Effect of position therapy and oral devices on sleep parameters in patients with obstructive sleep apnea

Suzuki, Masuko; Funayama, Yoshihiro; Homma, Mika; Shibasaki, Kana; Furukawa, Taiji; Yosizawa, Takayuki

doi:10.1007/s00405-021-06817-2

Cited by 7 publications

(8 citation statements)

References 27 publications

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“…OAs were made of self-cured acrylic resin as described in our previous study [ 6 ]. Each OA was custom-made and adjusted individually by a dentist, with the participant instructed on its use.…”

Section: Methodsmentioning

confidence: 99%

Exploring the dynamics of snoring in relation to sleep stages: Implications for gender differences, sleep position, and upper airway collapsibility

Suzuki,

Kawai,

Funayama

2024

PLoS ONE

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Objective The purpose of this study was to determine the sleep stage during which isolated snoring occurs in children and adults, and to analyze changes after treatment of obstructive sleep apnea (OSA). Methods This retrospective study examined duration of snoring time and respiratory events during each sleep stage in adults and children who underwent polysomnography, had an apnea-hypopnea index (AHI) < 15/h and had snoring time ≥ 10% of total sleep time. Changes in duration of snoring time were also examined in adult patients after treatment with an oral appliance (OA). Results Snoring time was shown to be predominant during N3 and N2 sleep and less dominant during REM sleep in both children (n = 47) and adults (n = 93). These results were seen even in children with REM dependency. The percentage of snoring time during N3 sleep was more pronounced in women than in men among young adult patients aged < 40 years but was not significantly different between men and women overall. There were no significant differences in the percentage of snoring time in each sleep stage between young women with mild OSA and non-OSA. In children, there were no significant differences between boys and girls in the percentage of snoring time in any sleep stage. The percentage of snoring time during N3 was significantly higher sleep in the non-supine position than in the supine position in children, whereas no significant differences were noted between the supine and non-supine positions in any sleep stage in adults. OA treatment for adult patients (n = 20) significantly increased the percentage of snoring time during N3 sleep, although it significantly decreased AHI, total snoring time, and snoring time during N1 sleep and REM sleep. Conclusions Snoring presented exclusively during the N3 sleep stage, especially in young women with mild OSA, and in children with OSA, especially in the non-supine position. Snoring time during N3 sleep increased during OA treatment for OSA.

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Section: Methodsmentioning

confidence: 99%

Exploring the dynamics of snoring in relation to sleep stages: Implications for gender differences, sleep position, and upper airway collapsibility

Suzuki,

Kawai,

Funayama

2024

PLoS ONE

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“…1. Our study involved five RCTs [25][26][27][28][29], which included a total of 377 patients suffering from positional POSA. The PT cohort included 130 males and 1 and 2 demonstrate the demographics and baseline characteristics of the involved patients and RCTs.…”

Section: Summary Of the Included Studiesmentioning

confidence: 99%

Oral appliance therapy vs. positional therapy for managing positional obstructive sleep apnea; a systematic review and meta-analysis of randomized control trials

Mohamed,

Mohammed,

Liu

et al. 2024

BMC Oral Health

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Aim To assess the efficacy of positional therapy and oral appliance therapy for the management of positional obstructive sleep apnea. Methods We searched PubMed, Web of Science, Cochrane, and SCOPUS for relevant clinical trials. Quality assessment of the included trials was evaluated according to Cochrane’s risk of bias tool. We included the following outcomes: The apnea-hypopnea index (AHI), AHI non-supine, AHI supine, sleep efficiency, percentage of supine sleep, Adherence (≥ 4 h/night, ≥ 5 days/week), Oxygen desaturation Index, Arousal Index, Epworth Sleepiness Scale score (ESS), Mean SpO2, and Functional Outcomes of Sleep Questionnaire. Results The AHI non-supine and the ESS scores were significantly lower in the OAT cohort than in the PT cohort. The PT cohort was associated with a significantly decreased percentage of supine sleep than the OAT cohort (MD= -26.07 [-33.15, -19.00], P = 0.0001). There was no significant variation between PT cohort and OAT cohort regarding total AHI, AHI supine, ODI, sleep efficiency, arousal index, FOSQ, adherence, and mean SpO2. Conclusion Both Positional Therapy and Oral Appliance Therapy effectively addressed Obstructive Sleep Apnea. However, Oral Appliance Therapy exhibited higher efficiency, leading to increased supine sleep percentage and more significant reductions in the Apnea Hypopnea Index during non-supine positions, as well as lower scores on the Epworth Sleepiness Scale.

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“…That is because snoring, in the absence of apneas and hypopneas, is not a recognized medical condition covered by insurance reimbursement in the United States. Although SAT has been reported to reduce loud snoring in supine dependent non-apneic and apneic patients, 16,21,41 there is some likelihood that snoring will remain bothersome to the bed partner. The proposed therapy selection criteria assumes lower cost alternatives to a custom oral appliance would be considered for non-apneic snoring 42 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…One of the advantages of vibrotactile SAT is, like positive airway pressure, patients can undergo a trial to determine their willingness to use SAT, based on objective monitoring of utilization/compliance [16][17][18][19][20][21][22]43 .…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…Positional-OSA patients can also be efficaciously treated with supine avoidance therapy (SAT), whereby the overall OSA severity is typically reduced to the magnitude measured in the non-supine positions [16][17][18] . The new A c c e p t e d M a n u s c r i p t generation of SAT devices, which utilize vibro-tactile feedback rather than position restriction to elicit the behavioral response, deliver improved outcomes and compliance in positional-OSA patients [16][17][18][19][20][21][22] . Despite these improvements in SAT technologies, it remains underutilized relative to OAT in positional-OSA patients, despite the fact that SAT and OAT effectiveness and compliance were reportedly similar [19][20][21] .…”

Section: Introductionmentioning

confidence: 99%

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Criteria for oral appliance and/or supine avoidance therapy selection based on outcome optimization and cost-effectiveness

Levendowski

Olmstead

Sall³

et al. 2021

Journal of Medical Economics

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Author ContributionsDL and BB designed the study. DL and RO performed that statistical analyses. All authors were involved in the interpretation of the results and preparation of the manuscript. AcknowledgementsWith their permission, the authors wish to thank Dorian Cruz Arista, DA and Teresa Fregoso RDA for their assistance in fitting the Apnea Guards and extracting data from the patient records, Todd Morgan DMD and William Odom DDS for their oversight of the cost-containment protocol, Samuel Clark MD for assistance in interpreting the home sleep studies, and William Hevener, RPSGT for his assistance in identifying and referring patients intolerant of positive airway pressure for this study.

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Effect of position therapy and oral devices on sleep parameters in patients with obstructive sleep apnea

Cited by 7 publications

References 27 publications

Exploring the dynamics of snoring in relation to sleep stages: Implications for gender differences, sleep position, and upper airway collapsibility

Exploring the dynamics of snoring in relation to sleep stages: Implications for gender differences, sleep position, and upper airway collapsibility

Oral appliance therapy vs. positional therapy for managing positional obstructive sleep apnea; a systematic review and meta-analysis of randomized control trials

Criteria for oral appliance and/or supine avoidance therapy selection based on outcome optimization and cost-effectiveness

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