High-Resolution Pulse Oximetry and Titration of a Mandibular Advancement Device for Obstructive Sleep Apnea

Metz, James E.; Attarian, Hrayr; Harrison, Mickey C.; Blank, James E.; Takacs, Christopher M.; Smith, Dale L.; Gozal, David

doi:10.3389/fneur.2019.00757

Cited by 11 publications

(8 citation statements)

References 49 publications

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“…The precise 3D measurements of the maxilla, mandible, and upper airway in this study were performed in standardized head orientation during image acquisition and image analysis procedures. Previous authors have evaluated the relationship between anatomic skeletal classes and the development of obstructive sleep apnea and the efficacy of the mandibular advancement device in OSA treatment [32][33][34][35][36][37]. However, the literature lacks research involving tomographic assessment of the craniofacial anatomy and UA as impact factors in OSA severity and its treatment prognosis.…”

Section: Discussionmentioning

confidence: 99%

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

et al. 2021

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Objectives This study aims to assess craniofacial dimensions in obstructive sleep apnea (OSA) patients treated with a mandibular advancement device (MAD) and to identify anatomic influences on OSA severity and MAD therapy outcomes. Materials and methods Twenty patients with OSA were prospectively treated with MAD. Clinical, cone-beam computed tomography, and polysomnography exams were performed before treatment and 4-6 months after achieving the MAD therapeutic position. Polysomnographic exams and three-dimensional maxillary, mandibular, and upper airway (UA) measurements were evaluated. Pearson's correlation and t-tests were applied. Results Before MAD treatment, the transverse width measured at the frontomaxillary suture and the angle between the mandibular ramus and Frankfurt horizontal were statistically correlated with apnea and the hypopnea index (AHI), while the gonial angle was correlated with therapeutic protrusion. After MAD treatment, all patients showed a significant AHI reduction and an improvement in minimum oxyhemoglobin saturation. The UA total volume, superior and inferior oropharynx volume, and area were statistically correlated with MAD therapeutic protrusion. The UA total area showed a statistical correlation with the improvement in AHI, and the superior oropharynx volume and area increased significantly. Conclusions The transversal frontomaxillary suture width and the mandibular ramus facial angle may influence OSA severity. The gonial angle, volume, and area of all UA regions may indicate the amount of protrusion needed for successful MAD treatment. Clinical relevanceThe craniofacial characteristics reported as important factors for OSA severity and MAD treatment outcomes impact therapy planning for OSA patients, considering individual anatomic characteristics, prognosis, and cost benefits.

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Section: Discussionmentioning

confidence: 99%

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

et al. 2021

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“…Pero, en otros estudios la oximetría de pulso registró una mejoría en el proceso de la terapia con un DAM. 25 Mohsenin en el 2001 26 indicó que los riesgos de accidente cerebrovascular e infarto de miocardio no se habían demostrado para los roncadores no apneicos.…”

Section: Discussionunclassified

Ronquido, Eventos Respiratorios y Cardíacos Después de la Colocación de un Dispositivo de Avance Mandibular

Aristizabal-Hoyos¹,

Soto²,

Mulett-Vásquez³

et al. 2021

revecuatneurol

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Objetivo: Comparar los niveles de ronquido, como síntomas o predecesores de la Apnea Obstructiva del Sueño (AOS), antes y después de la colocación de un nuevo dispositivo de avance mandibular (DAM), colocado como opción para el control de los mecanismos patológicos respiratorios del sueño que se han asociado con disfunciones cognitivas, somnolencia diurna excesiva y como un agravante del desarrollo del Alzheimer y del Parkinson. Metodología: Estudio de serie de casos que consideró 12 adultos roncadores identificados inicialmente con el App Roncolab®. Se realizó historia clínica del sueño y polisomnografía (PSG) inicial (A) y final de control (D). Se colocó un nuevo diseño de DAM que se revisó cada 20 días durante dos meses. Se analizaron parámetros neurofisiológicos, cardiopulmonares y del sueño. Las diferencias estadísticas entre las variables se establecieron según la distribución de los datos con pruebas de t-student o U de Mann-Whitney. Resultados: El promedio de eventos de ronquido según PSG fueron (A: D: 260) con p>0,05; según el Roncolab® (A: 73.6; D: 22.6) con un p <0,05. No hubo diferencias entre los promedios de oximetría (A: 0.84; D: 0.83) ni frecuencia cardíaca (A: 65; D: 66.9). Conclusiones: A corto plazo no hubo diferencia estadísticamente significativa después de la colocación del DAM en los eventos respiratorios y cardíacos, la oximetría ni en los episodios de apnea según PSG. El Roncolab® registró disminución significativa de los eventos de ronquido. Palabras clave: Apnea Obstructiva del Sueño, Disfunciones cognitivas, Férulas oclusales, Ronquido

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“…The methods used for OA titration vary and include mandibular advancement to patients' physical limits, monitoring symptom resolution, or using polysomnography or single-channel devices [83,84]. Other proposed titration protocols have used nasendoscopy to observe effects on the pharyngeal area for different levels of mandibular advancement (provided by an occlusal registration tool) [85].…”

Section: Devices and Customisationmentioning

confidence: 99%

Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

Sutherland

Cistulli

2019

JCM

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Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances (OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for OSA therapy, they are often considered only as second-line therapy following positive airway pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep study night, have been proposed, although none has been widely validated for clinical use. Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not be necessary to produce the same health benefits of PAP. This may be related to the more favourable adherence to OA therapy, which can now be objectively verified. Data on longer term health outcomes are needed, and there are additional opportunities for device improvement and combination therapy approaches. OAs have an important role in precision care of OSA as a chronic disorder through a multi-disciplinary care team. Future studies on real-world health outcomes following OA therapy are needed.

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High-Resolution Pulse Oximetry and Titration of a Mandibular Advancement Device for Obstructive Sleep Apnea

Cited by 11 publications

References 49 publications

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

Three-dimensional craniofacial characteristics associated with obstructive sleep apnea severity and treatment outcomes

Ronquido, Eventos Respiratorios y Cardíacos Después de la Colocación de un Dispositivo de Avance Mandibular

Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

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