Mandibular advancement appliances remain effective in lowering respiratory disturbance index for 2.5–4.5 years

Gauthier, Luc; Laberge, Luc; Beaudry, Michel; Laforte, Mario; Rompré, Pierre; Lavigne, Gilles

doi:10.1016/j.sleep.2011.05.004

Cited by 44 publications

(42 citation statements)

References 46 publications

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“…However, there were 3 articles that did not necessarily meet the above criteria, but were still included in our analysis. [9][10][11] In two studies by Gauthier et al, RDI was defined as the combination of apneas, hypopneas and arousals per hour of sleep, 9,10 while Gotsopoulos et al defined AHI as the combination of apneas, hypopneas, and arousals per hour of sleep. 11 The Task Force acknowledges that there are limitations to the direct comparisons made in this guideline due to the variety of ways AHI, RDI, and REI are defined and scored among the studies included.…”

Section: Literature Searchmentioning

confidence: 99%

“…Thirty-four RCTs with 1,301 patients assessed the effect of OAs on AHI and found an overall improvement in AHI. 4,[9][10][11]14,17, A meta-analysis was performed on all included trials that compared AHI pre-and post-treatment with OAs. The results are shown in Figure 9.…”

Section: Physiologic Sleep Parametersmentioning

confidence: 99%

“…4,[9][10][11]14,17,[20][21][22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46][47] Overall, custom OAs were found to substantially reduce the AHI. Meta-analysis (Figure 10) showed the mean reduction in AHI/RDI/REI for custom OAs to be 13.89 events/h (95% CI: 15.57, 12.20).…”

Section: Physiologic Sleep Parametersmentioning

confidence: 99%

See 2 more Smart Citations

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

663

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: Literature Searchmentioning

confidence: 99%

Section: Physiologic Sleep Parametersmentioning

confidence: 99%

See 1 more Smart Citation

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

663

474

View full text Add to dashboard Cite

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“…30 In a comparative study of two OAs, 94% of partners (n = 16) reported improved sleep quality, quality of life, and personal relationship with the patient at 3-mo followup and these improvements were maintained at 2.5-to 4.5-y follow-up (n = 14). 31,32 No improvements in quality of life assessed by the SAQLI were reported among 32 partners of patients with mild to moderate OSA participating in a randomized controlled crossover study of OA treatment versus a control device. 33 The short study time period of 1-w acclimatization followed by a 1-w washout could account for these results.…”

Section: Oral Appliancesmentioning

confidence: 99%

Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review

Luyster

2017

Journal of Clinical Sleep Medicine

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Study Objectives: Many adults sleep with a significant other; thus, sleep disorder symptoms and treatments of one partner are likely to impact the other partner's health. A literature review was conducted to examine the impact of obstructive sleep apnea (OSA) and OSA treatments on partner-assessed sleep and daytime functioning and partner involvement in OSA treatment. Methods: MEDLINE, EMBASE, and CINAHL searches yielded 38 pertinent quantitative and qualitative studies that described sleep and/or daytime functioning assessed in partners of patients with untreated OSA, sleep and/or daytime functioning assessed in partners who were referred for OSA treatment, including continuous positive airway pressure (CPAP) therapy, oral appliance (OA), or surgery, and/or associations between partner involvement and OSA treatment use. Results:The majority of studies found untreated OSA to have a negative impact on partners' objective and subjective sleep and daytime functioning, in particular mood, quality of life, and relationship quality. Improvements in partner-assessed sleep quality were reported for CPAP, OA, and surgery. Conflicting results were reported for partners' mood, quality of life, daytime sleepiness, and relationship quality. Perceived partner support was associated with greater CPAP use. Conclusions: Symptoms associated with OSA can negatively impact partners' sleep and daytime functioning. Treatment of OSA with CPAP, OA, or surgery can have health benefits for not only patients but also partners. Collaborative partner involvement may be a useful strategy for interventions promoting CPAP adherence. Keywords: continuous positive airway pressure, obstructive sleep apnea, oral appliance, partner, spouse Citation: Luyster FS. Impact of obstructive sleep apnea and its treatments on partners: a literature review.

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“…49,50 Diastolic and systolic blood pressure measurements are reduced after 2.5 to 4.5 years of OA m treatment. 50 Although OA m treatment appears to remain efficacious, usage may drop off somewhat over time. Seventy-six percent of patients report using their OA m after one year 53 and 62% of patients after 4 years.…”

Section: Long-term Effectiveness and Adherencementioning

confidence: 99%

Oral appliance treatment of obstructive sleep apnea: an update

Chan

Cistulli

2009

Current Opinion in Pulmonary Medicine

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Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OA m ). There is a strong evidence base demonstrating OA m improve OSA in the majority of patients, including some with more severe disease. However OA m are not effi cacious for all, with approximately one-third of patients experiencing no therapeutic benefi t. OA m are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OA m to gold-standard CPAP treatment. Head-to-head trials confi rm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater effi cacy does not necessarily translate into better health outcomes in clinical practice. O bstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring collapse of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation. OSA is defi ned as the occurrence of 5 or more episodes of complete (apnea) or partial (hypopnea) upper airway obstruction per hour of sleep (apnea-hypopnea index [AHI]) and is estimated to occur in around 24% of middleaged men and 9% of women.1 Daytime symptoms such as sleepiness, cognitive impairment, and effects on quality of life require appropriate treatment. Furthermore the association of OSA with increased risk of motor vehicle accidents, cardiovascular morbidity, and all-cause mortality emphasize the need for effective long-term treatment. 2,3The gold standard treatment for OSA is to pneumatically splint open the upper airway during sleep using continuous positive airway pressure (CPAP). Although CPAP is highly effi cacious in preventing upper airway collapse, patient acceptance, tolerance, and adherence is often low, thereby reducing effectiveness. 4 Hence, there is a major need for effective alternative treatments.

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Mandibular advancement appliances remain effective in lowering respiratory disturbance index for 2.5–4.5 years

Cited by 44 publications

References 46 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

Impact of Obstructive Sleep Apnea and Its Treatments on Partners: A Literature Review

Oral appliance treatment of obstructive sleep apnea: an update

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