Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea

Aarab, Ghizlane; Lobbezoo, Frank; Hamburger, Hans; Naeije, M.

doi:10.1007/s00784-009-0298-9

Cited by 162 publications

(165 citation statements)

References 23 publications

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“…In the current study a titratable, two-piece appliance was used which allows the jaw to be advanced incrementally over time to maximize efficacy. 21,22 Our treatments were implemented as part of a onemonth crossover trial of optimal forms of both MAS and CPAP treatment with a 2-week treatment washout period in between. This differs to the previous Japanese study in which long-term compliant CPAP users were invited to participate and try MAS therapy.…”

Section: Discussionmentioning

confidence: 99%

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

Sutherland

Phillips

Davies

et al. 2014

Journal of Clinical Sleep Medicine

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Study Objectives: Mandibular advancement splints (MAS) are often preferred to CPAP treatment for OSA but are not always equally effi cacious. High therapeutic CPAP pressure has been associated with MAS treatment failure in a Japanese population. We sought to assess the relationship between CPAP pressure and MAS treatment response in an Australian population. Methods: Therapeutic CPAP pressure and MAS treatment response were obtained from a one-month crossover trial of both treatments. Predictive utility of CPAP pressure to identify MAS treatment response was assessed. Results: Seventy-eight OSA patients were included (age 49.3 ± 11.1 years, BMI 29.1 ± 5.8 kg/m 2 ) with predominantly moderate-severe OSA (AHI 30.0 ± 12.7/h). CPAP pressure was lower in MAS responders (MAS AHI < 10/h) 9.7 ± 1.6 vs. 11.7 ± 2.4 cm H 2 O, p < 0.01, with area under ROC curve of 0.74 (95% CI 0.63-0.86), p < 0.01. The best cutoff value of 10.5 cm H 2 O useful for discriminating MAS responders and non-responders in the previous Japanese population, was inadequate for prediction in the current population (0.47 negative predictive value [NPV] S C I E N T I F I C I N V E S T I G A T I O N SC ontinuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnea (OSA). Although highly effi cacious, CPAP is often hindered by poor tolerance and suboptimal adherence, 1 limiting its effectiveness in the real world. Mandibular advancement splints (MAS) are an alternative option recommended as a fi rst-line treatment for mildmoderate OSA. 2 We have recently found that health outcome improvements, including sleepiness, are similar with MAS and CPAP treatments in patients with moderate-severe OSA. Superior patient adherence appears to offset any inferiority of MAS effi cacy, 3 and MAS may be considered a viable alternative for many patients.However despite similar health benefi ts between treatments, approximately one-third of OSA patients will not respond to MAS. [4][5][6][7] This is of signifi cant concern in terms of resource wastage and treatment delays. Much attention has been given to understanding patient phenotypes which relate to MAS response such as gender, obesity, craniofacial structure, and type and severity of OSA.8 However, none of these factors are universal, and hence there is an unresolved need for reliable indicators of MAS treatment response. A recent Japanese study has identifi ed pressure requirement in CPAP users as a predictor of MAS response. 9 In established CPAP users, a prescribed pressure of above 10.5 cm H 2 O indicated poor response to subsequent MAS therapy. This prediction method is, of course, restricted to patients who have used CPAP and wish to try MAS. However CPAP pressure would represent a simple predictor, either alone or possibly in combination with other patient characteristics to further improve BRIEF SUMMARY Current Knowledge/Study Rationale: CPAP pressure has been shown to predict oral appliance treatment response in Japanese male OSA patients and could be a simple and useful clini...

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Section: Discussionmentioning

confidence: 99%

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

Sutherland

Phillips

Davies

et al. 2014

Journal of Clinical Sleep Medicine

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“…Mandibular titration is, therefore, a key procedure when it comes to obtaining optimal effects on OSA with the device. A small advancement produces a suboptimal treatment effect, while too large an advancement produces more side-effects [10]. A non-advanced device is ineffective in reducing sleep apnoea [23,25,30] and may even increase the apnoea frequency.…”

Section: Mandibular Positioningmentioning

confidence: 99%

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Marklund¹,

Verbraecken²,

Randerath³

2011

Eur Respir J

166

136

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Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

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“…Esto se compara con la noche base (PSG inicial sin dispositivo) y los resultados encontrados por Aarab y cols. el 2010 (17) muestran en la noche inicial sin dispositivo un IAH de 21,6±11,1 y al instalar un dispositivo sin protrusión el IAH se eleva a 23±14,4; luego cuando se va agregando protrusión paulatinamente del 25%, 50% y 75% se obtienen mejoras en los valores; 10,7±7,4; 7,5±6 y 5,8±6 respectivamente (ante más protrusión mejores resultados). En resumen, sobre 17 pacientes con apnea obstructiva del sueño, se muestra un empeoramiento del IAH desde la noche base a la noche con dispositivo sin avance; comparado con la mejoría que se experimenta con la protrusión (razón por la cual los DAM son un tratamiento validado para el SAHOS).…”

Section: Discussionunclassified

“…Los autores explican esto ya que en posición supina cuando la mandíbula se abre hacia atrás, se produce un desplazamiento posterior de la lengua y el hueso hioides, reduciendo la permeabilidad de la vía aérea incluso más que cuando se duerme sin aparato intraoral. (17) Otros autores también han informado que los pacientes acusan más episodios de apneas con el uso de un dispositivo sin avance. (11) Sin embargo, un estudio con un número mayor de pacientes no encontró esta relación, sin obtener tampoco resultados positivos, por lo que concluyen que un dispositivo sin avance no aumenta la tensión muscular faríngea ni tiene un efecto placebo (18) ; lo que puede explicarse, porque al tener un número mayor de pacientes (n=483), no registraron los resultados o apreciaciones subjetivas, sino más bien sólo analizaron los datos grupales.…”

Section: Discussionunclassified

Disminución de la permeabilidad de la vía aérea con el uso de dispositivos intraorales estabilizadores en pacientes con trastornos respiratorios del sueño. Una revisión de la literatura.

Fariña-Vélez¹,

Parra-Stuardo

Leal-Hausdorf

2017

Rev. Clin. Periodoncia Implantol. Rehabil. Oral

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revisión bibliográficaDisminución de la permeabilidad de la vía aérea con el uso de dispositivos intraorales estabilizadores en pacientes con trastornos respiratorios del sueño. Una revisión de la literatura.Decreased airway permeability with the use of occlusal stabilization splints in patients with sleep-disordered breathing.A literature review. abstract introduction: Frequently, the oral devices or stabilization splints are indiscriminately indicated by the dentist, even when its therapeutic value is controversial and there is poor knowledge about its possible side effects. material and method : We reviewed in Pubmed and Ebsco-Host all the publications that included patients with polysomnographic diagnosis of Obstructive Sleep Apnea (OSA) who were being treated with stabilization splints and controlled by polysomnography, or patients who were used as control subjects with stabilization splints in studies evaluating mandibular advancement devices (MAD) effectiveness. results: Six publications met the inclusion criteria. They all describe that when the results of the study were considered as a group, the changes in the Apnea/Hypopnea Index or in the Respiratory Disturbance Index were considered as not statistically significant, but if each case was studied individually some patients experimented a violent increase of these values. conclusion: Although the increase of index is not a side effect in all patients, the risk in those who experimented it can determinate an important aggravation of a medic condition. It´s possible that there´s There may be a contraindication in the use of stabilization splints in patients with sleep respiratory disorders.

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Effects of an oral appliance with different mandibular protrusion positions at a constant vertical dimension on obstructive sleep apnea

Cited by 162 publications

References 23 publications

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Disminución de la permeabilidad de la vía aérea con el uso de dispositivos intraorales estabilizadores en pacientes con trastornos respiratorios del sueño. Una revisión de la literatura.

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