/2023] [Revised: 04/17/2024] [Accepted: 05/01/2024] [Indexed: 05/26/2024]
Abstract
Obstructive sleep apnea (OSA) is a chronic disorder characterized by recurrent episodes of upper airway collapse during sleep, which can lead to serious health issues like cardiovascular disease and neurocognitive impairments. While positive airway pressure serves as the standard treatment, intolerance in some individuals necessitates exploration of alternative therapies. Hypoglossal nerve stimulation (HGNS) promises to mitigate OSA morbidity by stimulating the tongue muscles to maintain airway patency. However, its effectiveness varies, prompting research for optimization. This review summarizes the effects of HGNS on upper airway obstruction from human and animal studies. It examines physiological responses including critical closing pressure, maximal airflow, nasal and upper airway resistance, compliance, stiffness, and geometry. Interactions among these parameters and discrepant findings in animal and human studies are explored. Additionally, the review summarizes the impact of HGNS on established OSA metrics, such as the apnea-hypopnea index, oxygen desaturation index, and sleep arousals. Various therapeutic modalities, including selective unilateral or bilateral HGNS, targeted unilateral HGNS, and whole unilateral or bilateral HGNS, are discussed. This review consolidates our understanding of HGNS mechanisms, fostering exploration of under-investigated outcomes and approaches to drive advancements in HGNS therapy.
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Affiliation(s)
- Marie-Michèle Serghani
- Sleep and Upper Airway Research Group (SUARG), Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut (AUB), Beirut, Lebanon
| | - Clemens Heiser
- Department of Otorhinolaryngology/Head and Neck Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany; Department ENT-HNS, Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Alan R Schwartz
- Department of Otorhinolaryngology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Otolaryngology, Vanderbilt University, Nashville, Tennessee, USA
| | - Jason Amatoury
- Sleep and Upper Airway Research Group (SUARG), Biomedical Engineering Program, Maroun Semaan Faculty of Engineering and Architecture (MSFEA), American University of Beirut (AUB), Beirut, Lebanon.
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Manetta IP, Duarte BB, Nucci LB, Enes CC. Relationship between OSA pathophysiological phenotypes and treatment response to mandibular advancement devices: a pilot study. J Clin Sleep Med 2024; 20:1321-1330. [PMID: 38557332 PMCID: PMC11294123 DOI: 10.5664/jcsm.11138] [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: 07/29/2023] [Revised: 03/26/2024] [Accepted: 03/27/2024] [Indexed: 04/04/2024]
Abstract
STUDY OBJECTIVES We assessed whether critical pathophysiological phenotypes predict treatment response in patients with obstructive sleep apnea using a mandibular advancement device (MAD). METHODS Thirty-one patients with obstructive sleep apnea were treated with a MAD. Individuals were categorized and graded into 4 pathophysiological phenotypes based on polysomnographic features (anatomical, ventilatory control, arousal threshold, and muscle responsiveness). Morpho-anthropometric data were additionally assessed. Patients were classified as responders or nonresponders. Associations between polysomnographic phenotypes and treatment response were documented, as were morpho-anthropometric data and their impact on therapeutic success. RESULTS There was a male predominance (64.5%), with a median age of 49 years (25th percentile: 40; 75th percentile: 55), body mass index = 27.4 kg/m2 (25th percentile: 26; 75th percentile: 28.8), and apnea-hypopnea index of 18.2 events/h (25th percentile: 11.7; 75th percentile: 27.6). The majority of patients treated with a MAD (58%) were good responders (68.0% mild and moderate vs 16.7% severe). Treatment response was associated with shorter intermolar and interpremolar distances in the lower arch (P = .0092 and .0129). Rapid eye movement sleep apnea-hypopnea index and MAD-related treatment response were inversely correlated (P = .0013). Favorable anatomical (P = .0339) and low muscle response (P = .0447) phenotypes were correlated with outcomes. CONCLUSIONS According to our results, a favorable response occurred in a better "anatomical phenotype" and in the worse "muscular responsiveness phenotype" according to polysomnographic data. Furthermore, other favorable predictors, such as a rapid eye movement sleep apnea-hypopnea index < 16 events/h and a smaller distance between lower molars and premolars, were found. These findings indicate that clinical and polysomnographic aspects can discriminate phenotypes that may guide decisions on MAD treatment for obstructive sleep apnea. CITATION Manetta IP, Duarte BB, Nucci LB, Enes CC. Relationship between OSA pathophysiological phenotypes and treatment response to mandibular advancement devices: a pilot study. J Clin Sleep Med. 2024;20(8):1321-1330.
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Affiliation(s)
- Izabella P. Manetta
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
| | - Bruno B. Duarte
- Department of Otolaryngology Head and Neck Surgery, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
| | - Luciana B. Nucci
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
| | - Carla C. Enes
- Postgraduate Program in Health Sciences, Pontifical Catholic University of Campinas, Campinas, São Paulo, Brazil
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Gurgel ML, Pereira RRR, Pereira AB, Fabbro CD, Kurita LM, Ribeiro TR, Cevidanes LHS, Costa FWG, Junior CMC. Mandibular advancement device in obstructive sleep apnea treatment: what happens to the condyle position and patient response? Sleep Breath 2024:10.1007/s11325-024-03093-2. [PMID: 39046657 DOI: 10.1007/s11325-024-03093-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 06/09/2024] [Accepted: 06/21/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND This study aims primarily to assess the mandibular condyles and patient response to MAD therapy using cone-beam computed tomography (CBCT). Also, the study proposes to analyze whether variations in condylar position, OSA severity and mandibular protrusion influence patient response. METHODS 23 patients diagnosed with mild/moderate OSA and treated with MAD comprised the sample. Clinical, CBCT, and PSG assessments were conducted at baseline and with MAD in therapeutic protrusion (4-6 months of MAD use). The condyle position was vertically and horizontally evaluated at baseline and at the therapeutic protrusion. RESULTS The condyle position significantly changed with MAD, showing anterior (7.3 ± 2.8 mm; p < 0.001) and inferior (3.5 ± 1 mm; p < 0.001) displacement. Patients with mild OSA required more protrusion (p = 0.02) for improvement. Responders exhibited a significantly prominent (p = 0.04) anterior baseline condyle position. A negative modest correlation was found between treatment response and baseline condyle anterior position (p = 0.03; r=-0.4), as well as between OSA severity and the percentage of maximum protrusion needed for therapeutic protrusion (p = 0.02; r=-0.4). The patient protrusion amount did not predict condylar positional changes. Neither condyle position, OSA severity, nor therapeutic protrusion were predictors of MAD treatment response. CONCLUSION MAD resulted in anterior and inferior condylar displacement, and the amount of protrusion did not predict condylar positional changes. Responders showed a more anterior baseline condyle position. OSA severity and mandibular protrusion did not predict treatment response.
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Affiliation(s)
- Marcela Lima Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
- Department of Orthodontics and Pediatric Dentistry, School of Dentistry, University of Michigan, Ann Arbor, MI, USA
| | - Rowdley Robert Rossi Pereira
- Department of Pneumology, Division of Sleep Medicine and Biology, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Amanda Barbosa Pereira
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | - Cibele Dal Fabbro
- Faculty of Dental Medicine, Center for Advance Research in Sleep Medicine & Stomatology, Universite de Montreal & CIUSSS Nord Ile de Montreal, CHUM, Montreal, QC, Canada
| | - Lucio Mitsuo Kurita
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | - Thyciana Rodrigues Ribeiro
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
| | | | - Fabio Wildson Gurgel Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil.
| | - Cauby Maia Chaves Junior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceará, 1273 Monsenhor Furtado St, Fortaleza, CE, Brazil
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Hawco C, Bonthu A, Pasek T, Sarna K, Smolley L, Hadeh A. The Correlation of Computerized Scoring in Home Sleep Apnea Tests with Technician Visual Scoring for Assessing the Severity of Obstructive Sleep Apnea. J Clin Med 2024; 13:4204. [PMID: 39064244 PMCID: PMC11277620 DOI: 10.3390/jcm13144204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 07/11/2024] [Accepted: 07/14/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Obstructive sleep apnea (OSA) affects a significant proportion of the global population, with many having moderate or severe forms of the disease. Home Sleep Apnea Testing (HSAT) has become the most common method of diagnosing OSA, replacing in-lab polysomnography. Polysmith software Version 11 by Nihon Kohden allows for the automatic scoring of respiratory events. This study aimed to assess the validity of this technology. Study Objectives: The objective was to assess the accuracy of the Polysmith Software Automatic Scoring Algorithm of HSATs in comparison to that of sleep technicians. Methods: One hundred twenty HSATs were scored by both sleep technicians and Polysmith software. The measured values were the respiratory event index (REI), apneic events, and hypopneic events. Agreement between the two methods was reached by utilizing the Kruskal-Wallis test, Pearson correlation coefficient, and Bland-Altman plot, as well as sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: The correlation between the REI calculated by the software and technicians proved to be strong overall (r = 0.96, p < 0.0001). The mild OSA group had a moderate correlation (r = 0.45, p = 0.0129). The primary snoring, moderate OSA, and severe OSA groups showed stronger correlations (r = 0.69, p < 0.0001; r = 0.56, p = 0.012; r = 0.71, p < 0.0001). The analysis conducted across all groups demonstrated an average sensitivity of 81%, specificity of 94%, PPV of 82%, and NPV of 94%, with an overall accuracy of 81%. When combining the moderate and severe OSA groups into a single category, the sensitivity was 90%, specificity was 100%, PPV was 100%, and NPV was 91%. Conclusions: OSA can be reliably diagnosed from HSATs with the automated Polysmith software across all OSA disease severity groups, with higher levels of accuracy in moderate/severe OSA and lower levels of accuracy in mild OSA.
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Affiliation(s)
| | - Amrita Bonthu
- School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA
| | | | | | | | - Anas Hadeh
- Cleveland Clinic Florida, Weston, FL 33331, USA
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Sousa S, Correia S, de Almeida AM, Videira G, Dias R, Ramos SF, Fonseca J. Treatment of obstructive sleep apnea syndrome (OSAS) with mandibular advancement devices-A statement of the Portuguese society of pulmonology, the Portuguese society of stomatology and dental medicine, the Portuguese dental association, and the Portuguese society of temporomandibular disorders, orofacial pain and sleep. Pulmonology 2024:S2531-0437(24)00093-X. [PMID: 39003191 DOI: 10.1016/j.pulmoe.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 05/21/2024] [Accepted: 05/27/2024] [Indexed: 07/15/2024] Open
Abstract
With the purpose of establishing a consensus around clinical orientations for professionals involved in managing patients with sleep breathing disorders (SBD), an interdisciplinary group of scientific societies involved in this field discussed and reviewed all the published international guidelines from the American Dental Association, American Academy of Sleep Medicine, American Academy of Dental Sleep Medicine and the European counterparts. Treatment of SBD is multidisciplinary and should be made in concert with the patient, the sleep physician, and the qualified dentist to solve the individual, social, and economic burden of the disease,. This consensus document represents the current thinking of a team of Portuguese experts on managing patients with SBD based on the available evidence.
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Affiliation(s)
- Susana Sousa
- CUF Tejo Hospital, Lisbon, Portugal; CUF Descobertas Hospital, Lisbon, Portugal; Nova Medical School, Lisbon, Portugal.
| | - Sílvia Correia
- Hospital da Boa Nova, Matosinhos, Portugal; Hospital Privado de Braga, Braga, Portugal
| | - André Mariz de Almeida
- CUF Tejo Hospital, Lisbon, Portugal; Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Egas Moniz School of Health and Science, Instituto Universitário Egas Moniz (IUEM), Almada, Portugal; Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep
| | - Gabriela Videira
- Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep; Luz Lisbon Hospital, Lisbon, Portugal
| | - Ricardo Dias
- Portuguese Society of Stomatology and Dental Medicine; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Susana Falardo Ramos
- Portuguese Dental Association, Portugal; Universidade Católica Portuguesa, Faculty of Dental Medicine, Centre for Interdisciplinary Research in Health, Viseu, Portugal
| | - Júlio Fonseca
- Portuguese Society of Temporomandibular Disorders, Orofacial Pain and Sleep; ORISCLINIC, Coimbra, Portugal
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Ioerger P, Afshari A, Hentati F, Strober W, Kallogjeri D, Ju YE, Piccirillo JF. Mandibular Advancement vs Combined Airway and Positional Therapy for Snoring: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024; 150:572-579. [PMID: 38780959 PMCID: PMC11117146 DOI: 10.1001/jamaoto.2024.1035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
Importance Approximately 150 million individuals in the US snore in the absence of obstructive sleep apnea (primary snoring), but few studies have examined the efficacy of treatments for snoring or evaluated the effect of snoring in sleeping partners. Objective To evaluate the efficacy of 2 treatments for primary snoring. Design, Setting, and Participants This pilot randomized clinical trial that included a convenience sample of people who snore without sleep apnea and their sleeping partner who underwent 4 weeks of snoring treatment was conducted at an academic medical center between October 3, 2022, and July 3, 2023. Interventions Fifty couples were randomized to either use a mandibular advancement device (MAD) or receive combined airway and positional therapy (CAPT; external nasal dilator, nasal saline lavage with mometasone, mouth taping, and lateral positional therapy). Main Outcome and Measure Percentage of sleeping partners who reported that their partner's snoring was either very much improved or much improved (responder) on the Clinical Global Impression of Improvement scale. Results A total of 42 dyads completed the study; 23 (55%) were randomized to MAD and 19 (45%) to CAPT. Among people who snore, 26 (62%) were female, and the mean (SD) age was 48 (14) years. Of 23 dyads randomized to MAD, 21 people who snore (91%) were rated by the sleeping partner as a responder, while 11 of the 19 dyads (58%) randomized to CAPT were rated by the sleeping partner as responder, resulting in a difference of 33 percentage points (95% CI, 8-58) and a number needed to treat of 3. Of the 10 participants who were withdrawn, 4 were withdrawn due to adverse effects of the treatment that were evenly distributed between the MAD (n = 2) and CAPT (n = 2) groups. Conclusion and Relevance The results of this randomized clinical trial showed that the MAD may be more effective than CAPT for treating primary snoring, while both treatment options were found to reduce primary snoring. Physicians should have a patient-centered discussion to determine which treatment is best for individual patients with primary snoring, weighing convenience, adverse effects, and cost as factors. Trial Registration ClinicalTrials.gov Identifier: NCT05756647.
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Affiliation(s)
- Patrick Ioerger
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- University of Kansas Medical Center, Kansas City
| | - Azadeh Afshari
- Department of Maxillofacial Prosthodontics, Barnes-Jewish Hospital, St Louis, Missouri
| | - Firas Hentati
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - William Strober
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Statistics Editor, JAMA Otolaryngology–Head & Neck Surgery
| | - Yo-El Ju
- Department of Neurology, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Anesthesiology, Washington University in St Louis School of Medicine, St Louis, Missouri
- Center on Biological Rhythms and Sleep, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Jay F. Piccirillo
- Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University in St Louis School of Medicine, St Louis, Missouri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
- Editor in Chief, JAMA Otolaryngology–Head & Neck Surgery
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15
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Mayoral Sanz P, Lagravère Vich M. Oral Appliances for Obstructive Sleep Apnea. Dent Clin North Am 2024; 68:495-515. [PMID: 38879283 DOI: 10.1016/j.cden.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
The use of mandibular repositioning devices (MRDs) in the management of patients with obstructive sleep apnea (OSA) has gained extensive recognition with relevant clinical evidence of its effectiveness. MRDs are designed to advance and hold the mandible in a protrusive position to widen the upper airway and promote air circulation. This review of the MRD aims to provide an evidence-based update on the optimal design features of an MRD, an analysis of the variety of appliances available, and the current understanding of the action mechanism.
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Affiliation(s)
- Pedro Mayoral Sanz
- Catholic University of Murcia UCAM, Calle Conde de Peñalver 61 - 1º, Madrid 28029, Spain.
| | - Manuel Lagravère Vich
- School of Dentistry, 5-488 Edmonton Clinic Health Academy, University of Alberta, 11405-87 Avenue Northwest, Edmonton, Alberta T6G 1C9, Canada
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16
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Rengasamy Venugopalan S, Allareddy V, Yadav S. Interdisciplinary Role of Orthodontist in Screening and Managing Obstructive Sleep Apnea in Children and Adults. Dent Clin North Am 2024; 68:475-483. [PMID: 38879281 DOI: 10.1016/j.cden.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
Obstructive sleep apnea (OSA) can affect children and adults, and, if left untreated, could have a major impact on the general and overall well-being of the patient. Dental health care providers and orthodontists have an interdisciplinary role in screening patients at risk for OSA and make a referral to establish a definitive diagnosis by a sleep physician. The gold standard of diagnostic testing is polysomnography. The adeno-tonsillar hypertrophy is the primary cause of sleep apnea in children; therefore, adeno-tonsillectomy must be the first line of treatment. Post adeno-tonsillectomy, if there is residual OSA due to underlying skeletal discrepancy, the patient may be referred to an orthodontist for appropriate management. Currently the evidence in the literature for prophylactic growth modification in children to prevent OSA is weak. In adults, the gold standard for managing OSA is Positive Airway Pressure (PAP) therapy; however, adherence to this treatment is rather low. The oral appliance (OA) therapy is an alternate for PAP intolerant patients and for mild to moderate OSA patients. The OA therapy has to be administered by a qualified dentist or orthodontist after careful examination of dental and periodontal health as well as any pre-existing joint conditions. The OA therapy could cause OA-associated malocclusion and patients have to be made aware of prior to initiating treatment. In patients with severe OSA, surgical maxilla-mandibular advancement (MMA) is highly effective.
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Affiliation(s)
| | - Veerasathpurush Allareddy
- Department of Orthodontics, University of Illinois College of Dentistry, 801 S. Paulina Street, IL 60612, USA
| | - Sumit Yadav
- Department of Growth and Development, University of Nebraska Medical Center, UNMC College of Dentistry, Room 2432, 4000 East Campus Loop South, Lincoln, NE 68583-0740, USA
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Essick G. Combination Therapies with an Oral Appliance in the Management of Obstructive Sleep Apnea. Dent Clin North Am 2024; 68:517-531. [PMID: 38879284 DOI: 10.1016/j.cden.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Combination therapy (CT) with a mandibular advancement device (MAD) and positive airway pressure (PAP) has been advocated for patients for whom neither MAD nor PAP alone provides an efficacious and tolerated therapy. This article reviews the small and limited, but growing body of evidence in support of CT and highlights details in its implementation. In most studies, CT was found to be preferred by many, but not all PAP-intolerant patients. CT can be more efficacious than either MAD or PAP alone.
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Affiliation(s)
- Greg Essick
- Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA.
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Sunwoo BY, Raphelson JR, Malhotra A. Chronic obstructive pulmonary disease and obstructive sleep apnea overlap: who to treat and how? Expert Rev Respir Med 2024; 18:527-537. [PMID: 39036943 DOI: 10.1080/17476348.2024.2384036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 07/21/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION The co-existence of chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA), or the overlap syndrome, is common and associated with a distinct pattern of nocturnal hypoxemia and worse clinical outcomes than either disease alone. Consequently, identifying who and how to treat these patients is essential. AREAS COVERED Treatment is recommended in all patients with OSA and symptoms or systemic hypertension, but determining symptoms attributable to OSA can be challenging in patients with COPD. Treatment should be considered in asymptomatic patients with moderate to severe OSA and COPD with pulmonary hypertension and comorbid cardiovascular and cerebrovascular disease, especially if marked hypoxic burden. CPAP is effective, but in patients with the overlap syndrome and daytime hypercapnia, high-intensity noninvasive ventilation aiming to lower PaCO2 may have additional benefits. Additionally, in those with severe resting daytime hypoxemia, supplemental oxygen improves survival and should be added to positive airway pressure. The role of alternative non-positive airway pressure therapies in the overlap syndrome needs further study. EXPERT OPINION Both COPD and OSA are heterogeneous disorders with a wide range of disease severity and further research is needed to better characterize and prognosticate patients with the overlap syndrome to personalize treatment.
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Affiliation(s)
- Bernie Y Sunwoo
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California, USA
| | - Janna R Raphelson
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California, USA
| | - Atul Malhotra
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California, USA
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Maniaci A, Lavalle S, Anzalone R, Lo Giudice A, Cocuzza S, Parisi FM, Torrisi F, Iannella G, Sireci F, Fadda G, Lentini M, Masiello E, La Via L. Oral Health Implications of Obstructive Sleep Apnea: A Literature Review. Biomedicines 2024; 12:1382. [PMID: 39061956 PMCID: PMC11274061 DOI: 10.3390/biomedicines12071382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 06/03/2024] [Accepted: 06/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is a prevalent sleep disorder characterized by repeated episodes of partial or complete obstruction of the upper airway during sleep. While the systemic implications of OSA are well documented, the dental consequences are less frequently discussed yet equally significant. This review aims to elucidate the oral health impacts of OSA, emphasizing the importance of interdisciplinary care. METHODS A comprehensive literature search was conducted across several databases to identify studies examining the relationship between OSA and various oral health parameters. The review included observational studies, clinical trials, and systematic reviews published in English up to January 2024. RESULTS OSA was significantly associated with heightened risks of bruxism, dry mouth, periodontal disease, temporomandibular joint disorders, palatal and dental changes, and alterations in taste sensation. Mouth breathing associated with OSA was a critical factor in exacerbating xerostomia and dental caries. Furthermore, the systemic inflammation induced by OSA appeared to correlate with the severity of periodontal disease. Patients using oral appliance therapy for OSA also showed notable changes in dental occlusion and required ongoing dental monitoring. CONCLUSIONS The findings underscore the bidirectional relationship between OSA and oral health, highlighting the need for dental professionals to be integral participants in the management of OSA. Early dental evaluation and intervention can contribute to the overall health and quality of life of individuals with OSA. The review advocates for the development of clinical guidelines to facilitate the early identification and management of OSA-related oral health issues within dental practice and encourages a collaborative approach to patient care.
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Affiliation(s)
- Antonino Maniaci
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (S.L.); (F.T.)
| | - Salvatore Lavalle
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (S.L.); (F.T.)
| | - Riccardo Anzalone
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, 90127 Palermo, Italy; (R.A.); (F.S.)
| | - Antonino Lo Giudice
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, 95123 Catania, Italy;
| | - Salvatore Cocuzza
- Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95124 Catania, Italy; (S.C.); (F.M.P.)
| | - Federica Maria Parisi
- Department of Medical, Surgical Sciences and Advanced Technologies “GF Ingrassia” ENT Section, University of Catania, 95124 Catania, Italy; (S.C.); (F.M.P.)
| | - Filippo Torrisi
- Department of Medicine and Surgery, University of Enna Kore, 94100 Enna, Italy; (S.L.); (F.T.)
| | - Giannicola Iannella
- Otorhinolaryngology Department, Sapienza University of Rome, 00161 Rome, Italy;
| | - Federico Sireci
- Otorhinolaryngology Section, Biomedicine, Neuroscience and Advanced Diagnostic Department, University of Palermo, 90127 Palermo, Italy; (R.A.); (F.S.)
| | - Gianluca Fadda
- Department of Otolaryngology, San Luigi Gonzaga Hospital, University of Turin, 10043 Orbassano, Italy;
| | - Mario Lentini
- ASP Ragusa-Hospital Giovanni Paolo II, 97100 Ragusa, Italy;
| | - Edoardo Masiello
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Luigi La Via
- Department of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Policlinico “G.Rodolico-San Marco”, 95123 Catania, Italy;
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20
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Malhotra A, Grunstein RR, Fietze I, Weaver TE, Redline S, Azarbarzin A, Sands SA, Schwab RJ, Dunn JP, Chakladar S, Bunck MC, Bednarik J. Tirzepatide for the Treatment of Obstructive Sleep Apnea and Obesity. N Engl J Med 2024. [PMID: 38912654 DOI: 10.1056/nejmoa2404881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
BACKGROUND Obstructive sleep apnea is characterized by disordered breathing during sleep and is associated with major cardiovascular complications; excess adiposity is an etiologic risk factor. Tirzepatide may be a potential treatment. METHODS We conducted two phase 3, double-blind, randomized, controlled trials involving adults with moderate-to-severe obstructive sleep apnea and obesity. Participants who were not receiving treatment with positive airway pressure (PAP) at baseline were enrolled in trial 1, and those who were receiving PAP therapy at baseline were enrolled in trial 2. The participants were assigned in a 1:1 ratio to receive either the maximum tolerated dose of tirzepatide (10 mg or 15 mg) or placebo for 52 weeks. The primary end point was the change in the apnea-hypopnea index (AHI, the number of apneas and hypopneas during an hour of sleep) from baseline. Key multiplicity-controlled secondary end points included the percent change in AHI and body weight and changes in hypoxic burden, patient-reported sleep impairment and disturbance, high-sensitivity C-reactive protein (hsCRP) concentration, and systolic blood pressure. RESULTS At baseline, the mean AHI was 51.5 events per hour in trial 1 and 49.5 events per hour in trial 2, and the mean body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) was 39.1 and 38.7, respectively. In trial 1, the mean change in AHI at week 52 was -25.3 events per hour (95% confidence interval [CI], -29.3 to -21.2) with tirzepatide and -5.3 events per hour (95% CI, -9.4 to -1.1) with placebo, for an estimated treatment difference of -20.0 events per hour (95% CI, -25.8 to -14.2) (P<0.001). In trial 2, the mean change in AHI at week 52 was -29.3 events per hour (95% CI, -33.2 to -25.4) with tirzepatide and -5.5 events per hour (95% CI, -9.9 to -1.2) with placebo, for an estimated treatment difference of -23.8 events per hour (95% CI, -29.6 to -17.9) (P<0.001). Significant improvements in the measurements for all prespecified key secondary end points were observed with tirzepatide as compared with placebo. The most frequently reported adverse events with tirzepatide were gastrointestinal in nature and mostly mild to moderate in severity. CONCLUSIONS Among persons with moderate-to-severe obstructive sleep apnea and obesity, tirzepatide reduced the AHI, body weight, hypoxic burden, hsCRP concentration, and systolic blood pressure and improved sleep-related patient-reported outcomes. (Funded by Eli Lilly; SURMOUNT-OSA ClinicalTrials.gov number, NCT05412004.).
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Affiliation(s)
- Atul Malhotra
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ronald R Grunstein
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ingo Fietze
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Terri E Weaver
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Susan Redline
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Ali Azarbarzin
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Scott A Sands
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Richard J Schwab
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Julia P Dunn
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Sujatro Chakladar
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Mathijs C Bunck
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
| | - Josef Bednarik
- From the University of California, San Diego, La Jolla (A.M.); Woolcock Institute of Medical Research, Macquarie University, Royal Prince Alfred Hospital, and the University of Sydney - all in Sydney (R.R.G.); the Center of Sleep Medicine, Charité University Hospital Berlin, Berlin (I.F.); the College of Nursing, University of Illinois Chicago, Chicago (T.E.W.); the School of Nursing (T.E.W.) and Perelman School of Medicine (R.J.S.), University of Pennsylvania, Philadelphia; the Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, and Harvard Medical School - both in Boston (S.R., A.A., S.A.S.); and Eli Lilly, Indianapolis (J.P.D., S.C., M.C.B., J.B.)
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Parthasarathy S, Ayas NT, Bogan R, Hwang D, Kushida C, Lown JS, Ojile JM, Patel I, Prasad B, Rapoport DM, Strollo P, Vanderveken OM, Viviano J. Oral appliance therapy and hypoglossal nerve stimulation as non-positive airway pressure treatment alternatives for obstructive sleep apnea: a narrative expert review. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae035. [PMID: 38966620 PMCID: PMC11223066 DOI: 10.1093/sleepadvances/zpae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 05/13/2024] [Indexed: 07/06/2024]
Abstract
This perspective on alternatives to positive airway pressure (PAP) therapy for the treatment of obstructive sleep apnea (OSA) summarizes the proceedings of a focus group that was conducted by the Sleep Research Society Foundation. This perspective is from a multidisciplinary panel of experts from sleep medicine, dental sleep medicine, and otolaryngology that aims to identify the current role of oral appliance therapy and hypoglossal nerve stimulation for the treatment of OSA with emphasis on the US practice arena. A secondary aim is to identify-from an implementation science standpoint-the various barriers and facilitators for adoption of non-PAP treatment that includes access to care, multidisciplinary expertise, reimbursement, regulatory aspects, current treatment guidelines, health policies, and other factors related to the delivery of care. The panel has contextualized the review with recent events-such as a large-scale PAP device recall compounded by supply chain woes of the pandemic-and emerging science in the field of OSA and offers solutions for multidisciplinary approaches while identifying knowledge gaps and future research opportunities.
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Affiliation(s)
- Sairam Parthasarathy
- Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA
| | - Najib T Ayas
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Richard Bogan
- Department of Psychaiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Dennis Hwang
- Division of Sleep Medicine, Kaiser Permanente Southern California, Fontana, CA, USA
| | - Clete Kushida
- Division of Sleep Medicine, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | | | - Imran Patel
- Department of Medicine, University of Arizona Health Sciences Center for Sleep and Circadian Sciences, University of Arizona, Tucson, AZ, USA
- Dental Sleep Service Line, Banner University Medical Center - Tucson, Tucson, AZ, USA
| | - Bharati Prasad
- Department of Medicine, University of Illinois at Chicago and Jesse Brown VA Medical Center, Chicago, IL, USA
| | - David M Rapoport
- Mount Sinai Health System Integrative Sleep Center, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Patrick Strollo
- Division of Pulmonary, Allergy, and Critical Care Medicine University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Oliver M Vanderveken
- Department of ENT-HNS, Antwerp University Hospital, Edegem, Belgium and Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - John Viviano
- Sleep Disorders Dentistry Research and Learning Center, Mississauga, ON, Canada
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22
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Belanche Monterde A, Zubizarreta-Macho Á, Lobo Galindo AB, Albaladejo Martínez A, Montiel-Company JM. Mandibular advancement devices decrease systolic pressure during the day and night in patients with obstructive sleep apnea: A systematic review and meta-analysis. Sleep Breath 2024; 28:1037-1049. [PMID: 38180683 PMCID: PMC11196326 DOI: 10.1007/s11325-023-02984-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 11/25/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
The aim of this systematic review and meta-analysis was to analyze whether or not mandibular advancement devices (MADs) produce changes in blood pressure in patients with obstructive sleep apnea (OSA) in relation to use time and if the device is used at night or day. MATERIALS AND METHOD A systematic review of the literature and meta-analysis was carried out in accordance with PRISMA guidelines. In the bibliographic search, a total of four databases were consulted: PubMed-Medline, Scopus, Web of Science, and Cochrane. Of the 622 articles initially revealed, 160 duplicates were eliminated. After applying the selection criteria, 17 articles were included for the qualitative analysis and 4 for the meta-analysis. The studies were combined using a random effects model with the inverse method of variance, determining the mean differences in systolic and diastolic pressure before and after treatment using the MAD splint as the effect size. Day/night circadian effect and treatment time were analyzed using meta-regression with a mixed-effects model. RESULTS MAD treatment was not found to affect diastolic pressure. By combining the four studies with the control group in a meta-analysis (I2 = 75%; z = - 0.15; p-value = 0.882), the mean difference in diastolic pressure between the MAD group and the control group was estimated at - 0.06 (- 0.86; 0.74). The meta-regression also showed no significant effect of day/night (p = 0.560) or treatment time (p = 0.854) on diastolic pressure. When combining the four studies with the control group (I2 = 84%%; z = - 1.47; p-value = 0.142), a non-significant mean difference in systolic pressure between the MAD group and the control group of - 0.99 (- 2.31; 0.33) was estimated in the meta-analysis. However, when assessing the effect of day/night or treatment time on systolic blood pressure using a meta-regression, the latter showed significant covariates that reduce systolic blood pressure values in the model at night (p < 0.001) and in relation to treatment time (p < 0.001). CONCLUSIONS Only systolic pressure appears to be affected by the use of the MAD in patients with OSA, and this decrease in systolic pressure is greater at night and when treatment time is longer.
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Affiliation(s)
- Alba Belanche Monterde
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain
| | - Álvaro Zubizarreta-Macho
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain.
- Department of Implant Surgery, Faculty of Health Sciences, Alfonso X El Sabio University, 28691, Madrid, Spain.
| | - Ana Belén Lobo Galindo
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, 37008, Salamanca, Spain
| | | | - José María Montiel-Company
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, 46010, Valencia, Spain
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23
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Thomas CL, Carr K, Yang F, Fleisher S, Um P, Clemens B, McNutt R, Balkin T, Collen JF. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med 2024; 20:973-981. [PMID: 38420974 PMCID: PMC11145036 DOI: 10.5664/jcsm.11088] [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: 12/07/2023] [Revised: 02/15/2024] [Accepted: 02/15/2024] [Indexed: 03/02/2024]
Abstract
Diagnoses of military-relevant sleep disorders have increased substantially since the terrorist attacks of September 11, 2001. The cause of this increase appears to be complicated and multifactorial, with military and civilian populations clearly differing with respect to both the nature and distribution of sleep disorders diagnoses. In part, these differences may be attributable to the fact that a majority of service members are chronically sleep-restricted-an unavoidable consequence of continuous and sustained military operations that "set the stage" for development of specific sleep disorders. The purpose of this narrative review is to describe the military relevance of several common sleep disorders, assess the extent to which these disorders currently constitute a burden on the military health care system, and suggest strategies to alleviate that burden. The military health care system does not have enough sleep medicine providers to address the immediate and long-term consequences of sleep disorders in military personnel. Digital technologies and education packages can be leveraged to improve access to care. CITATION Thomas CL, Carr K, Yang F, et al. From trenches to technology: a narrative review of sleep medicine in the military. J Clin Sleep Med. 2024;20(6):973-981.
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Affiliation(s)
- Connie L. Thomas
- Walter Reed Army Institute of Research, Silver Spring, Maryland
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
| | - Kyle Carr
- Uniformed Services University, Bethesda, Maryland
| | - Felix Yang
- Uniformed Services University, Bethesda, Maryland
| | | | - Paul Um
- Uniformed Services University, Bethesda, Maryland
| | | | - Ryan McNutt
- Womack Army Medical Center, Fort Liberty, North Carolina
| | - Thomas Balkin
- Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Jacob F. Collen
- Walter Reed National Military Medical Center, Bethesda, Maryland
- Uniformed Services University, Bethesda, Maryland
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24
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Deyang T, Baig MAI, Dolkar P, Hediyal TA, Rathipriya AG, Bhaskaran M, PandiPerumal SR, Monaghan TM, Mahalakshmi AM, Chidambaram SB. Sleep apnoea, gut dysbiosis and cognitive dysfunction. FEBS J 2024; 291:2519-2544. [PMID: 37712936 DOI: 10.1111/febs.16960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/14/2023] [Accepted: 09/13/2023] [Indexed: 09/16/2023]
Abstract
Sleep disorders are becoming increasingly common, and their distinct effects on physical and mental health require elaborate investigation. Gut dysbiosis (GD) has been reported in sleep-related disorders, but sleep apnoea is of particular significance because of its higher prevalence and chronicity. Cumulative evidence has suggested a link between sleep apnoea and GD. This review highlights the gut-brain communication axis that is mediated via commensal microbes and various microbiota-derived metabolites (e.g. short-chain fatty acids, lipopolysaccharide and trimethyl amine N-oxide), neurotransmitters (e.g. γ-aminobutyric acid, serotonin, glutamate and dopamine), immune cells and inflammatory mediators, as well as the vagus nerve and hypothalamic-pituitary-adrenal axis. This review also discusses the pathological role underpinning GD and altered gut bacterial populations in sleep apnoea and its related comorbid conditions, particularly cognitive dysfunction. In addition, the review examines the preclinical and clinical evidence, which suggests that prebiotics and probiotics may potentially be beneficial in sleep apnoea and its comorbidities through restoration of eubiosis or gut microbial homeostasis that regulates neural, metabolic and immune responses, as well as physiological barrier integrity via the gut-brain axis.
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Affiliation(s)
- Tenzin Deyang
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
| | - Md Awaise Iqbal Baig
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
| | - Phurbu Dolkar
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
| | - Tousif Ahmed Hediyal
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru, India
| | | | - Mahendran Bhaskaran
- College of Pharmacy and Pharmaceutical Sciences, Frederic and Mary Wolf Center, University of Toledo Health Science Campus, OH, USA
| | - Seithikuruppu R PandiPerumal
- Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India
- Division of Research and Development, Lovely Professional University, Phagwara, India
| | - Tanya M Monaghan
- National Institute for Health Research Nottingham Biomedical Research Centre, University of Nottingham, UK
- Nottingham Digestive Diseases Centre, School of Medicine, University of Nottingham, UK
| | - Arehally M Mahalakshmi
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru, India
- SIG-Brain, Behaviour and Cognitive Neurosciences Research (BBRC), JSS Academy of Higher Education & Research, Mysuru, India
| | - Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru, India
- Centre for Experimental Pharmacology and Toxicology, Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru, India
- SIG-Brain, Behaviour and Cognitive Neurosciences Research (BBRC), JSS Academy of Higher Education & Research, Mysuru, India
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25
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Xu X, Peng Q, Meng L, Yang H, Wang Y, Luo Y, Dong M, Wang C, Wang M. Quality assessment of clinical practice guidelines for adult obstructive sleep apnea: A systematic review. Sleep Med 2024; 118:16-28. [PMID: 38581804 DOI: 10.1016/j.sleep.2024.03.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 03/03/2024] [Accepted: 03/28/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE Clinical Practice Guidelines (CPGs) are crucial in standardizing the management of obstructive sleep apnea (OSA) in adults. However, there has been insufficient evaluation of the overall quality of CPGs for adult OSA. This review aimed to comprehensively assess the overall quality of CPGs in the field of adult OSA. METHODS A systematic search was conducted on various literature databases, guideline-related databases, and academic websites from January 2013 to December 2023 to select CPGs relevant to adult OSA. The methodological and reporting quality of the eligible CPGs were thoroughly appraised by three reviewers using the AGREE II instrument and RIGHT checklist, respectively. RESULTS This review included 44 CPGs, consisting of 42 CPGs in English and 2 CPGs in Chinese. The assessment of methodological quality revealed that four domains attained an average standardized score above 60%. Among the domains, "clarity of presentation" received the highest standardized score of 85.10%, while the lowest standardized score was observed in the "rigor of development" domain with the value of 56.77%. The evaluation of reporting quality indicated an overall reporting rate of 51.30% for the eligible CPGs, with only three domains achieving an average reporting rate higher than 50%. The domain with the highest reporting rate was "basic information" at 60.61%, while the domain with the lowest reporting rate was "review and quality assurance" at 15.91%. Furthermore, a significantly positive correlation was found between the AGREE II standardized scores and the RIGHT reporting rates (r = 0.808, P < 0.001). CONCLUSIONS The overall quality of the currently available guidelines for adult OSA demonstrated considerable variability. Researchers should prioritize the utilization of evidence-based methods and adhere to the items listed in the RIGHT checklist when developing CPGs to enhance efficient clinical decision-making and promote the translation of evidence into practice.
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Affiliation(s)
- Xiaopan Xu
- Department of Respiratory and Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, China
| | - Qianqian Peng
- Department of Graduate School, Wannan Medical College, Wuhu, China
| | - Ling Meng
- Department of Nursing, Jining NO.1 People's Hospital, Jining, China
| | - Hualu Yang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Regions, China; Department of Nursing, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Yingzhen Wang
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yan Luo
- School of Nursing, Zhuhai Campus of the Zunyi Medical University, Zhuhai, China
| | - Min Dong
- School of Nursing, Zhuhai Campus of the Zunyi Medical University, Zhuhai, China
| | - Changyu Wang
- Department of Respiratory and Critical Care Medicine, Lu'an Hospital of Anhui Medical University, Lu'an, China.
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Regions, China.
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26
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Ou YH, Colpani JT, Cheong CS, Loke W, Thant AT, Shih EC, Lee F, Chan SP, Sia CH, Koo CY, Wong S, Chua A, Khoo CM, Kong W, Chin CW, Kojodjojo P, Wong PE, Chan MY, Richards AM, Cistulli PA, Lee CH. Mandibular Advancement vs CPAP for Blood Pressure Reduction in Patients With Obstructive Sleep Apnea. J Am Coll Cardiol 2024; 83:1760-1772. [PMID: 38588926 DOI: 10.1016/j.jacc.2024.03.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Hypertension guidelines recommend diagnosis and treatment of obstructive sleep apnea (OSA) in patients with hypertension. The mandibular advancement device (MAD) is an oral appliance therapy for patients who decline or cannot tolerate continuous positive airway pressure (CPAP). OBJECTIVES We compared the relative effectiveness of MAD vs CPAP in reducing 24-hour ambulatory blood pressure (BP). METHODS In an investigator-initiated, randomized, noninferiority trial (prespecified margin 1.5 mm Hg), 321 participants aged ≥40 years with hypertension and increased cardiovascular risk were recruited at 3 public hospitals for polysomnography. Of these, 220 participants with moderate-to-severe OSA (apnea-hypopnea index ≥15 events per hour) were randomized to either MAD or CPAP (1:1). The primary outcome was the difference between the 24-hour mean arterial BP at baseline and 6 months. RESULTS Compared with baseline, the 24-hour mean arterial BP decreased by 2.5 mm Hg (P = 0.003) at 6 months in the MAD group, whereas no change was observed in the CPAP group (P = 0.374). The between-group difference was -1.6 mm Hg (95% CI: -3.51 to 0.24, noninferiority P < 0.001). The MAD group demonstrated a larger between-group reduction in all secondary ambulatory BP parameters compared with the CPAP group, with the most pronounced effects observed in the asleep BP parameters. Both the MAD and CPAP improved daytime sleepiness, with the between-group difference similar (P = 0.384). There were no between-group differences in cardiovascular biomarkers. CONCLUSIONS MAD is noninferior to CPAP for reducing 24-hour mean arterial BP in participants with hypertension and increased cardiovascular risk. (Cardiosleep Research Program on Obstructive Sleep Apnea, Blood Pressure Control and Maladaptive Myocardial Remodeling-Non-inferiority Trial [CRESCENT]; NCT04119999).
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Affiliation(s)
- Yi-Hui Ou
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Juliana Tereza Colpani
- Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - Crystal S Cheong
- Department of Otolaryngology-Head & Neck Surgery, National University Hospital, Singapore, Singapore
| | - Weiqiang Loke
- Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - As Tar Thant
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - E' Ching Shih
- Department of Otolaryngology-Head & Neck Surgery, National University Hospital, Singapore, Singapore
| | - Frank Lee
- Department of Endodontics, Operative Dentistry and Prosthodontics, Faculty of Dentistry, National University of Singapore, Singapore
| | - Siew-Pang Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Chieh-Yang Koo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Serene Wong
- Department of Medicine, Alexandra Hospital, Singapore
| | - Aiping Chua
- Department of Medicine, Ng Teng Fong General Hospital, Singapore
| | - Chin-Meng Khoo
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - Calvin W Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore; Cardiovascular ACP, Duke-NUS Medical School, Singapore
| | - Pipin Kojodjojo
- Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | | | - Mark Y Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore
| | - A Mark Richards
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore; Christchurch Heart Institute, University of Otago, Dunedin, New Zealand
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia; Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Chi-Hang Lee
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Cardiovascular Research Institute, National University Heart Centre, Singapore, Singapore; Department of Cardiology, National University Heart Centre, Singapore, Singapore.
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27
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Spille J, Conrad J, Sengebusch A, Wiltfang J, Dörfer C, Naujokat H. Preferences and experiences regarding the treatment of obstructive sleep apnea with mandibular advancement splints - a cross-sectional pilot survey. Cranio 2024; 42:298-304. [PMID: 34338613 DOI: 10.1080/08869634.2021.1962148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To obtain a current overview of the use of mandibular advancement splints (MAS) as a therapeutic option for obstructive sleep apnea (OSA) in the dental profession in Northern Germany. METHODS A questionnaire was mailed to 2431 dental professionals, and 8.3% responded. Descriptive data analysis was performed on each question separately. RESULTS Most of the surveyed dentists (51.7%) estimated the success rate of MAS therapy to be higher than 75%. Analysis of the relationship between the number of splints prescribed annually and the dental specialization (p = 0.22), work experience (p = 0.14), estimated success rate of MAS therapy (p = 0.96), and discontinuation of MAS therapy (p = 0.57) revealed no significant correlations. CONCLUSION Mandibular advancement splints seem to be a safe and successful therapy for OSA. There seems to be a lack of information on the patient side and a lack of education on the dentist side.
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Affiliation(s)
- Johannes Spille
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jonas Conrad
- Department of Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Kiel, Germany
| | - André Sengebusch
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jörg Wiltfang
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Christof Dörfer
- Department of Conservative Dentistry and Periodontology, School of Dental Medicine, Kiel University, Kiel, Germany
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
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28
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Degraeve M, Beij T, Lammens I, Vagenende T, De Meyer M, Aps J, Jacquet W. A systematic review on 4D images of the upper airway in patients with OSA. Sleep Breath 2024; 28:597-606. [PMID: 38127191 DOI: 10.1007/s11325-023-02948-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/23/2023]
Abstract
AIM-BACKGROUND In the treatment of obstructive sleep apnoea (OSA), oral appliances are now being recognized as a valuable alternative to continuous positive airway pressure (CPAP). Various static imaging techniques of the upper airways allow for assessment of bone and soft tissue structures. However, static images do not capture dynamic airway characteristics. The aim of this paper was to review 4D imaging techniques in patients with OSA. METHODS PubMed/MEDLINE, Web of Science and Embase were systematically searched for studies published before June 2022. The review was compliant with the PRISMA guidelines. The quality of each eligible study was critically evaluated by all four authors independently. Four unique articles with qualitative analyses were retrieved. All included studies had a clear objective/aim, an appropriate endpoint and sufficiently described eligibility criteria. RESULTS With dynamic imaging (4D) evaluation of the upper airway, the incidence of upper airway collapsibility due to use of a mandibular advancement device (MAD) was reduced, extraluminal tissue pressure was decreased and the space in the upper airway was increased, notably in the retropalatal and retroglossal areas of the airway. These findings suggest that MADs may be effective for OSA regardless of whether or not the obstruction site is in the velopharynx or oropharynx. However, further investigation of dynamic changes in the upper airway is required to explain the efficacy of OSA treatment and the underlying mechanisms.
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Affiliation(s)
- Michiel Degraeve
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium.
- Department of Oral and Maxillofacial Surgery, University Hospitals Ghent, Ghent, Belgium.
| | - Tessa Beij
- Department of Oral and Maxillofacial Surgery, RadboudUMC, Nijmegen, The Netherlands
| | - Inés Lammens
- Faculty of Medicine and Health Sciences, Ghent University Hospital, Ghent, Belgium
| | - Tim Vagenende
- Department of Oral and Maxillofacial Surgery, Jan Palfijn General Hospital, Ghent, Belgium
| | - Miche De Meyer
- Department of Adult Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Dentistry, Radboud University Medical Center and Radboud Institute for Health Sciences, Nijmegen, the Netherlands
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Johan Aps
- Department of Dentistry, Groningen University Medical Center, Groningen, the Netherlands
- OpiniDent BV, Marke, Belgium
| | - Wolfgang Jacquet
- Department of Adult Educational Sciences EDWE-LOCI, Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Oral Health Sciences ORHE, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
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Priyadarshini P, Singh D, Sharma VK, Chaturvedi TP, Singh AK. Effect of mandibular advancement therapy on inflammatory biomarkers in obstructive sleep apnea: A systematic review. Natl J Maxillofac Surg 2024; 15:177-182. [PMID: 39234125 PMCID: PMC11371302 DOI: 10.4103/njms.njms_79_22] [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: 05/25/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 09/06/2024] Open
Abstract
To review the literature on the effect of mandibular advancement therapy (MAT) on inflammatory biomarkers in obstructive sleep apnea (OSA). The present systematic review addresses the following focus question: What is the effect of MAT on inflammatory biomarkers in OSA? Electronic and manual literature searches were conducted on databases: PubMed/MEDLINE, Web of Science, and Cochrane Library for studies published until September 2021 to collect information about the effect of mandibular advancement therapy, a non-continuous positive airway pressure alternative measurement of OSA. A systematic literature review was performed following the PRISMA guidelines to identify studies evaluating the effect of MAT in patients suffering from OSA. Randomized clinical trials were included, and case reports, retrospective studies, literature reviews, in-vitro studies, observational studies, authors' opinions, letters to the editor, and engineering articles were excluded. Fifty-nine articles published before September 2021 were identified. Fifty-four articles met the inclusion criteria. After assessing inclusion criteria, three clinical trials were included with 148 patients suffering from OSA and treated with mandibular advancement therapy. The follow-up period ranged from two to three months, with the average follow-up being 1.66 months. The mean age of the patients was observed to be 53.11 ± 2.65 years. The mean Epworth Sleepiness Scale observed in patients in all three clinical trials was 9.75 ± 0.89. MAT in patients with moderate or severe OSA reduced apnea-hypopnea index but has less effect on inflammatory and metabolic biomarkers.
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Affiliation(s)
| | - Deepak Singh
- Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
| | | | - T P Chaturvedi
- Faculty of Dental Sciences, IMS, BHU, Varanasi, Uttar Pradesh, India
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Liao J, Shi Y, Gao X, Zhang B, Li Y, Xu W, Han D. Efficacy of Oral Appliance for Mild, Moderate, and Severe Obstructive Sleep Apnea: A Meta-analysis. Otolaryngol Head Neck Surg 2024; 170:1270-1279. [PMID: 38363016 DOI: 10.1002/ohn.676] [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: 09/20/2023] [Revised: 12/14/2023] [Accepted: 12/31/2023] [Indexed: 02/17/2024]
Abstract
OBJECTIVE Oral appliances (OA) are the recommended first-line option for mild-to-moderate obstructive sleep apnea (OSA)-hypopnea. However, there is a lack of evidence to compare the effectiveness of OA in different severities of OSA. The purpose of this study was to investigate the therapeutic effects of preferred OA (tongue retention devices [TRD] and mandibular advancement device [MAD]) in different severities of OSA. DATA SOURCES PubMed/MEDLINE, The Cochrane Library, and Web of Science. REVIEW METHODS Concentrating on the efficacy of OA, 2 authors searched 3 databases up to November 10, 2022, independently and systematically, following the requirements and steps of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. RESULTS Ultimately, 42 studies with 2265 patients met the criteria for inclusion in OA. Overall, the apnea-hypopnea index improved by 48% (5.6), 67% (14.92), and 62% (32.1) in mild, moderate, and severe OSA, respectively. Subgroup analysis showed a significant difference between MAD and TRD efficacy in mild OSA (58% vs 21%). However, no significant difference was seen between MAD and TRD efficacy in moderate (67% vs 66%) and severe OSA (66% vs 51%). There was no significant difference across groups in the Epworth Sleepiness Scale, oxygen desaturation index (ODI), and lowest oxygen saturation (LSAT). CONCLUSION Overall, both TRD and MAD are effective treatments for moderate and severe OSA. MAD is efficacious in mild OSA, while TRD requires further validation. Furthermore, mild-moderate and severe OSA received similar improvements in sleepiness, ODI, and LSAT. This study complements the evidence for the efficacy of OA.
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Affiliation(s)
- Jianhong Liao
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Yunhan Shi
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Xiang Gao
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Bowen Zhang
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Yanru Li
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Wen Xu
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
| | - Demin Han
- Department of Sleep Medical Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Obstructive Sleep Apnea-Hypopnea Syndrome Clinical Diagnosis and Therapy and Research Centre, Capital Medical University, Beijing, China
- Key Laboratory of Otolaryngology, Head and Neck Surgery, Ministry of Education, Beijing, China
- Xinjiang Key Laboratory of Biopharmaceuticals and Medical Devices, Xinjiang Medical University, Xinjiang, China
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Caram JM, Guimarães MDLR, de Azevedo PG, Silva ALC, Resende V. A mandibular advancement device associated with lingual control: a new treatment option for obstructive sleep apnea? Sleep Breath 2024; 28:657-663. [PMID: 37875770 DOI: 10.1007/s11325-023-02938-6] [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: 06/16/2023] [Revised: 09/22/2023] [Accepted: 10/13/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE Oral appliances (OA) have become the main alternative to positive pressure airway devices (PAP) for the control of obstructive sleep apnea (OSA). Despite literature support, controversies about the mode of action and the effectiveness of these devices persist. The aim of this study was to evaluate the efficacy of modified mandibular advancement devices (MAD) in patients with OSA who failed treatment with MAD and to evaluate the role of the tongue as a factor in patients who failed treatment with MAD. MATERIALS AND METHODS Patients unable to control the apnea-hypopnea index (AHI) using a MAD were subsequently treated with a modified version that included a tongue trimming accessory. The objective was to stabilize the tongue by preventing it from sliding with the consequent collapse of the upper airway (UA). New polysomnography (PSG) was performed with the modified MAD in place. RESULTS A total of 20 patients who failed MAD therapy were studied including 15 men (75%) with mean age (± standard deviation) of 58.5 ± 13.1 years and BMI 29.6 ± 5.0 Kg/m2. After installing the tongue trimmer, the number of patients who achieved complete success with the new MAD (AHI < 5) went from 0 to 30% and those who achieved partial success (5 < AHI < 10) went from 0 to 20%. The number of patient responders (AHI reduced by at least 50%) went from 20 to 75%. CONCLUSION The results suggest that the tongue, even in the presence of a MAD, may be one of the contributing factors for the collapse of the UA and consequent device ineffectiveness. By stabilizing the tongue through the insertion of a tongue trimmer, the MAD became more effective in many cases.
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Affiliation(s)
- Jorge Machado Caram
- Department of Surgery and Ophthalmology, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria de Lourdes Rabelo Guimarães
- Center for Technology in Molecular Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Benvinda de Carvalho, 105/101, Santo Antônio, Belo Horizonte, Minas Gerais, 30330-180, Brazil.
| | - Pedro Guimarães de Azevedo
- Center for Technology in Molecular Medicine, Faculty of Medicine, Universidade Federal de Minas Gerais, Benvinda de Carvalho, 105/101, Santo Antônio, Belo Horizonte, Minas Gerais, 30330-180, Brazil
| | | | - Vivian Resende
- Department of Surgery and Ophthalmology, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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Pépin JL, Cistulli PA, Crespeigne E, Tamisier R, Bailly S, Bruwier A, Le-Dong NN, Lavigne G, Malhotra A, Martinot JB. Mandibular Jaw Movement Automated Analysis for Oral Appliance Monitoring in Obstructive Sleep Apnea: A Prospective Cohort Study. Ann Am Thorac Soc 2024; 21:814-822. [PMID: 38330168 PMCID: PMC11109906 DOI: 10.1513/annalsats.202312-1077oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/08/2024] [Indexed: 02/10/2024] Open
Abstract
Rationale: Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. Objectives: To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA. Methods: This observational, prospective study included 135 patients with OSA eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. Additionally, MJM monitoring at home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was revaluated using Bland-Altman analysis. Changes in AHI during the home-based oral appliance titration process were evaluated using a generalized linear mixed model and a generalized estimating equation model. Results: The automated MJM analysis demonstrated strong agreement with PG in assessing AHI at the end of titration, with a median bias of 0.24/h (limits of agreement, -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across three evaluation conditions: in-laboratory PG (-59.6%; 95% confidence interval, -59.8% to -59.5%), in-laboratory automated MJM analysis (-59.2%; -65.2% to -52.2%), and at-home automated MJM analysis (-59.7%; -67.4% to -50.2%). Conclusions: Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.
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Affiliation(s)
- Jean-Louis Pépin
- Laboratoire HP2, Institut National de la Santé et de la Recherche Médicale, U1300, Université Grenoble Alpes, Grenoble, France
- Laboratoire Exploration Fonctionnelle Cardio-Respiratoire (EFCR), Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Peter A. Cistulli
- Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Etienne Crespeigne
- Laboratoire du sommeil, Centre Hospitalier Universitaire (CHU) Université catholique de Louvain (UCL), Site Sainte-Elisabeth, Namur, Belgium
| | - Renaud Tamisier
- Laboratoire HP2, Institut National de la Santé et de la Recherche Médicale, U1300, Université Grenoble Alpes, Grenoble, France
- Laboratoire Exploration Fonctionnelle Cardio-Respiratoire (EFCR), Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Sébastien Bailly
- Laboratoire HP2, Institut National de la Santé et de la Recherche Médicale, U1300, Université Grenoble Alpes, Grenoble, France
- Laboratoire Exploration Fonctionnelle Cardio-Respiratoire (EFCR), Centre Hospitalier Universitaire Grenoble Alpes (CHUGA), Grenoble, France
| | - Annick Bruwier
- Département D’orthodontie et Orthopédie Dentofaciale, Centre Hospitalier Universitaire (CHU) de Liège, Liège, Belgium
| | | | - Gilles Lavigne
- Department of Oral Health, Faculty of Dental Medicine, University of Montréal, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal (CIUSSS NIM) et Centre Hospitalier de l’Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Atul Malhotra
- University of California, San Diego, La Jolla, California; and
| | - Jean-Benoît Martinot
- Laboratoire du sommeil, Centre Hospitalier Universitaire (CHU) Université catholique de Louvain (UCL), Site Sainte-Elisabeth, Namur, Belgium
- Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain Bruxelles Woluwe, Bruxelles, Belgium
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Leonhard AG, Donovan LM. Remote Titration of Mandibular Advancement Devices: What Outcomes Should We Target? Ann Am Thorac Soc 2024; 21:703-705. [PMID: 38691008 PMCID: PMC11109908 DOI: 10.1513/annalsats.202402-219ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024] Open
Affiliation(s)
- Aristotle G Leonhard
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington; and
| | - Lucas M Donovan
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle, Washington; and
- Division of Pulmonary and Critical Care Medicine and
- Health Services Research and Development, Veterans Affairs Puget Sound Healthcare System, Seattle Division, Seattle, Washington
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Gogou ES, Psarras V, Giannakopoulos NN, Minaritzoglou A, Tsolakis IA, Margaritis V, Tzakis MG. Comparing efficacy of the mandibular advancement device after drug-induced sleep endoscopy and continuous positive airway pressure in patients with obstructive sleep apnea. Sleep Breath 2024; 28:773-788. [PMID: 38085497 DOI: 10.1007/s11325-023-02958-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/26/2023] [Accepted: 11/22/2023] [Indexed: 05/31/2024]
Abstract
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.
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Affiliation(s)
- Evgenia Sp Gogou
- School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece.
| | - Vasileios Psarras
- School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece
| | - Nikolaos Nikitas Giannakopoulos
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, 11527, Athens, Greece
- Department of Prosthodontics, University Clinic of Würzburg, Würzburg, Germany
| | - Aliki Minaritzoglou
- Center of Sleep Disorders, Department of Critical Care and Pulmonary Services, Medical School of National and Kapodistrian University of Athens, Evaggelismos Hospital, Athens, Greece
| | - Ioannis A Tsolakis
- Department of Orthodontics, School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | | | - Michail Ger Tzakis
- School of Dentistry, Orofacial Pain Clinic, National and Kapodistrian University of Athens, 11527, Athens, Greece
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Resende Martinez AB, Barbosa GR, Lopes MR, Barbosa RHDA. Sleep apnea and sudden death in the non-cardiac population: A systematic review. Rev Port Cardiol 2024; 43:279-290. [PMID: 38309430 DOI: 10.1016/j.repc.2024.01.003] [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: 08/03/2021] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Obstructive sleep apnea (OSA) is one of the main risk factors for cardiovascular diseases and is associated with both morbidity and mortality. OSA has also been linked to arrhythmias and sudden death. OBJECTIVE To assess whether OSA increases the risk of sudden death in the non-cardiac population. METHODS This is a systematic review of the literature. The descriptors "sudden death" and "sleep apnea" and "tachyarrhythmias" and "sleep apnea" were searched in the PubMed/Medline and SciELO databases. RESULTS Thirteen articles that addressed the relationship between OSA and the development of tachyarrhythmias and/or sudden death with prevalence data, electrocardiographic findings, and a relationship with other comorbidities were selected. The airway obstruction observed in OSA triggers several systemic repercussions, e.g., changes in intrathoracic pressure, intermittent hypoxia, activation of the sympathetic nervous system and chemoreceptors, and release of catecholamines. These mechanisms would be implicated in the appearance of arrhythmogenic factors, which could result in sudden death. CONCLUSION There was a cause-effect relationship between OSA and cardiac arrhythmias. In view of the pathophysiology of OSA and its arrhythmogenic role, studies have shown a higher risk of sudden death in individuals who previously had heart disease. On the other hand, there is little evidence about the occurrence of sudden death in individuals with OSA and no heart disease, and OSA is not a risk factor for sudden death in this population.
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Okuno K, Wang L, Almeida FR. Focus of dental sleep medicine on obstructive sleep apnea in older adults: A narrative review. J Prosthodont Res 2024; 68:227-236. [PMID: 37648523 DOI: 10.2186/jpr.jpr_d_23_00047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE To review dental sleep medicine in older adults based on the literature. STUDY SELECTION This narrative review focuses on sleep physiology, common sleep disorders, and obstructive sleep apnea (OSA) in older adults and their management. RESULTS Sleep physiology differs between older and younger adults, with sleep disturbances occurring more frequently in older adults. The prevalence of insomnia increases in older adults due to age-related changes in sleep physiology. Insomnia, sleep-disordered breathing, periodic limb movement disorder, restless legs syndrome, and rapid eye movement (REM) sleep behavior disorder are common sleep disorders in older adults. OSA is more prevalent in older adults, and its effects on them are considered more substantial than those on younger adults. The treatment of older patients with mandibular advancement devices may be less effective and more complex owing to potential impairments in oral and dental health. Furthermore, the prevalence of edentulism in older adults is decreasing while life expectancy is increasing. CONCLUSIONS As older adults have comorbidities that affect sleep quality, dentists should consider the effects of sleep physiology and sleep disorders in these patients. OSA may decrease the quality of life and increase the risk of developing other diseases. Therefore, dentists proposing treatment with mandibular advancement devices need to inform patients of their potential lack of efficacy and the requirement for careful follow-up owing to known and unknown side effects.
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Affiliation(s)
- Kentaro Okuno
- Department of Geriatric Dentistry, Osaka Dental University, Hirakata, Japan
- Center for Dental Sleep Medicine, Osaka Dental University Hospital, Osaka, Japan
| | - Liqin Wang
- Department of Geriatric Dentistry, Osaka Dental University, Hirakata, Japan
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, Vancouver, Canada
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Abd-Ellah ME, Mohamed FS, Khamis MM, Abdel Wahab NH. Modified biblock versus monoblock mandibular advancement appliances for treatment of obstructive sleep apnea: A randomized controlled trial. J Prosthet Dent 2024; 131:633-642. [PMID: 35379469 DOI: 10.1016/j.prosdent.2022.02.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/20/2022] [Accepted: 02/21/2022] [Indexed: 11/19/2022]
Abstract
STATEMENT OF PROBLEM The high prevalence of obstructive sleep apnea represents a serious public health problem. Oral appliances have gained wide acceptance among patients diagnosed with obstructive sleep apnea, who should wear them every night. A comfortable oral appliance is mandatory for successful treatment outcomes. PURPOSE The purpose of this randomized controlled trial was the assessment of the influence of 2 different designs of the mandibular advancement appliance (MAA), modified biblock and monoblock, for the management of obstructive sleep apnea. MATERIAL AND METHODS The study was designed as a prospective 2-arm randomized controlled clinical trial conducted in parallel. Twenty participants (aged 40 ±7.5 years) diagnosed with moderate obstructive sleep apnea were randomly assigned to a control group (n=10), receiving monoblock MAA, and a study group (n=10), receiving modified biblock MAA with elastics. Both appliances were fabricated by using computer-aided design and computer-aided manufacture (CAD-CAM) technology at different mandibular advancement levels (MALs): 50% and 75% of maximum MAL. A total of 60 cone beam computed tomography scans, 60 overnight full polysomnography sleep tests, 60 STOP-Bang questionnaires, and 40 Usability of Sleep Apnea Equipment-Oral Appliance (USE-OA) questionnaires were collected and analyzed blindly at baseline (initial visit), 50% MAL (3 months), and 75% MAL (6 months). The main outcome measures were the upper airway volume, linear anteroposterior and cross-sectional airway measurements, Apnea Hypopnea Index, Respiratory Disturbance Index, STOP-Bang questionnaire scoring, and USE-OA questionnaire scoring. Nonparametric statistical analysis was performed by using a statistical software program (α=.05). With a beta error accepted of up to 20%, the power of the study was 80%. RESULTS At 75% MAL, the percentage change in upper airway volumetric measurements showed a favorable increase: biblock group (115%) and monoblock group (42%), with a statistically significant difference (P=.001). The linear anteroposterior airway measurements and the percentage change in cross-sectional airway measurements were statistically similar: biblock group (80%) and (75%) monoblock group (60%), (54%) (P=.450, P=.151, respectively). The percentage change in the Apnea Hypopnea Index significantly decreased: biblock group (-89%) and monoblock group (-54%) (P<.001). The percentage change in the Respiratory Disturbance Index decreased: biblock group (-78%) and monoblock group (-62%) (P<.023). From the STOP-Bang questionnaire scoring, 100% of both groups showed low risk for obstructive sleep apnea at 75% MAL. From the satisfaction scoring on the USE-OA questionnaire, the biblock group was 100% strong satisfaction and the monoblock group was 50% satisfaction and 50% fairly satisfied. CONCLUSIONS The modified biblock MAA with elastics showed significant improvements in patients diagnosed with obstructive sleep apnea regarding upper airway measurements and full polysomnography vital parameters when compared with monoblock MAA.
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Affiliation(s)
- Mervat E Abd-Ellah
- Lecturer, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
| | - Faten S Mohamed
- Professor, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed M Khamis
- Professor and Chairman, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Nashwa H Abdel Wahab
- Professor, Department of Chest Diseases, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Ayyalasomayajula V, Moxness M, Skallerud B. Potential of computational models in personalized treatment of obstructive sleep apnea: a patient-specific partial 3D finite element study. Biomech Model Mechanobiol 2024; 23:507-524. [PMID: 37975969 PMCID: PMC10963546 DOI: 10.1007/s10237-023-01788-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
The upper airway experiences mechanical loads during breathing. Obstructive sleep apnea is a very common sleep disorder, in which the normal function of the airway is compromised, enabling its collapse. Its treatment remains unsatisfactory with variable efficacy in the case of many surgeries. Finite element models of the upper airway to simulate the effects of various anatomic and physiologic manipulations on its mechanics could be helpful in predicting surgical success. Partial 3D finite element models based on patient-specific CT-scans were undertaken in a pilot study of 5 OSA patients. Upper airway soft tissues including the soft palate, hard palate, tongue, and pharyngeal wall were segmented around the midsagittal plane up to a width of 2.5 cm in the lateral direction. Simulations of surgical interventions such as Uvulopalatopharyngoplasty (UPPP), maxillo-mandibular advancement (MMA), palatal implants, and tongue implants have been performed. Our results showed that maxillo-mandibular advancement (MMA) surgery of 1 cm improved the critical closing pressure by at least 212.2%. Following MMA, the best improvement was seen via uvulopalatopharyngoplasty (UPPP), with an improvement of at least 19.12%. Palatal and tongue implants also offered a certain degree of improvement. Further, we observed possible interacting mechanisms that suggested simultaneous implementation of UPPP and tongue stiffening; and palatal and tongue stiffening could be beneficial. Our results suggest that computational modeling is a useful tool for analyzing the influence of anatomic and physiological manipulations on upper airway mechanics. The goal of personalized treatment in the case of OSA could be achieved with the use of computational modeling.
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Affiliation(s)
- Venkat Ayyalasomayajula
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Mads Moxness
- Department of Otolaryngology, Aleris Hospital, Trondheim, Norway
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørn Skallerud
- Department of Structural Engineering, Norwegian University of Science and Technology, Trondheim, Norway
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Sangalli L, Yanez-Regonesi F, Moreno-Hay I. Evolution of adherence and self-reported symptoms over 36 months with mandibular advancement device therapy for obstructive sleep apnea: a retrospective study. J Clin Sleep Med 2024; 20:487-496. [PMID: 37909061 PMCID: PMC10985294 DOI: 10.5664/jcsm.10900] [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: 07/27/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 11/02/2023]
Abstract
STUDY OBJECTIVES Mandibular advancement devices (MAD) constitute a feasible option for management of mild-to-moderate obstructive sleep apnea (OSA) and in severe cases, when indicated. As a chronic condition, the management of OSA with MAD requires long-term patient adherence to treatment. The aim of the study was to investigate adherence to MAD therapy during a 36-month observation period in relation to changes in self-reported symptoms and objective response to therapy. METHODS Retrospective chart review of patients referred to the Orofacial Pain Clinic (University of Kentucky) between 2016 and 2021 for management of OSA with MAD was performed. Based on a posttreatment sleep study with MAD in situ, participants were subdivided into optimal response (> 50% reduction of baseline apnea-hypopnea index) and suboptimal response (< 50% reduction of baseline apnea-hypopnea index) groups. Outcomes included self-reported adherence to MAD use, self-reported OSA symptoms including snoring, apneic episodes, tiredness upon awakening, fatigue, and sleep quality (on a 100-mm numerical rating scale), and daytime sleepiness (0-24 on the Epworth Sleepiness Scale). Intragroup and intergroup differences at different time points over a 36-month observation period were assessed with one-way and repeated-measures analysis of variance. RESULTS Of 54 participants included (46.3% female, age 64.4 ± 10.71 years), 30 (55.6%) achieved optimal response and 24 (44.4%) achieved suboptimal response. At baseline, participants with optimal response differed from those with suboptimal response in apnea-hypopnea index (P = .007), snoring (P = .026), and sleep quality (P = .042). Although fluctuating in both groups, no difference was found over time in adherence (7 nights/wk, 7 h/night) and in OSA symptoms (all P > .05). CONCLUSIONS Adherence to MAD was maintained over 36 months regardless of fluctuation in self-reported OSA symptoms and effectiveness of MAD therapy. CITATION Sangalli L, Yanez-Regonesi F, Moreno-Hay I. Evolution of adherence and self-reported symptoms over 36 months with mandibular advancement device therapy for obstructive sleep apnea: a retrospective study. J Clin Sleep Med. 2024;20(4):487-496.
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Affiliation(s)
- Linda Sangalli
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, Kentucky
- College of Dental Medicine – Illinois, Midwestern University, Downers Grove, Illinois
| | | | - Isabel Moreno-Hay
- Orofacial Pain Clinic, College of Dentistry, University of Kentucky, Lexington, Kentucky
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Mohamed B, Yarlagadda K, Self Z, Simon A, Rigueiro F, Sohooli M, Eisenschenk S, Doré S. Obstructive Sleep Apnea and Stroke: Determining the Mechanisms Behind their Association and Treatment Options. Transl Stroke Res 2024; 15:239-332. [PMID: 36922470 DOI: 10.1007/s12975-023-01123-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/02/2023] [Accepted: 01/02/2023] [Indexed: 03/18/2023]
Abstract
Sleep-disordered breathing (SDB) can be a sequela of stroke caused by vascular injury to vital respiratory centers, cerebral edema, and increased intracranial pressure of space-occupying lesions. Likewise, obstructive sleep apnea (OSA) contributes to increased stroke risk through local mechanisms such as impaired ischemic cerebrovascular response and systemic effects such as promoting atherosclerosis, hypercoagulability, cardiac arrhythmias, vascular-endothelial dysfunction, and metabolic syndrome. The impact of OSA on stroke outcomes has been established, yet it receives less attention in national guidelines on stroke management than hyperglycemia and blood pressure dysregulation. Furthermore, whether untreated OSA worsens stroke outcomes is not well-described in the literature. This scoping review provides an updated investigation of the correlation between OSA and stroke, including inter-relational pathophysiology. This review also highlights the importance of OSA treatment and its role in stroke outcomes. Knowledge of pathophysiology, the inter-relationship between these common disorders, and the impact of OSA therapy on outcomes affect the clinical management of patients with acute ischemic stroke. In addition, understanding the relationship between stroke outcomes and pre-existing OSA will allow clinicians to predict outcomes while treating acute stroke.
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Affiliation(s)
- Basma Mohamed
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Keerthi Yarlagadda
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Zachary Self
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Alexandra Simon
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Frank Rigueiro
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Maryam Sohooli
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Stephan Eisenschenk
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA
| | - Sylvain Doré
- Department of Anesthesiology, Center for Translational Research in Neurodegenerative Disease, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Department of Neurology, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
- Departments of Neurology, Psychiatry, Pharmaceutics, and Neuroscience, Center for Translational Research in Neurodegenerative Disease, McKnight Brain Institute, University of Florida College of Medicine, Gainesville, FL, 32610, USA.
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Kamata Y, Takashio O, Sato R, Kawai H, Ishii H, Aoyagi K, Tomita A, Toda S, Iwanami A. Relationship Between Insomnia and Continued Outpatient Treatment in Psychiatric Patients. Neuropsychiatr Dis Treat 2024; 20:697-723. [PMID: 38559773 PMCID: PMC10981878 DOI: 10.2147/ndt.s454757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Purpose Sleep plays an essential role in maintaining both physical and mental well-being. Many patients in psychiatric outpatient settings complain of insomnia. However, the causal relationship between insomnia and depressive symptoms in all mental illnesses remains unclear. Moreover, research on insomnia and the continuation of outpatient treatment is lacking. We hypothesize a high correlation between depression and insomnia among patients with diverse mental illnesses. Additionally, we posit that insomnia significantly influences the continuity of outpatient visits. To this end, we evaluated insomnia and depression symptoms in psychiatric patients both at their initial visit and one year later. We also examined factors related to insomnia at the outset and factors associated with the ongoing utilization of outpatient treatment. Patients and Methods The participants of the study consisted of patients who made their first visit to the outpatient department of psychiatry and neurology at Showa University East Hospital between June 1, 2021, and March 31, 2023, and who continued attending the outpatient clinic for one year. Clinical characteristics were assessed using the Self-rating Depression Scale (SDS) and the Athens Insomnia Scale (AIS). Results The study's findings were collected from a cohort of 1106 patients and revealed that more than 70% experienced insomnia at the time of their initial visit. In total 137 patients continued to receive outpatient treatment for one year, and their AIS scores improved from 9 points to 5 points. A multivariate analysis revealed that the SDS items of depressed mood and insomnia were confounding factors influencing AIS improvement. Conclusion Given that 70% of patients complained of insomnia at the time of their first visit and that sleep improved in many of the 12.4% of patients who continued to receive outpatient treatment for at least one year, the results suggest that sleep status is an important determinant of whether a patient continues to attend outpatient clinics.
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Affiliation(s)
- Yukinori Kamata
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Osamu Takashio
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Ryotaro Sato
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Hideaki Kawai
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Hiroki Ishii
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Keisuke Aoyagi
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Akisa Tomita
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Shigenobu Toda
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
| | - Akira Iwanami
- Department of Psychiatry, Showa University School of Medicine, Tokyo, Japan
- Department of Psychiatry and Neurology, Showa University East Hospital, Tokyo, Japan
- Showa University Karasuyama Hospital, Tokyo, Japan
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Yoshioka J, Nagano T, Sekiya R, Mimura C, Satoh H, Otoshi T, Hazama D, Katsurada N, Yamamoto M, Tachihara M, Nishimura Y, Kobayashi K. Effects of Tongue Strength Training on Patients with Mild to Moderate Sleep-disordered Breathing: A Randomized Controlled Trial. Prog Rehabil Med 2024; 9:20240010. [PMID: 38529043 PMCID: PMC10961225 DOI: 10.2490/prm.20240010] [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: 08/09/2023] [Accepted: 03/13/2024] [Indexed: 03/27/2024] Open
Abstract
Objectives : Several studies have reported that oropharyngeal myofunctional therapy (OMT) reduces the severity of obstructive sleep apnea (OSA). However, because OMT protocols are often complicated, they take time and effort to implement. The aim of this study was to determine the therapeutic effect of 8 weeks of simple tongue strength training with a training device. Methods : Twenty patients with mild to moderate sleep-disordered breathing were randomized to the control group (n=10) or intervention group (n=10). The patients in the intervention group completed 8 weeks of daily tongue strength training using a training device. After 8 weeks, we evaluated each patient for sleep-disordered breathing by portable monitoring. We also evaluated each patient's body mass index (BMI), neck circumference, Epworth Sleepiness Scale (ESS) score, and tongue pressure. Results No significant difference was found in the change in apnea hypopnea index (AHI) from baseline to 8 weeks between the control and intervention groups (P=0.44). However, the changes in neck circumference (P=0.02) and maximum tongue pressure (P=0.03) from baseline to 8 weeks were significantly different between the two groups. No significant difference was found for changes in BMI and ESS scores from baseline to 8 weeks between the two groups. Conclusions : Tongue strength training in patients with sleep-disordered breathing did not significantly improve AHI as measured by portable monitoring, although significant changes were observed for increased tongue pressure and reduced neck circumference.
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Affiliation(s)
- Junya Yoshioka
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tatsuya Nagano
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Reina Sekiya
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Chihiro Mimura
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroki Satoh
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiro Otoshi
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hazama
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoko Katsurada
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Masatsugu Yamamoto
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Motoko Tachihara
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Nishimura
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuyuki Kobayashi
- Division of Respiratory Medicine, Department of Internal
Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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Selvaraj M, Sennimalai K, Parija PP, Siddiqui HP, Singh A, Mohaideen K. Content quality and reliability of YouTube videos on oral appliance therapy for obstructive sleep apnea: A systematic analysis. SPECIAL CARE IN DENTISTRY 2024. [PMID: 38520058 DOI: 10.1111/scd.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/01/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
INTRODUCTION YouTube's popularity as a health information source raises concerns about credibility due to the absence of peer review. Therefore, this study assessed the content quality and reliability of YouTube videos related to oral appliance therapy for obstructive sleep apnea (OSA). METHODS Videos were systematically searched on August 20, 2023, using terms determined through Google Trends. Videos were included based on predefined criteria and independently assessed by two researchers. Video demographics were extracted. Video quality was evaluated using audio-visual (AV) quality, video information and quality index (VIQI), global quality score (GQS), and reliability using a modified DISCERN tool (mDISCERN). High and low-content videos were defined based on the customized 10-point scoring system. Inter- and intra-examiner reliability of scoring system were calculated. RESULTS Most videos were educational (46.3%), presented by dental sleep medicine specialists (42.6%), and aimed at laypersons (63%), with the majority originating from the United States (79.6%). The final 54 videos were categorized as high-content (n = 29, 54%) and low-content (n = 25, 46%). High-content videos had more views, comments, and longer video durations (7.07 ± 6.04 min). Significant differences (p < .05) were observed among high and low-content videos in total VIQI, mDISCERN, GQS, and TCS. Moderate correlations were found between GQS and TCS (r = 0.721), mDISCERN and VIQI (r = 0.649), GQS and VIQI (r = 0.601), and AV quality and VIQI (r = 0.531). CONCLUSION The study highlights variable content quality and reliability of YouTube videos on oral appliance therapy for OSA, emphasizing the need for guidelines to enhance their educational value and deliver reliable, evidence-based information to patients.
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Affiliation(s)
- Madhanraj Selvaraj
- Division of Orthodontics and Dentofacial Orthopedics, Department of Dentistry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Karthik Sennimalai
- Department of Orthodontics, All India Institute of Medical Sciences, Jammu, Jammu & Kashmir, India
| | - Pragyan Paramita Parija
- Department of Community Medicine, All India Institute of Medical Sciences, Jammu, Jammu & Kashmir, India
| | | | - Amardeep Singh
- Department of E.N.T., All India Institute of Medical Sciences, Jammu, Jammu & Kashmir, India
| | - Kaja Mohaideen
- Department of Dentistry, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India
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Alshhrani WM, Kohzuka Y, Okuno K, Hamoda MM, Fleetham JA, Almeida FR. Compliance and side effects of tongue stabilizing device in patients with obstructive sleep apnea. Cranio 2024; 42:171-184. [PMID: 33899699 DOI: 10.1080/08869634.2021.1917900] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the long-term effectiveness, compliance, and side effects of tongue stabilizing devices (TSDs). METHODS Thirty-nine patients were followed up after 12 and 30 months. The subjective effectiveness was assessed using the Epworth Sleepiness Scale (ESS), the Functional Outcomes Sleep Questionnaire (FOSQ-10), the Chalder Fatigue Scale (CFQ), and a sleep-related quality of life questionnaire (QoL). Compliance and side effects were assessed. RESULTS At 12-months, 35.9% of patients confirmed continuing the therapy, compared to only 15.4% of patients at 30 months. At 30 months, a significant average improvement of ESS (2.0 ± 2.8) was observed compared to baseline levels in six patients. Six patients demonstrated an average increase in blood pressure. The most frequently reported side effects were mouth dryness and excessive salivation. The 3D analysis revealed small tooth movements. CONCLUSION The TSD therapy demonstrated a good long-term subjective effectiveness against OSA but had a relatively low treatment acceptance rate.
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Affiliation(s)
- Waled M Alshhrani
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
| | - Yuuya Kohzuka
- Department of Perioperative Medicine, Division of Anesthesiology, Showa University School of Dentistry, Tokyo, Japan
| | - Kentaro Okuno
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
- Department of Geriatric Dentistry, Osaka Dental University, Japan
| | - Mona M Hamoda
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - John A Fleetham
- Division of Respiratory Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
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Navarro RE, Karadede B, Karadede Ünal B, Salvador DM. Predictive factors of therapeutic response according to craniofacial skeletal biotype in patients with sleep apnea syndrome using mandibular advancement devices: a pilot study. Angle Orthod 2024; 94:216-223. [PMID: 37788163 PMCID: PMC10893917 DOI: 10.2319/092822-670.1] [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: 09/01/2022] [Accepted: 08/01/2023] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES To evaluate the influence of facial biotype in the therapeutic effect of mandibular advancement devices (MADs) according to polysomnographic records in patients diagnosed with sleep apnea-hypopnea syndrome (SAHS). MATERIALS AND METHODS A total of 46 patients were recruited. Patients were classified according to facial biotype (mesofacial, brachyfacial, or dolichofacial). The quantitative variables were described as the arithmetic mean and standard deviation or the median and interquartile range. Hypothesis tests used were Pearson's chi-square, paired-sample Student's t- test, the Wilcoxon test, one-way analysis of variance, Kruskal-Wallis test, and Mann-Whitney U-test. P < .05 was considered statistically significant. RESULTS A total of 46 patients were categorized into three facial biotype subgroups with no significant differences among them in age, body mass index, neck circumference, and sex. The respiratory disturbance index (RDI) results were as follows: brachyfacial patients had a reduction to 15 events/h (P < .001), the mesofacial patients had a reduction to 14 events/h (P < .001), and the dolichofacial patients did not show a significant reduction. The oxygen desaturation index (ODI) results were as follows: brachyfacial patients had a reduction in ODI episodes to 45 episodes/h (P = .001), mesofacial patients had a reduction to 18 episodes/h (P = .001). In the brachyfacial group, the number of awakenings with MAD therapy was reduced to 23 events/h (P = .003), while, in the mesofacial group, it was reduced to 37 episodes/h (P = .012). CONCLUSIONS The facial biotype influences the effectiveness of MAD therapy and is considered a good predictive factor.
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Henson J, Covenant A, Hall AP, Herring L, Rowlands AV, Yates T, Davies MJ. Waking Up to the Importance of Sleep in Type 2 Diabetes Management: A Narrative Review. Diabetes Care 2024; 47:331-343. [PMID: 38394635 DOI: 10.2337/dci23-0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/27/2023] [Indexed: 02/25/2024]
Abstract
For the first time, the latest American Diabetes Association/European Association for the Study of Diabetes (ADA/EASD) consensus guidelines have incorporated a growing body of evidence linking health outcomes associated with type 2 diabetes to the movement behavior composition over the whole 24-h day. Of particular note, the importance of sleep as a key lifestyle component in the management of type 2 diabetes is promulgated and presented using three key constructs: quantity, quality, and timing (i.e., chronotype). In this narrative review we highlight some of the key evidence justifying the inclusion of sleep in the latest consensus guidelines by examining the associations of quantity, quality, and timing of sleep with measures of glycemia, cardiovascular disease risk, and mortality. We also consider potential mechanisms implicated in the association between sleep and type 2 diabetes and provide practical advice for health care professionals about initiating conversations pertaining to sleep in clinical care. In particular, we emphasize the importance of measuring sleep in a free-living environment and provide a summary of the different methodologies and targets. In summary, although the latest ADA/EASD consensus report highlights sleep as a central component in the management of type 2 diabetes, placing it, for the first time, on a level playing field with other lifestyle behaviors (e.g., physical activity and diet), the evidence base for improving sleep (beyond sleep disorders) in those living with type 2 diabetes is limited. This review should act as a timely reminder to incorporate sleep into clinical consultations, ongoing diabetes education, and future interventions.
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Affiliation(s)
- Joseph Henson
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Alix Covenant
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Andrew P Hall
- University Hospitals of Leicester NHS Trust, Leicester, U.K
- Hanning Sleep Laboratory, Leicester General Hospital, Leicester, U.K
| | - Louisa Herring
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
- University Hospitals of Leicester NHS Trust, Leicester, U.K
| | - Alex V Rowlands
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
- Alliance for Research in Exercise, Nutrition and Activity (ARENA), UniSA Allied Health and Human Performance, University of South Australia, Adelaide, Australia
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
| | - Melanie J Davies
- NIHR Leicester Biomedical Research Centre, Diabetes Research Centre, College of Life Sciences, University of Leicester, U.K
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Kang CRS, Knowles S, Dekow M. The Success of Oral Appliance Therapy Based on Symptom-Driven Titration. Mil Med 2024; 189:620-626. [PMID: 35986605 DOI: 10.1093/milmed/usac248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/06/2022] [Accepted: 08/06/2022] [Indexed: 02/18/2024] Open
Abstract
STUDY OBJECTIVE Obstructive sleep apnea (OSA) is a chronic condition that could lead to debilitating and sometimes life-threatening consequences. Oral appliance therapy (OAT) is effective in providing a conservative, nonsurgical treatment option for patients diagnosed with mild-to-moderate OSA. The primary goal of this study is to describe a symptom-based titration protocol and determine if the patients can be effectively managed with oral appliances (OAs). METHOD A retrospective chart review of patients who were treated with OAs was analyzed for the management of OSA. Patients were self-titrated for symptomatic improvement before posttreatment titration sleep studies were conducted. RESULTS Our study has found that 87.5% of the test population was successfully managed with OAs after overnight titration. Seventy-five percentage of the patients were titrated to Apnea-Hypopnea Index (AHI) < 5 with an average of 79.6% reduction from the baseline. Statistical studies showed that patients' body mass index and age at baseline polysomnogram studies significantly influenced the reduction in AHI achieved, whereas the baseline AHI did not show any significant correlation. CONCLUSION Oral appliance therapy (OAT) can be a reliable treatment modality to treat OSA, and performing a separate overnight posttreatment titration study further ensures its effectiveness. Furthermore, OAT can be an effective treatment modality even for moderate-to-severe OSA with posttreatment titration.
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Affiliation(s)
- Cpt Ryan S Kang
- Carl R Darnall Army Medical Center, Fort Hood, TX 76544, USA
- AEGD-2YR, Billy Johnson Dental Clinic, Fort Hood, TX 76544, USA
| | - Shelley Knowles
- Carl R Darnall Army Medical Center, Fort Hood, TX 76544, USA
| | - Matthew Dekow
- Carl R Darnall Army Medical Center, Fort Hood, TX 76544, USA
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Francisco I, Nunes C, Baptista Paula A, Marques F, Prata Ribeiro M, McEvoy M, Santos M, Oliveira C, Marto CM, Spagnuolo G, Carrilho E, Travassos R, Vale F. Patient-Reported Outcomes of Maxillomandibular Surgery for Obstructive Sleep Apnea Treatment: A Scoping Review. J Clin Med 2024; 13:1232. [PMID: 38592097 PMCID: PMC10932142 DOI: 10.3390/jcm13051232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/12/2024] [Accepted: 02/18/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: The present scoping review aims to scrutinize all existing patient-reported outcomes and assess the perspectives of obstructive sleep apnea patients after maxillomandibular surgery. (2) Methods: The review was carried out according to the extensions for scoping reviews using the PRISMA-ScR guidelines. Several databases were used to carry out the initial search. This study included randomized controlled trials, cohort studies, cross-sectional and case-control studies. The included studies considered patients with obstructive sleep apnea who were submitted to orthognathic surgery as the main subjects, and the patient's perception of quality of life, satisfaction, treatment experience and side effects were assessed. (3) Results: From 1407 examined articles, a total of 16 were included. Most of the included studies used more than one questionnaire to assess quality of life, except for five articles. The most commonly referred instruments were the Epworth Sleepiness Scale, SF-36, the Functional Outcomes of Sleep and Ottawa Sleep Apnea. The most commonly assessed outcomes were sleep quality, daytime function, facial aesthetics, dental function and emotional health. (4) Conclusions: The number of variables that can be evaluated from a patient's perspective are endless, as are the tools available to assess them. Not all of these tools, which are generally questionnaires, assess all the various outcomes, and some do not compare the pre- and post-surgical situations. Most of them are generic and lack specificity for obstructive sleep apnea.
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Affiliation(s)
- Inês Francisco
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Catarina Nunes
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Anabela Baptista Paula
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Filipa Marques
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Madalena Prata Ribeiro
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Mariana McEvoy
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Mariana Santos
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Catarina Oliveira
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
| | - Carlos Miguel Marto
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
- Institute of Experimental Pathology, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reprodutive and Odontostomatological Sciences, University of Naples “Federico II”, 80138 Naples, Italy
| | - Eunice Carrilho
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
- Institute of Integrated Clinical Practice, Faculty of Medicine, University of Coimbra, 3004-531 Coimbra, Portugal
| | - Raquel Travassos
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
| | - Francisco Vale
- Institute of Orthodontics, Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.N.); (A.B.P.); (F.M.); (M.P.R.); (M.M.); (M.S.); (C.O.); (R.T.); (F.V.)
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Area of Environment Genetics and Oncobiology (CIMAGO), Faculty of Medicine, University of Coimbra, 3000-075 Coimbra, Portugal; (C.M.M.); (E.C.)
- Laboratory for Evidence-Based Sciences and Precision Dentistry, University of Coimbra, 3000-075 Coimbra, Portugal
- Centre for Innovative Biomedicine and Biotechnology (CIBB), University of Coimbra, 3000-075 Coimbra, Portugal
- Clinical Academic Center of Coimbra (CACC), 3030-370 Coimbra, Portugal
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Fernández-Sanjuán P, Alcaraz M, Bosco G, Pérez-Martín N, Morato M, Lugo R, Arrieta JJ, Sanabria J, Ríos-Lago M, Plaza G. Modifications in Upper Airway Collapsibility during Sleep Endoscopy with a Mandibular Positioner: Study in Snorers and Obstructive Sleep Apnea Patients. J Clin Med 2024; 13:1184. [PMID: 38592035 PMCID: PMC10932289 DOI: 10.3390/jcm13051184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. METHODS This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. RESULTS In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. CONCLUSIONS The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition.
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Affiliation(s)
- Patricia Fernández-Sanjuán
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Universidad Rey Juan Carlos, 28002 Madrid, Spain
| | - Marta Alcaraz
- Department of Otolaryngology, Hospital Universitario La Moraleja, 28050 Madrid, Spain;
| | - Gabriela Bosco
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario La Zarzuela, 28023 Madrid, Spain
| | - Nuria Pérez-Martín
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario La Zarzuela, 28023 Madrid, Spain
| | - Marta Morato
- Department of Otolaryngology, Hospital Quirónsalud San José, 28002 Madrid, Spain;
| | - Rodolfo Lugo
- Department of Otolaryngology Head and Neck Surgery, Hospital San José, Monterrey 64718, Mexico;
| | - Juan José Arrieta
- Department of Stomatology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Jaime Sanabria
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Marcos Ríos-Lago
- Department of Basic Psychology II, Faculty of Psychology, UNED—Universidad Nacional de Educación a Distancia, 28040 Madrid, Spain;
| | - Guillermo Plaza
- Sleep Respiratory Disorders Unit, Hospital Universitario La Zarzuela, 28023 Madrid, Spain; (P.F.-S.); (G.B.); (N.P.-M.)
- Universidad Rey Juan Carlos, 28002 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, 28942 Madrid, Spain
- Department of Otolaryngology, Hospital Universitario La Zarzuela, 28023 Madrid, Spain
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Lee PL, Wu YW, Cheng HM, Wang CY, Chuang LP, Lin CH, Hang LW, Yu CC, Hung CL, Liu CL, Chou KT, Su MC, Cheng KH, Huang CY, Hou CJY, Chiu KL. Recommended assessment and management of sleep disordered breathing in patients with atrial fibrillation, hypertension and heart failure: Taiwan Society of Cardiology/Taiwan Society of sleep Medicine/Taiwan Society of pulmonary and Critical Care Medicine joint consensus statement. J Formos Med Assoc 2024; 123:159-178. [PMID: 37714768 DOI: 10.1016/j.jfma.2023.08.024] [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: 04/16/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 09/17/2023] Open
Abstract
Sleep disordered breathing (SDB) is highly prevalent and may be linked to cardiovascular disease in a bidirectional manner. The Taiwan Society of Cardiology, Taiwan Society of Sleep Medicine and Taiwan Society of Pulmonary and Critical Care Medicine established a task force of experts to evaluate the evidence regarding the assessment and management of SDB in patients with atrial fibrillation (AF), hypertension and heart failure with reduced ejection fraction (HFrEF). The GRADE process was used to assess the evidence associated with 15 formulated questions. The task force developed recommendations and determined strength (Strong, Weak) and direction (For, Against) based on the quality of evidence, balance of benefits and harms, patient values and preferences, and resource use. The resulting 11 recommendations are intended to guide clinicians in determining which the specific patient-care strategy should be utilized by clinicians based on the needs of individual patients.
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Affiliation(s)
- Pei-Lin Lee
- Center of Sleep Disorder, National Taiwan University Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yen-Wen Wu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Division of Faculty Development, Taipei Veterans General Hospital, Taipei, Taiwan; PhD Program of Interdisciplinary Medicine (PIM), National Yang Ming Chiao Tung University College of Medicine, Taipei, Taiwan
| | - Cheng-Yi Wang
- Department of Internal Medicine, Cardinal Tien Hospital and School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Pang Chuang
- Sleep Center, Department of Thoracic Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan; School of Medicine, Chang Gung University, Tauyan, Taiwan
| | - Chou-Han Lin
- Division of Respirology, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Liang-Wen Hang
- School of Nursing & Graduate Institute of Nursing, China Medical University, Taichung, Taiwan; Sleep Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Chieh Yu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chung-Lieh Hung
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; Institute of Biomedical Sciences, Mackay Medical College, Taipei, Taiwan
| | - Ching-Lung Liu
- Division of Chest, Departments of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Kun-Ta Chou
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Clinical Respiratory Physiology, Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Mao-Chang Su
- Sleep Center, Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - Kai-Hung Cheng
- Kao-Ho Hospital, Kaohsiung, Taiwan; Division of Cardiology, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan
| | - Chun-Yao Huang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Charles Jia-Yin Hou
- Cardiovascular Center, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
| | - Kuo-Liang Chiu
- Division of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan.
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