Efficacy of an Adjustable Oral Appliance and Comparison With Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome

Holley, Aaron B.; Lettieri, Christopher J.; Shah, Anita

doi:10.1378/chest.10-2851

Cited by 97 publications

(81 citation statements)

References 28 publications

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“…Based on a single retrospective study by Holley in 2011, however, there was no significant difference in the percentage of mild OSA patients achieving their target AHI/RDI/REI (< 5, < 10, > 50% reduction) after treatment between OAs and CPAP. 13 For patients with moderate to severe OSA, however, the odds of achieving the target AHI was significantly greater with CPAP than with OAs. 13 In an RCT conducted by Randerath in 2002, the odds of achieving the target AHI of < 10 in mild to moderate adult patients was significantly greater with CPAP than OA therapy.…”

Section: Guideline Low Benefits Clearly Outweigh Harmsmentioning

confidence: 96%

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

Ramar

Dort

Katz³

et al. 2015

Journal of Clinical Sleep Medicine

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660

474

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Introduction:Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientifi c literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modifi ed Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefi t of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the fi nal guideline recommendations. Recommendations: 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualifi ed dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualifi ed dentists provide oversightrather than no follow-up-of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dentalrelated side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confi rm treatment effi cacy, rather than conduct follow-up without sleep testing, for patients fi tted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualifi ed dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic offi ce visitsas opposed to no follow-up-with a qualifi ed dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline refl ects the state of knowledge at the time of publication and will require updates if new evidence warrants signifi cant changes to the current recommendations.

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Section: Guideline Low Benefits Clearly Outweigh Harmsmentioning

confidence: 96%

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

Ramar

Dort

Katz³

et al. 2015

Journal of Clinical Sleep Medicine

Self Cite

660

474

View full text Add to dashboard Cite

show abstract

“…6 Compliance is better for oral appliances such as the mandibular advancement device (MAD), but the treatment efficacy is lower for oral appliances than for CPAP. [7][8][9] Surgical therapy is another therapeutic option. It can be curative without using any device during sleep.…”

Section: Introductionmentioning

confidence: 99%

A Comparison of Different Success Definitions in Non-Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Using Cardiopulmonary Coupling

Lee

Hong

Kim

et al. 2016

Journal of Clinical Sleep Medicine

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Study Objectives: The definition and the criteria for the successful treatment of obstructive sleep apnea vary, depending on the study. This study aimed to compare different success criteria of non-continuous positive airway pressure (non-CPAP) treatment for obstructive sleep apnea in terms of sleep quality by using cardiopulmonary coupling. Methods: We included 98 patients who had been treated with sleep surgery or with a mandibular advancement device at our sleep clinic from January 2011 to March 2013. The success and failure groups were divided by 6 criteria that have been used in the literature. The validity of each of the 6 criteria was evaluated by cardiopulmonary coupling-based sleep quality. Results: The parameters of cardiopulmonary coupling indicated that sleep quality improved with non-CPAP treatment: low-frequency coupling decreased from 57.4% ± 17.7% to 46.9% ± 16.5%, whereas high-frequency coupling increased from 30.2% ± 17.1% to 37.4% ± 16.7%. In multiple regression analysis, only the criterion of a reduction in the apnea-hypopnea index greater than 50% was significantly associated with sleep quality improvement (p = 0.016; 95% confidence interval, 1.008-1.076 in the high-frequency coupling increment; p = 0.001; 95% confidence interval, 1.025-1.099 in the low-frequency coupling decrement). Conclusions: Cardiopulmonary coupling analysis showed that a reduction in the apnea-hypopnea index of more than 50% might be the optimal criterion to determine the success or failure of non-CPAP treatment in terms of sleep quality. Keywords: cardiopulmonary coupling, non-continuous positive airway pressure, obstructive sleep apnea, sleep quality, success criteria Citation: Lee WH, Hong SN, Kim HJ, Rhee CS, Lee CH, Yoon IY, Kim JW. A comparison of different success definitions in non-continuous positive airway pressure treatment for obstructive sleep apnea using cardiopulmonary coupling.

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“…Similar oral appliances are also used in adult OSA patients to prevent upper airway collapse during sleep. 9,10 Although there are numerous studies those have evaluated the nature of Class II correction by various functional appliances in growing skeletal Class II children, there are only a few studies that mention the PAP dimension changes following functional appliance treatment. Studies have been conducted to evaluate the effect of the Harvold activator, 11 an activator with high-pull headgear, 12 cervical headgear, 6 the Farmand appliance, 13 the modified bionator, 14 the Klammt appliance, 15 the Herbst appliance, 16 and rapid maxillary expansion with Herbst appliance therapy 17 on the PAP in Class II patients.…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible

Jena

Singh

Utreja

2012

The Angle Orthodontist

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Objective: To test the hypothesis that twin-block and Mandibular Protraction Appliance-IV (MPA-IV) are not effective in improving the pharyngeal airway passage (PAP) dimensions among Class II malocclusion subjects with a retrognathic mandible. Materials and Methods: Eighty-three subjects ranging in age from 8 to 14 years were divided into four groups. Group I included 30 Class I malocclusion subjects (healthy controls); group II consisted of 16 Class II malocclusion subjects (Class II controls); group III had 16 subjects in whom Class II malocclusion was treated by MPA-IV; and the remaining 21 subjects formed group IV, whose Class II malocclusions were corrected by twin-block appliance. Lateral cephalograms recorded at the beginning of orthodontic treatment in group I subjects and at the beginning and end of follow-up/treatment with functional appliance in group II, III, and IV subjects were analyzed to determine the PAP dimensions. Paired t-test, one-way analysis of variance, and Tukey tests were applied for statistical analysis, and a P-value .05 was considered statistically significant. Results: Soft palate length was decreased significantly in group III (P , .05) and group IV (P , .001) subjects. Soft palate thickness in group IV subjects was increased significantly as compared to group II (P , .05) and group III (P , .01) subjects. The improvement in soft palate inclination in group III and group IV subjects was significant (P , .01). The oropharynx depth was increased significantly in group III (P , .05) and group IV (P , .001) subjects. The depth of the hypopharynx was increased significantly (P , .01) in group IV subjects. Conclusions: The twin-block appliance was more efficient than the MPA-IV in the improvement of PAP dimensions among Class II malocclusion subjects with retrognathic mandible. (Angle Orthod. 2013;83:728-734.)

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Efficacy of an Adjustable Oral Appliance and Comparison With Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome

Cited by 97 publications

References 28 publications

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

A Comparison of Different Success Definitions in Non-Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Using Cardiopulmonary Coupling

Effectiveness of twin-block and Mandibular Protraction Appliance-IV in the improvement of pharyngeal airway passage dimensions in Class II malocclusion subjects with a retrognathic mandible

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