Effect of Oral Appliance Therapy on Neurobehavioral Functioning In Obstructive Sleep Apnea: A Randomized Controlled Trial

Naismith, Sharon L.; Winter, Virginia Ramseyer; Hickie, Ian B.; Cistulli, Peter A.

doi:10.5664/jcsm.26365

Cited by 103 publications

(73 citation statements)

References 32 publications

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“…These authors used adjustable MADs and applied 0.5-to 1-mm increments every 1 or 2 weeks for 4 to 6 months. In addition to all the above effects, Naismith et al 33 stated that MADs improve the individual's reaction time and psychomotor component, as well as the subjective perception of sleepiness and fatigue levels.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review

Serra-Torres¹,

Bellot-Arcís²,

Montiel-Company³

et al. 2015

The Laryngoscope

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Section: Discussionmentioning

confidence: 99%

Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review

Serra-Torres¹,

Bellot-Arcís²,

Montiel-Company³

et al. 2015

The Laryngoscope

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“…Although some trials of CPAP therapy have been equivocal regarding its effectiveness in improving depression, most controlled trials have shown a decrease in depression scores after CPAP treatment . Additionally, two small trials of oral appliance therapy have shown improvement in various BDI subscores, though not in overall BDI scores …”

Section: Discussionmentioning

confidence: 99%

“…Several studies examining the effect of CPAP on depression have reported improvement in depression symptom scores after CPAP treatment . Two studies have measured the effect of oral appliance therapy on depression . The first study found a significant decrease in the BDI after therapy; however, it was equivalent to the improvement after a placebo condition .…”

Section: Introductionmentioning

confidence: 99%

“…The first study found a significant decrease in the BDI after therapy; however, it was equivalent to the improvement after a placebo condition . The second study found no improvement in overall BDI scores ( P > 0.05), but a mild improvement in the somatic component (P < 0.05) . Investigations of the impact of surgery on depression in adults with OSA consist of three single‐modality studies in which patients underwent uvulopalatopharyngoplasty (UPPP) or radiofrequency ablation to the tongue base .…”

Section: Introductionmentioning

confidence: 99%

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Does surgery for obstructive sleep apnea improve depression and sleepiness?

Ishman

Benke²,

Cohen

et al. 2014

The Laryngoscope

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Objectives/Hypothesis: To determine if surgical intervention for OSA (obstructive sleep apnea), particularly multilevel surgery, decreases depression and sleepiness.Study Design: Prospective cohort study. Methods: Chart and prospective outcome database review of patients who underwent surgery from August 2008 through November 2012. Patients were evaluated before and after surgery using the Epworth Sleepiness Scale (ESS), the Beck Depression Index (BDI), and overnight polysomnography.Results: Forty-four patients (12 females; 32 males) met inclusion criteria. Mean age of participants was 44.0 years (SD, 10.2); mean body mass index was 31.9 (SD, 9.3). The mean preoperative obstructive respiratory disturbance index (RDI) was 35.8 events/hour (SD, 21.9; range, 6.6-94.2), which decreased to 17.1 (SD, 19.5; range, 0.8-78.1; P < 0.0001). Mean ESS improved from 10.8 (SD, 4.7) to 6.3 (SD, 3.7; P 5 0.0001); whereas BDI scores improved from 8.4 (SD, 8.2) to 4.9 (SD, 6.0; P 5 0.0051). There were 22 (50.0%) patients with excessive daytime sleepiness and 12 (27.3%) patients with depression before surgery. Surgery was associated with resolution of sleepiness in 17 patients (77.3%) and depression in 9 patients (75.0%). In multivariable regression analysis, only change in ESS (P 5 0.003) and baseline BDI (P < 0.001) were associated with improvement in depression. RDI was not significant (P 5 0.15).Conclusions: Surgical treatment of OSA, especially multilevel surgery, resulted in significantly reduced depression, with resolution in 75% of patients. Similarly, surgery resulted in significantly reduced sleepiness, with resolution in 77% of patients. Reduction in sleepiness scores, but not OSA severity, was predictive of improvement in depression scores. Further evaluation with a larger sample size and a control group is warranted.

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“…[2][3][4][5][6] Although not as efficacious as continuous positive airway pressure (CPAP) at ameliorating OSA, they have a proven positive impact on sleepiness, blood pressure and quality of life. [7][8][9][10][11] Additionally, studies suggest that treatment outcomes of oral appliances and CPAP are similar, 12 reflecting superior adherence to oral appliance therapy. Efficacy of oral appliance therapy is variable across OSA patients.…”

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confidence: 99%

Polysomnographic Endotyping to Select Patients with Obstructive Sleep Apnea for Oral Appliances

et al. 2019

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Rationale: Oral appliance therapy is efficacious in many patients with obstructive sleep apnea (OSA) but prediction of treatment outcome is challenging. Small, detailed physiological studies have identified key OSA endotypic traits (pharyngeal collapsibility and loop gain) as determinants of greater oral appliance efficacy. Objectives: We used a clinically-applicable method to estimate OSA traits from routine polysomnography and identify an endotype-based subgroup of patients expected to show superior efficacy. Methods: In 93 patients (baseline apnea-hypopnea index [AHI] ≥20 events/hr), we examined whether polysomnography-estimated OSA traits (pharyngeal: collapsibility and muscle compensation; non-pharyngeal: loop gain, arousal threshold and ventilatory response to arousal) were associated with oral appliance efficacy (percent reduction in AHI from baseline) and could predict responses to treatment. Multivariable regression (with interactions) defined endotype-based subgroups of "predicted" responders and non-responders (based on 50% reduction in AHI). Treatment efficacy was compared between the predicted subgroups (with cross-validation). Results: Greater oral appliance efficacy was associated with favorable non-pharyngeal traits (lower loop gain, higher arousal threshold and lower response to arousal), moderate (non-mild, non-severe) pharyngeal collapsibility and weaker muscle compensation (overall R 2 =0.30, adjusted R 2 =0.19, p=0.003). Predicted responders (N=54), compared with predicted nonresponders (N=39), exhibited a greater reduction in AHI from baseline (73[66-79] vs. 51[38-61]%, mean[95%CI], p<0.0001) and a lower treatment AHI (8[6-11] vs. 16[12-20]events/hr, p=0.002). Differences persisted after adjusting for clinical covariates (including baseline AHI, body mass index, and neck circumference). Conclusions: Quantifying OSA traits using clinical polysomnography can identify an endotypebased subgroup of patients that is highly responsive to oral appliance therapy. Prospective validation is warranted.

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Effect of Oral Appliance Therapy on Neurobehavioral Functioning In Obstructive Sleep Apnea: A Randomized Controlled Trial

Cited by 103 publications

References 32 publications

Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review

Effectiveness of mandibular advancement appliances in treating obstructive sleep apnea syndrome: A systematic review

Does surgery for obstructive sleep apnea improve depression and sleepiness?

Polysomnographic Endotyping to Select Patients with Obstructive Sleep Apnea for Oral Appliances

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