Mandibular Advancement Splints

Bamagoos, Ahmad A.; Sutherland, Kate; Cistulli, Peter A.

doi:10.1016/j.jsmc.2016.04.002

Cited by 14 publications

(9 citation statements)

References 106 publications

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“…Reported mean reductions in AHI range between 24% and 72% (Bamagoos et al . ). Therefore, investigators have sought predictors of oral appliance therapy success.…”

Section: Discussionmentioning

confidence: 97%

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Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Marques

Genta

Azarbarzin

et al. 2019

The Journal of Physiology

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Key points •Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear. •In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances. •We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders). •The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy. Abstract A major limitation to the administration of oral appliance therapy for obstructive sleep apnoea (OSA) is that therapeutic responses remain unpredictable. In the present study, we tested the hypotheses that oral appliance therapy (i) reduces pharyngeal collapsibility preferentially in patients with posteriorly‐located tongue and (ii) is most efficacious (reduction in apnoea‐hypopnea index; AHI) in patients with a posteriorly‐located tongue and less‐severe baseline pharyngeal collapsibility. Twenty‐five OSA patients underwent upper airway endoscopy during natural sleep to assess tongue position (type I: vallecula entirely visible; type II: vallecula obscured; type III: vallecula and glottis obscured), as well as obstruction as a result of other pharyngeal structures (e.g. epiglottis). Additional sleep studies with and without oral appliance were performed to measure collapsibility (critical closing pressure; Pcrit) and assess treatment efficacy. Overall, oral appliance therapy reduced Pcrit by 3.9 ± 2.4 cmH2O (mean ± SD) and AHI by 69 ± 19%. Therapy lowered Pcrit by an additional 2.7 ± 0.9 cmH2O in patients with posteriorly‐located tongue (types II and III) compared to those without (type I) (P < 0.008). Posteriorly‐located tongue (p = 0.03) and lower collapsibility (p = 0.04) at baseline were significant determinants of (greater‐than‐average) treatment efficacy. Predicted responders (type II and III and Pcrit < 1 cmH2O) exhibited a greater reduction in the AHI (83 ± 9 vs. 48 ± 8% baseline, P < 0.001) and a lower treatment AHI (9 ± 6 vs. 32 ± 15 events h–1, P < 0.001) than predicted non‐responders. The site and severity of pharyngeal collapse combine to determine oral appliance efficacy. Specifically, patients with a posteriorly‐located tongue plus less‐severe collapsibility are the strongest candidates for oral appliance therapy.

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“…Reported mean reductions in AHI range between 24% and 72% (Bamagoos et al . ). Therefore, investigators have sought predictors of oral appliance therapy success.…”

Section: Discussionmentioning

confidence: 97%

“…A major limitation to administration of oral appliances as a first‐line therapy is that responses to therapy remain largely unpredictable (Bamagoos et al . ).…”

Section: Introductionmentioning

confidence: 97%

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Marques

Genta

Azarbarzin

et al. 2019

The Journal of Physiology

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“… 30 However, in general, it is reported that the mean reduction in AHI ranges between 24% and 72% and that the mean proportion of patients who achieve a posttreatment AHI of <5 ranges between 29% and 71%. 31 However, the apnea reduction of MAD treatment may be smaller and more variable compared with CPAP treatment. 15 , 20 A success rate defined as a posttreatment AHI of <10 events/h has been found to range from 30% to 85% for MAD and from 62% to 100% for CPAP.…”

Section: Mad Treatmentmentioning

confidence: 99%

Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives

Knappe

Sonnesen

2018

NSS

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The purpose of this article is to review 1) mandibular advancement device (MAD) – indication, treatment success, and side effects; 2) maxillomandibular advancement (MMA) surgery of the jaws – indication, treatment success, and side effects; and 3) current perspectives. Both MAD and MMA are administered to increase the upper airway volume and reduce the collapsibility of the upper airway. MAD is noninvasive and is indicated as a first-stage treatment in adult patients with mild-to-moderate obstructive sleep apnea (OSA) and in patients with severe OSA unable to adhere to continuous positive airway pressure (CPAP). MAD remains inferior to CPAP in reducing the apnea–hypopnea index (AHI) with a treatment success ranging between 24% and 72%. However, patient compliance to MAD is greater, and with regard to subjective sleepiness and health outcomes, MAD and CPAP have been found to be similarly effective. Short-term side effects of MAD are minor and often transient. Long-term side effects primarily appear as changes in the dental occlusion related to decreases in overjet and overbite. MMA is efficacious but highly invasive and indicated as a second-stage treatment in patients with moderate-to-severe OSA, with prior failure to other treatment modalities or with craniofacial abnormalities. The surgical success and cure rates are found to be 86.0% and 43.2%, respectively. Side effects may appear as postsurgical complications such as temporary facial paresthesia and compromised facial esthetics. However, most patients report satisfaction with their postsurgical appearance. Both treatment modalities require experienced clinicians and multidisciplinary approaches in order to efficaciously treat OSA patients. Some researchers do propose possible predictors of treatment success, but clear patient selection criteria and clinical predictive values for treatment success are still needed in both treatment modalities.

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“…OSA can be efficaciously treated medically, but poor adherence to therapy is a major challenge [2]. Although continuous positive airway pressure (CPAP) [3] and the use of a mandibular advancement splint (MAS) [4] have proven efficacy, many patients find the treatments difficult to tolerate. A 2009 review showed that as few as 17% of people with OSA may be adherent to CPAP treatment after 5 years [3].…”

Section: Introductionmentioning

confidence: 99%

Sleep Apnea Multilevel Surgery (SAMS) trial protocol: a multicenter randomized clinical trial of upper airway surgery for patients with obstructive sleep apnea who have failed continuous positive airway pressure

Carney

Antic

Catcheside

et al. 2019

Sleep

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Study Objectives Obstructive sleep apnea (OSA) is a serious and costly public health problem. The main medical treatment, continuous positive airway pressure, is efficacious when used, but poorly tolerated in up to 50% of patients. Upper airway reconstructive surgery is available when medical treatments fail but randomized trial evidence supporting its use is limited. This protocol details a randomized controlled trial designed to assess the clinical effectiveness, safety, and cost-effectiveness of a multilevel upper airway surgical procedure for OSA. Methods A prospective, parallel-group, open label, randomized, controlled, multicenter clinical trial in adults with moderate or severe OSA who have failed or refused medical therapies. Six clinical sites in Australia randomly allocated participants in a 1:1 ratio to receive either an upper airway surgical procedure consisting of a modified uvulopalatopharyngoplasty and minimally invasive tongue volume reduction, or to continue with ongoing medical management, and followed them for 6 months. Results Primary outcomes: difference between groups in baseline-adjusted 6 month OSA severity (apnea–hypopnea index) and subjective sleepiness (Epworth Sleepiness Scale). Secondary outcomes: other OSA symptoms (e.g. snoring and objective sleepiness), other polysomnography parameters (e.g. arousal index and 4% oxygen desaturation index), quality of life, 24 hr ambulatory blood pressure, adverse events, and adherence to ongoing medical therapies (medical group). Conclusions The Sleep Apnea Multilevel Surgery (SAMS) trial is of global public health importance for testing the effectiveness and safety of a multilevel surgical procedure for patients with OSA who have failed medical treatment. Clinical Trial Registration Multilevel airway surgery in patients with moderate-severe Obstructive Sleep Apnea (OSA) who have failed medical management to assess change in OSA events and daytime sleepiness. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366019&isReview=true Australian New Zealand Clinical Trials Registry ACTRN12614000338662, prospectively registered on 31 March 2014.

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Mandibular Advancement Splints

Cited by 14 publications

References 106 publications

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Mandibular positioning techniques to improve sleep quality in patients with obstructive sleep apnea: current perspectives

Sleep Apnea Multilevel Surgery (SAMS) trial protocol: a multicenter randomized clinical trial of upper airway surgery for patients with obstructive sleep apnea who have failed continuous positive airway pressure

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