Severe obstructive sleep apnea treatment with oral appliance: the impact on obstructive, central and mixed events

Guimarães, Maria de Lourdes Rabelo; Hermont, Ana Paula; Azevedo, Pedro Guimarães de; Bastos, Poliana Lima; Oliveira, Millena Teles Portela de; Melo, Iracema Matos de; Ottoboni, Guilherme Salles; Vedolin, Gabriela; Caram, Jorge Machado

doi:10.1007/s11325-017-1535-0

Cited by 6 publications

(6 citation statements)

References 20 publications

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“…In the present study, all patients underwent the baseline and after-treatment polysomnography in the same sleep laboratory in order to standardize the comparison of results. A recent study, published in 2018 17 , also evaluated the efficacy of this appliance, but it focused on evaluating the impacts on central and mixed events. In addition, the polysomnographic exams were not conducted in the same laboratory.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the lingual device also decreased the desaturation events and increased the minimum oxyhemoglobin saturation (SpO 2 ). However, it is important to show the possible side effects of lingual orthosis, such as difficulty swallowing, gagging, vomiting, and injury to the mucosa 17 . To prevent such effects, the lingual device must be carefully titrated, especially when it is necessary to place the spring in a position far below the oropharynx.…”

Section: Discussionmentioning

confidence: 99%

“…Nearly two months after beginning oral appliance therapy, the wires are fully extended and support the acrylic retainer that must be in close contact with the tongue's base. Once some classic symptoms of OSA, such as excessive daytime sleepiness and snoring, have been treated, the patients are referred to a post-treatment PSG exam 17 .…”

Section: Lingual Orthosismentioning

confidence: 99%

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Assessment of a novel type of oral appliance for the treatment of severe obstructive sleep apnea syndrome: a case series

et al. 2023

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Aim: This study aimed to evaluate the respiratory parameters among patients diagnosed with severe obstructive sleep apnea (OSA) syndrome treated with a novel design of an oral appliance (OA): a lingual orthosis.Methods: A case series study was conducted with 11 patients suffering from severe OSA, apnea-hypopnea index (AHI) > 30 events/h. All patients underwent pre- and post-treatment overnight polysomnography and were diagnosed by a physician based on polysomnography indexes. All selected patients had a history of nonadherence to continuous positive airway pressure devices.Results: Before treatment, the mean AHI of the sample was 65.9 ± 30.5. After reaching the optimal OA titration, the polysomnography (PSG) showed an average AHI of 10.1 ± 5.5 (p<0.001). There was a significant reduction in obstructive events that decreased from 60.0 ± 31.7 to 8.5 ± 3.8 events/hour (p<0.001). The minimal oxyhemoglobin saturation showed significant improvement after the OA treatment, increasing from 74.3 ± 7.8 to 83.4 ± 4.9 (p<0.05).Conclusion: Lingual orthosis was effective in resolving severe OSAS, showing satisfactory results within the present sample. Further studies are needed in order to broaden the knowledge regarding the effectiveness of this oral appliance.Uniterms: Sleep apnea, obstructive. Orthotic devices. Case reports.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Assessment of a novel type of oral appliance for the treatment of severe obstructive sleep apnea syndrome: a case series

et al. 2023

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“…Predictive accuracy has shown a broad variability depending on the definitions of success for the treatment 44 . Researchers have found some predictors of success related to treatment with OA such as waist circumference, obesity, overbite, class II division 2 malocclusion 35 . However, in the present study, only baseline AHI proved to be a significant predictor of a complete response rate (AHI <10 / h) during MAD therapy.…”

Section: Discussionmentioning

confidence: 99%

When adherence to CPAP fails, how do we treat workers with obstructive sleep apnea?

Guimarães¹,

Azevedo²,

Barros-Vieira³

et al. 2022

Sleep Sci

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Aims:A cross-sectional study was designed to evaluate the effectiveness of a mandibular advancement device (MAD) with respect to respiratory and sleep parameters among miners with obstructive sleep apnea syndrome (OSAS) and primary snore. Methods: The target sample was composed by 102 Brazilian miners with a history of non-adherence to continuous positive airway pressure. All patients were treated with a MAD and underwent pre and post-treatment full-night polysomnography. Ethical approval and consents were obtained. Bivariate and logistic regression analyses were conducted. The level of statistical significance was set at 5%. Results: After the treatment with MAD, 71.8% of patients presented a decrease ≥ 50% in the basal apnea-hypopnea index (AHI), 51.2% presented an AHI < 5 events/h and 83.3% reached an AHI<10/h, whereas 22.5% did not show any changes and 7.5% of the sample presented an increase in the AHI (p<0.05). There was an increase in the mean SpO2 nadir (p<0.001) and in the baseline duration of the REM sleep stage (p<0.05). The MAD significantly decreased snore events (p<0.05). Multivariate analysis did not identify predictive factors related to therapy success (decrease ≥ 50% of AHI). However, basal AHI was a significant predictor related to the secondary endpoint (AHI<10/h) (OR= 1.06, IC 95%1.00-1.13, p=0.007). Conclusions:The MAD therapy showed significant improvements in AHI, minimum oxygen saturation, REM sleep and snoring.

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“…The objective effective rate was 88.2%, and the effective subjective rate was 93.3% (12). Many clinical studies have confirmed that adjustable dental appliances can change mandibular positioning, effectively increase the airway cross-sectional area, and effectively reduce the respiratory disorder index in OSAS patients (13).…”

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confidence: 91%

The effectiveness of adjustable oral appliance for older adult patients with obstructive sleep apnea syndrome

et al. 2020

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Background: Oral appliance (OA) treatment for obstructive sleep apnea syndrome (OSAS) has attracted more and more attention due to its low price, comfort, portable and non-invasion. This study aimed to investigate the clinical effectiveness of adjustable oral appliance on older adult patients with OSAS.Methods: Thirty older adult patients diagnosed with OSAS were chosen as the study participants and received an adjustable OA for 6 months. Then, the patients were subjected to a polysomnographic examination, Berlin Questionnaire (BQ) scale questionnaire, and cone beam computer tomography (CBCT) analytical measurement to evaluate their symptom improvement and the morphologic changes of the upper airway.Results: After treatment with adjustable oral appliance for six months, the results showed that there was an improvement of different degrees in the subjective symptoms. Apnea hypopnea index (AHI) had decreased from (27.65±1.31) per hour to (6.74±0.75) per hour (P<0.05); the maximum apnea time (MAT) had decreased from 43.82±2.69 to 21.37±3.18 s (P<0.05); the average oxygen saturation (MSaO 2 ) had increased from (89.24±7.27)% to (92.69±4.46)%; the lowest oxygen saturation (LSaO 2 ) from (81.85±8.31)% to (86.93±4.45)%. Moreover, the CBCT scanning analysis showed that the minimal sagittal diameter, sectional area, and the volume of the palatopharynx, as well as the sagittal diameter and volume of the glossopharynx significantly increased. Conclusions:The adjustable OA had considerable clinical efficacy and comfort in older adult OSAS patients by enlarging the palatopharynx and glossopharynx.

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Severe obstructive sleep apnea treatment with oral appliance: the impact on obstructive, central and mixed events

Abstract: The treatment was effective in reducing obstructive events which were evaluated through the AHI and minimum oxygen saturation. The oral appliances also normalized central and mixed events among patients with severe OSAS.

Cited by 6 publications

References 20 publications

Assessment of a novel type of oral appliance for the treatment of severe obstructive sleep apnea syndrome: a case series

Assessment of a novel type of oral appliance for the treatment of severe obstructive sleep apnea syndrome: a case series

When adherence to CPAP fails, how do we treat workers with obstructive sleep apnea?

The effectiveness of adjustable oral appliance for older adult patients with obstructive sleep apnea syndrome

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