Update on oral appliance therapy

Marklund, Marie; Braem, M; Verbraecken, Johan

doi:10.1183/16000617.0083-2019

Cited by 43 publications

(25 citation statements)

References 85 publications

(83 reference statements)

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“…Other complications include face acne, mask leaks causing dry eyes, chest pain, bloating, infections from improper cleaning and not to mention the cost of maintaining the PAP device. For mild OSA, other treatment options include mandibular advancement device [9], positional therapy [10], and the novel eXciteOSA treatment. These also have better compliance than PAP machines.…”

Section: Discussionmentioning

confidence: 99%

The Many Fronts of Battling Obstructive Sleep Apnea

Wasey¹,

Wasey²,

Saleh³

et al. 2021

Cureus

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Obstructive sleep apnea (OSA) is a breathing disorder during sleep secondary to collapsing upper airways that leads to a significant decrease or a complete cessation of airflow despite an effort to breathe. As the name suggests, an obstruction, likely caused by an inherited narrow airway, is the most common cause. But there are less known factors that may contribute to the worsening of OSA. We present a case of very severe OSA contributed by weight gain, opioid use, and anterior cervical discectomy and fusion (ACDF), in addition to a genetically narrow airway. This case highlights the importance of battling OSA on many different fronts. Our patient eventually was able to stop positive airway pressure (PAP) therapy, once the contributing factors were addressed appropriately.

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Section: Discussionmentioning

confidence: 99%

The Many Fronts of Battling Obstructive Sleep Apnea

Wasey¹,

Wasey²,

Saleh³

et al. 2021

Cureus

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show abstract

“…24,25 Mandibular advancement devices are the most commonly used and evaluated appliances and increase upper airway diameter by advancing the mandible forward. 26 Most clinical commissioning groups do not provide guidance for treatment with mandibular advancement devices, with a minority funding their use in the presence of CPAP intolerance. National Institute for Health and Care Excellence guidance considers mandibular advancement devices as a potential treatment modality for moderate OSA, but uncertainty remains because of insufficient data for their effectiveness compared with CPAP in mild and severe disease.…”

Section: Discussionmentioning

confidence: 99%

Variations in funding for treatment of obstructive sleep apnoea in England

Chaidas

Ashman

2021

J. Laryngol. Otol.

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Objectives This study aimed to review the funding policies of clinical commissioning groups for treatment of obstructive sleep apnoea in England. Methods Published policies from a randomly selected sample of 60 out of 190 clinical commissioning groups were reviewed. Results Continuous positive airway pressure was funded based on a clinical assessment or according to criteria that were in line with national guidelines in most clinical commissioning groups (49 of 60), with 11 clinical commissioning groups offering no policy. Mandibular advancement devices, tonsillectomy and nasal surgery were funded based on a clinical assessment or certain criteria in 16, 25 and 16 clinical commissioning groups, respectively. In contrast, only one clinical commissioning group provided funding for soft palate, tongue base or mandibular surgery. Hypoglossal nerve stimulation was not mentioned in any clinical commissioning group's policy. Conclusion Although most clinical commissioning groups provide funding for the use of continuous positive airway pressure, the availability of funding for other obstructive sleep apnoea treatment modalities is heterogeneous, leaving continuous positive airway pressure intolerant patients with limited therapeutic options in some regions.

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“…CPAP and MAD keep the upper airway open during sleep. It has been suggested that CPAP and MAD therapies attenuate some cardiovascular diseases including atherosclerosis, hypertension, heart failure, and cardiac arrhythmias ( Barnes et al, 2004 ; Gotsopoulos et al, 2004 ; Bradley and Floras, 2009 ; Marklund et al, 2019 ; Yamamoto et al, 2019 ; Chen et al, 2021 ; O’Donnell et al, 2021 ).…”

Section: Hypoxia and Cardiovascular Diseasesmentioning

confidence: 99%

Hypoxic Regulation of the Large-Conductance, Calcium and Voltage-Activated Potassium Channel, BK

et al. 2021

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Hypoxia is a condition characterized by a reduction of cellular oxygen levels derived from alterations in oxygen balance. Hypoxic events trigger changes in cell-signaling cascades, oxidative stress, activation of pro-inflammatory molecules, and growth factors, influencing the activity of various ion channel families and leading to diverse cardiovascular diseases such as myocardial infarction, ischemic stroke, and hypertension. The large-conductance, calcium and voltage-activated potassium channel (BK) has a central role in the mechanism of oxygen (O2) sensing and its activity has been related to the hypoxic response. BK channels are ubiquitously expressed, and they are composed by the pore-forming α subunit and the regulatory subunits β (β1–β4), γ (γ1–γ4), and LINGO1. The modification of biophysical properties of BK channels by β subunits underly a myriad of physiological function of these proteins. Hypoxia induces tissue-specific modifications of BK channel α and β subunits expression. Moreover, hypoxia modifies channel activation kinetics and voltage and/or calcium dependence. The reported effects on the BK channel properties are associated with events such as the increase of reactive oxygen species (ROS) production, increases of intracellular Calcium ([Ca2+]i), the regulation by Hypoxia-inducible factor 1α (HIF-1α), and the interaction with hemeproteins. Bronchial asthma, chronic obstructive pulmonary diseases (COPD), and obstructive sleep apnea (OSA), among others, can provoke hypoxia. Untreated OSA patients showed a decrease in BK-β1 subunit mRNA levels and high arterial tension. Treatment with continuous positive airway pressure (CPAP) upregulated β1 subunit mRNA level, decreased arterial pressures, and improved endothelial function coupled with a reduction in morbidity and mortality associated with OSA. These reports suggest that the BK channel has a role in the response involved in hypoxia-associated hypertension derived from OSA. Thus, this review aims to describe the mechanisms involved in the BK channel activation after a hypoxic stimulus and their relationship with disorders like OSA. A deep understanding of the molecular mechanism involved in hypoxic response may help in the therapeutic approaches to treat the pathological processes associated with diseases involving cellular hypoxia.

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Update on oral appliance therapy

Cited by 43 publications

References 85 publications

The Many Fronts of Battling Obstructive Sleep Apnea

The Many Fronts of Battling Obstructive Sleep Apnea

Variations in funding for treatment of obstructive sleep apnoea in England

Hypoxic Regulation of the Large-Conductance, Calcium and Voltage-Activated Potassium Channel, BK

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