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Alessandri-Bonetti G, Incerti-Parenti S, Bartolucci ML, Bortolotti F, Stipa C, Manfredini D. Response to letter to the Editor: Look at the elephant! Commentary on 'Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study'. J Oral Rehabil 2023; 50:1371-1372. [PMID: 37654158 DOI: 10.1111/joor.13582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
Obstructive sleep apnoea and temporomandibular disorders are complex pathologies. Considering dento-skeletal occlusion as their main predisposing factor could be detrimental for optimal patient care.
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Affiliation(s)
- Giulio Alessandri-Bonetti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Serena Incerti-Parenti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Maria Lavinia Bartolucci
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Francesco Bortolotti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Chiara Stipa
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Daniele Manfredini
- Orofacial Pain Unit, School of Dentistry, Department of Biomedical Technologies, University of Siena, Siena, Italy
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Bartolucci ML, Bortolotti F, Pelligra I, Stipa C, Sorrenti G, Incerti-Parenti S, Alessandri-Bonetti G. Prevalence of temporomandibular disorders in adult obstructive sleep apnoea patients: A cross-sectional controlled study. J Oral Rehabil 2023; 50:318-323. [PMID: 36681885 DOI: 10.1111/joor.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/16/2022] [Accepted: 01/13/2023] [Indexed: 01/23/2023]
Abstract
BACKGROUND Obstructive sleep apnoea (OSA) is characterised by partial or complete obstruction of the upper airways during sleep and it has been associated with temporomandibular disorders (TMDs) on the basis of several pathophysiological hypotheses. OBJECTIVES To assess the prevalence of TMDs in a population of patients affected by OSA compared to a control group of subjects not affected by OSA. METHODS A cross-sectional controlled study was conducted on a group subjects studied by polygraphy (PG) at the snoring section of the ENT department, Sant'Orsola-Malpighi Hospital - University of Bologna. Patients who received a diagnosis of OSA were included in the study group and subjects with a negative PG diagnosis for Sleep Disordered Breathing and PG respiratory pattern that did not suggest the occurrence of sleep disorders were enrolled in the control group. Both the subjects included in the study group and the control group underwent an examination following the Diagnostic Criteria for Temporomandibular Disorders Axis I and II. RESULTS Forty-three OSA patients (29 M, 16 F, mean age 52.26 ± 11.40) and 43 healthy controls (25 M, 18 F, mean age 49.95 ± 7.59) were included in the study. No significant differences were found between groups in demographic data. TMD prevalence and Axis II results did not differ between groups. CONCLUSIONS This paper does not highlight a higher prevalence of TMDs in adults with OSA compared to healthy controls. Further high-quality studies are needed to confirm the results and to give possible pathophysiological explanations, providing reliable evidence.
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Affiliation(s)
- Maria Lavinia Bartolucci
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Francesco Bortolotti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Irene Pelligra
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Chiara Stipa
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi Hospital - University of Bologna, Bologna, Italy
| | - Serena Incerti-Parenti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
| | - Giulio Alessandri-Bonetti
- Section of Orthodontics and Dental Sleep Medicine, Department of Biomedical Sciences, University of Bologna, Bologna, Italy
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Stipa C, Incerti-Parenti S, Cameli M, Ippolito DR, Gracco A, Alessandri-Bonetti G. Antero-Posterior Mandibular Excursion in Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Device: A Retrospective Cohort Study. Int J Environ Res Public Health 2023; 20:3561. [PMID: 36834252 PMCID: PMC9960680 DOI: 10.3390/ijerph20043561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Since obstructive sleep apnea (OSA) management with a mandibular advancement device (MAD) is likely to be life-long, potential changes in mandibular movements during therapy should be investigated. The purpose of this study was to use a method that has already been shown to be reliable in order to determine whether the range of antero-posterior mandibular excursion, the procedure upon which MAD titration is based, varies between baseline (T0) and at least 1 year of treatment (T1). The distance between maximal voluntary protrusion and maximal voluntary retrusion determined using the millimetric scale of the George Gauge was retrospectively collected from the medical records of 59 OSA patients treated with the MAD and compared between T0 and T1. A regression analysis was performed to evaluate the influence of treatment time, MAD therapeutic advancement and the patient's initial characteristics in excursion range variation. A statistically significant increase of 0.80 ± 1.52 mm (mean ± standard deviation, p < 0.001) was found for antero-posterior mandibular excursion. The longer the treatment time (p = 0.044) and the smaller the patient's mandibular excursion at T0 (p = 0.002), the greater the increase was. These findings could be explained by a muscle-tendon unit adaptation to the forward mandibular repositioning induced by the MAD. During MAD therapy, patients can develop a wider range of antero-posterior mandibular excursion, especially those with a smaller initial excursion capacity.
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Affiliation(s)
- Chiara Stipa
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Serena Incerti-Parenti
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Matteo Cameli
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Daniela Rita Ippolito
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
| | - Antonio Gracco
- Department of Neurosciences, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Giulio Alessandri-Bonetti
- Unit of Orthodontics and Sleep Dentistry, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
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Stipa C, Cameli M, Sorrenti G, Ippolito DR, Pelligra I, Alessandri-Bonetti G. Relationship between cephalometric parameters and the apnoea-hypopnoea index in OSA patients: a retrospective cohort study. Eur J Orthod 2020; 42:101-106. [PMID: 31143924 DOI: 10.1093/ejo/cjz038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the relationship between cephalometric parameters and apnoea-hypopnoea index (AHI) controlling for the effect of gender, age, and body mass index (BMI) on a large sample of patients with obstructive sleep apnoea (OSA). METHODS This retrospective cohort study was conducted on the lateral cephalograms of 253 Caucasian adult OSA patients. Cephalometric analyses were performed using 14 parameters for skeletal and soft tissue morphology, including antero-posterior and vertical jaw relationships, hyoid bone position, soft palate length and thickness, airway space, and tongue length and height. A hierarchical regression was run to examine the amount of variability in AHI that cephalometric variables explained after controlling for patients' general characteristics (gender, age, and BMI). RESULTS After controlling for gender, age, and BMI, the increase in AHI variance accounted for by cephalometric parameters was equal to 0.103. Among the cephalometric variables, only MP-H and PNS-P were statistically significant (P < 0.05). LIMITATIONS Given the retrospective nature of the study, it is difficult to assess whether other confounding variables not considered in the present study could have influenced the relationship between cephalometric parameters and AHI. CONCLUSIONS This study revealed the existence of a relationship between OSA severity and some cephalometric parameters. Indeed soft palate length and vertical position of the hyoid bone were significant predictors of AHI in adult Caucasian OSA patients.
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Affiliation(s)
- Chiara Stipa
- Department of Orthodontics, School of Dentistry, University of Bologna, Bologna
| | - Matteo Cameli
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples 'Federico II', Naples
| | - Giovanni Sorrenti
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Daniela R Ippolito
- Department of Orthodontics, School of Dentistry, University of Bologna, Bologna
| | - Irene Pelligra
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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Ippolito DR, Stipa C, Cameli M, Sorrenti G, Pelligra I, Alessandri-Bonetti G. Maximum voluntary retrusion or habitual bite position for mandibular advancement assessment in the treatment of obstructive sleep apnoea patients. J Oral Rehabil 2019; 47:301-306. [PMID: 31698516 DOI: 10.1111/joor.12902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/30/2019] [Accepted: 10/29/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is no consensus on whether the range of mandibular advancement for the construction of mandibular advancement devices in obstructive sleep apnoea (OSA) patients should be measured from a starting position of maximum voluntary retrusion or habitual bite position. OBJECTIVE The purposes of this study were to investigate the differences in mandibular advancement registrations starting from maximum voluntary retrusion or from habitual bite position and to evaluate the reliability of these assessments. METHODS A retrospective cohort analysis of 126 patients with OSA was performed. All patients had their mandibular range of motion evaluated twice (starting from maximum voluntary retrusion and from habitual bite position) through the George Gauge before undergoing drug-induced sleep endoscopy. The Dahlberg formula and paired t test were used to calculate random and systematic errors of dental positions assessment. Test-retest reliability was quantified using the intra-class correlation coefficient (ICC). RESULTS The mean mandibular range starting from maximum voluntary retrusion and from habitual bite position were 12.49 ± 2.19 mm and 7.68 ± 2.29 mm, respectively, with a mean distance between the two starting positions of 4.81 ± 1.75 mm. No systematic error was found (P > .05), and random errors ranged from 0.30 to 0.95 mm. ICC values were excellent for maximum voluntary protrusion (ICC = 0.986) and maximum voluntary retrusion (ICC = 0.956), whereas habitual bite position showed a good value (ICC = 0.818). CONCLUSION The difference between maximum voluntary retrusion and habitual bite position is potentially relevant. Maximum retrusion is advisable as starting point of the mandibular advancement registration since it provides a more reliable measure.
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Affiliation(s)
- Daniela Rita Ippolito
- Department of Orthodontics, School of Dentistry, University of Bologna, Bologna, Italy
| | - Chiara Stipa
- Department of Orthodontics, School of Dentistry, University of Bologna, Bologna, Italy
| | - Matteo Cameli
- Department of Neurosciences, Reproductive Sciences and Oral Sciences, Section of Orthodontics, University of Naples "Federico II", Naples, Italy
| | - Giovanni Sorrenti
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Irene Pelligra
- Department of Otolaryngology Head and Neck Surgery, Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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Alessandri-Bonetti G, D'Antò V, Stipa C, Rongo R, Incerti-Parenti S, Michelotti A. Dentoskeletal effects of oral appliance wear in obstructive sleep apnoea and snoring patients. Eur J Orthod 2018; 39:482-488. [PMID: 27932405 DOI: 10.1093/ejo/cjw078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives To evaluate the dentoskeletal changes associated with long-term and continuous mandibular advancement device (MAD) use in sleep-related breathing disorder patients. Methods Cephalometric measurements and three-dimensional model analysis were performed at baseline and after 3.5 ± 1.1 years in 20 snoring and obstructive sleep apnoea patients treated with the Silensor® appliance. Intra-group differences were compared using paired t-test or Wilcoxon signed-rank test. A regression analysis was performed for variables that showed a statistically significant difference between time points to evaluate the influence of treatment time and patient's initial characteristics on their variations. The statistical significance was set at P < 0.05. Results At cephalometric assessment, the maxilla revealed a significant decrease in horizontal position (SNA: -0.4 ± 0.72 degree, P = 0.021) and a significant retroclination of the upper incisor (-1.59 ± 1.07 degree, P < 0.001), while the mandible displayed a significant downward rotation (0.88 ± 1.28 degree, P = 0.006) and a proclination of the lower incisor (2.27 ± 1.38 degree, P < 0.001). Model analysis showed a decrease in upper total space discrepancy (-0.66 ± 0.72 mm, P < 0.002), overjet (OJ; -0.34 ± 0.47 mm, P < 0.011), and overbite (-0.4 ± 0.52 mm, P < 0.004). In the regression analysis, treatment time influenced the lower incisor inclination (Beta = -0.713, P = 0.018) and OJ (Beta = -0.218, P = 0.018); patients' initial characteristics had an effect on OJ (Beta = -0.195, P = 0.011). Limitations A larger sample size could increase the generalizability of the findings. Conclusion MAD wear after a mean of 3.5 years determines statistically significant but clinically irrelevant dentoskeletal changes. Their potential occurrence should be thoroughly discussed with patients; regular follow-up visits by a specialist experienced in dental sleep medicine are also mandatory during treatment in addition to polysomnographic examinations.
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Affiliation(s)
| | - Vincenzo D'Antò
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'.,Department of Surgery, Bambino Gesù Children's Hospital, Rome, Italy
| | - Chiara Stipa
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'
| | - Roberto Rongo
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'
| | | | - Ambrosina Michelotti
- Department of Neuroscience, Reproductive Sciences and Oral Science, Section of Orthodontics, University of Naples 'Federico II'
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Cavallieri F, Mandrioli J, Tondelli M, Vitetta F, Stipa C, Vallone S, Georgoulopoulou E, Barbi F, Liguori R, Parchi P, Nichelli P. Pearls & Oy-sters: Rapidly progressive dementia: Prions or immunomediated? Neurology 2014; 82:e149-52. [DOI: 10.1212/wnl.0000000000000354] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Magini P, Bisulli F, Baldassari S, Stipa C, Naldi I, Licchetta L, Menghi V, Tinuper P, Seri M, Pippucci T. LGI1 microdeletions are not a frequent cause of partial epilepsy with auditory features (PEAF). Epilepsy Res 2014; 108:972-7. [PMID: 24721199 DOI: 10.1016/j.eplepsyres.2014.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 01/27/2014] [Accepted: 03/16/2014] [Indexed: 10/25/2022]
Abstract
Heterozygous mutations of the leucine-rich, glioma-inactivated 1 gene (LGI1) are the major known cause of partial epilepsy with auditory features (PEAF), accounting for roughly 50% of families. Recently, a partial gene microdeletion has been reported in a single family. To assess the contribution of LGI1 microrearrangements to the pathogenesis of PEAF, we screened 50 patients negative for point mutations through multiplex ligation-dependent probe amplification (MLPA) analysis. No cryptic imbalances were found in LGI1, suggesting that LGI1 microdeletions are not a frequent cause of PEAF. Despite the small number of examined patients and the need for replication studies, these findings support the hypothesis that diagnostic screening for LGI1 microrearrangements lacks clinical utility, especially for sporadic cases, and further highlight genetic heterogeneity of familial and sporadic PEAF.
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Affiliation(s)
- P Magini
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy.
| | - F Bisulli
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - S Baldassari
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - C Stipa
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - I Naldi
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - L Licchetta
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - V Menghi
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - P Tinuper
- IRCCS Istituto delle Scienze Neurologiche and Department of Neurological, Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - M Seri
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - T Pippucci
- U.O. Medical Genetics, Polyclinic Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
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Stipa C, Bisulli F, Licchetta L, Alvisi L, Zara F, Gennaro E, Pini A, Gobbi G, Tinuper P. A novel intronic variant of SCN1A gene responsible for severe epileptic encephalopathy with refractory status epilepticus. J Neurol Sci 2013. [DOI: 10.1016/j.jns.2013.07.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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