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Oral Appliance for Sleep Apnea

P E Vonk, A M E H Beelen, N de Vries
PURPOSE: To evaluate the effect of different passive maneuvers on upper airway patency during drug-induced sleep endoscopy (DISE) compared to recent literature on treatment outcomes of positional therapy (PT), oral appliance therapy (OAT), and combined treatment in obstructive sleep apnea (OSA) patients. METHODS: A retrospective, single-center cohort study including a consecutive series of 200 OSA patients. All patients underwent DISE with and without manually performed jaw thrust and lateral head rotation by using the VOTE classification...
March 9, 2018: Sleep & Breathing, Schlaf & Atmung
Sylvan S Mintz, Reka Kovacs
PURPOSE: In 2005, the American Academy of Sleep Medicine stated, "Oral appliances are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA) who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP." However, this recommendation is based upon variable results from only six studies with more than 100 participants. These studies have assessed the effectiveness of mandibular advancement devices (MADs) in specific groups (military populations, academic institutions, or hospital settings) with no large study conducted in a fee-for-service private practice where the majority of patients receive MADs for OSA...
March 8, 2018: Sleep & Breathing, Schlaf & Atmung
Arthur H Friedlander, Lindsay L Graves, Tina I Chang, K Karl Kawakami, Urie K Lee, Shannon C Grabich, Zhuang T Fang, Michelle R Zeidler, JoAnn A Giaconi
OBJECTIVE: Our objective was to determine primary open-angle glaucoma (POAG) prevalence among obstructive sleep apnea (OSA) patients because the perioperative environment risks further damaging the optic nerve. STUDY DESIGN: We analyzed a "convenience sample" referred by Sleep Medicine for oral appliances because of continuous positive airway pressure intolerance. We determined the aggregate prevalence of the 3 POAG subtypes-"classic" open-angle glaucoma (COAG), normal-tension glaucoma (NTG), and open-angle glaucoma suspect (OAGS)-among the index population and compared it with that of same hospital's general population...
January 31, 2018: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Seo Yun Jo, Sung Min Lee, Kang Hyun Lee, Dong-Kyu Kim
PURPOSE: Oral appliance therapy is an alternative treatment modality for obstructive sleep apnea (OSA). However, there have been no studies to determine whether changes in the obstructive pattern occur following long-term use of oral devices. Therefore, we examined whether the obstructive pattern changes in patients with OSA who undergo long-term oral appliance therapy using drug-induced sleep endoscopy (DISE). METHODS: We investigated 156 consecutive patients diagnosed with OSA...
February 26, 2018: European Archives of Oto-rhino-laryngology
Elodie Gautier-Veyret, Jean-Louis Pépin, Françoise Stanke-Labesque
Obstructive sleep apnea (OSA) is characterized by recurrent episodes of partial or complete upper airway obstruction, occurring during sleep, leading to chronic intermittent hypoxia (IH), which harms the cardiovascular system. OSA is associated with both functional and structural vascular alterations that contribute to an increased prevalence of fatal and non-fatal cardiovascular events. OSA is a heterogeneous disease with respect to the severity of hypoxia, the presence of daytime symptoms, obesity, and cardiovascular comorbidities...
December 22, 2017: Pharmacology & Therapeutics
B Saglam-Aydinatay, T Taner
BACKGROUND: Despite the advances in the treatment of obstructive sleep apnea (OSA) with mandibular advancement appliances (MAA), their effectiveness is dependent on the patients compliance. Our aims were to evaluate the long-term adherence to MAA therapy and patients experiences of the treatment in OSA. MATERIAL AND METHODS: Sixty-nine patients (52 males, 17 females; Mean age: 54.4±10.8 years) were included in the study. The subjects were mild (56%) and moderate (44%) OSA patients who had been treated using MAA at least 4 years prior to the study...
December 23, 2017: Medicina Oral, Patología Oral y Cirugía Bucal
Ming-Chin Lan, Yen-Bin Hsu, Ming-Ying Lan, Yun-Chen Huang, Ming-Chang Kao, Tung-Tsun Huang, Tsan-Jen Chiu, Mei-Chen Yang
PURPOSE: The aim of this study was to identify possible upper airway obstructions causing a higher continuous positive airway pressure (CPAP) titration level, utilizing drug-induced sleep endoscopy (DISE). METHODS: A total of 76 patients with obstructive sleep apnea (OSA) underwent CPAP titration and DISE. DISE findings were recorded using the VOTE classification system. Polysomnographic (PSG) data, anthropometric variables, and patterns of airway collapse during DISE were analyzed with CPAP titration levels...
December 15, 2017: Sleep & Breathing, Schlaf & Atmung
Ryan J Soose, Tapan A Padhya, M Boyd Gillespie, Oleg Froymovich, Ho-Sheng Lin, B Tucker Woodson
Objectives: Analyze the obstructive sleep apnea (OSA) treatment history in a group of participants who enrolled in a hypoglossal nerve stimulation trial. Methods: Moderate-severe OSA patients with difficulty adhering to CPAP presented for enrollment in a multicenter trial. Self-reported history on prior OSA medical therapy was collected at enrollment, including OSA diagnosis date, CPAP start and stop dates, oral appliance trial, and reasons for discontinuation or non-adherence...
June 2017: World journal of otorhinolaryngology—head and neck surgery
Hitomi Ono Minagi, Kentaro Okuno, Kanji Nohara, Takayoshi Sakai
STUDY OBJECTIVES: The aim of this study was to investigate the predictors of dental changes associated with long-term treatment with oral appliances (OAs) in patients with obstructive sleep apnea (OSA). METHODS: This was a retrospective study to investigate Japanese patients with OSA receiving long-term treatment with OAs. Comparisons of cephalometric analysis were carried out between the initial and follow-up assessments of dental and skeletal changes. Based on dental changes, predictors that may cause side effects were investigated...
January 15, 2018: Journal of Clinical Sleep Medicine: JCSM: Official Publication of the American Academy of Sleep Medicine
Grietje E de Vries, Peter J Wijkstra, Ewout J Houwerzijl, Huib A M Kerstjens, Aarnoud Hoekema
Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. This study systematically reviews the effects of oral appliance therapy (OAT) on a broad spectrum of cardiovascular outcomes. A literature search was performed up to December 31st 2016. Twenty-five relevant full-text articles were retrieved. Sixteen articles were considered methodologically sufficient, including 11 randomized controlled trials. Pooled data of the RCTs showed significant reductions in daytime systolic and diastolic blood pressure compared to baseline, but no significant reductions in heart rate, except for daytime heart rate when compared to inactive/placebo OAT...
October 26, 2017: Sleep Medicine Reviews
Enrique Fernández-Julián, Tomás Pérez-Carbonell, Rocío Marco, Verónica Pellicer, Enrique Rodriguez-Borja, Jaime Marco
OBJECTIVE/HYPOTHESIS: To investigate outcomes including efficacy, quality of life, and levels of inflammatory markers of a mandibular advancement device (MAD) for moderate-to-severe obstructive sleep apnea (OSA). STUDY DESIGN: Case-control study. METHODS: Patients with apnea-hypopnea index (AHI) ≥ 15/hr who only accepted MAD therapy (study group) or who refused any treatment (control group) were recruited. At baseline and at 6 months, polysomnography, Epworth Sleepiness Scale (ESS), Functional Outcomes of Sleep Questionnaire (FOSQ), C-reactive protein (CRP), interleukin 1β, interleukin 6, and tumor necrosis factor α (TNF-α) were assessed in both groups...
November 20, 2017: Laryngoscope
Martha Schwartz, Luis Acosta, Yuan-Lung Hung, Mariela Padilla, Reyes Enciso
The purpose of this review is to conduct a systematic review and meta-analysis comparing the effects of continuous positive airway pressure (CPAP) with a mandibular advancement device (MAD) in improving the quality of life (sleepiness, cognitive, and functional outcomes) in patients diagnosed with obstructive sleep apnea (OSA). Authors identified randomized, placebo-controlled studies from MEDLINE through PubMed, Web of Science, and the Cochrane Library. Studies were assessed for inclusion and exclusion criteria, as well as risk of bias...
November 11, 2017: Sleep & Breathing, Schlaf & Atmung
Geun-Shin Lee, Hye-Kyoung Kim, Mee-Eun Kim
Objective To identify potential risk factors of response to oral appliance in patients with obstructive sleep apnea (OSA). Methods Fifteen OSA patients were enrolled. Clinical characteristics, cephalometric measurements, and the results of home sleep testing were retrospectively obtained at baseline, and a sleep test was done again at the end of treatment. Results Twelve subjects were responders and three were non-responders. The diastolic blood pressure, minimum pulse rate, SNA (Angle between sella-nasion and nasion-A point), ANB (Anteroposterior maxilla/mandible discrepancy), and facial convexity of non-responders was higher than those of responders...
November 8, 2017: Cranio: the Journal of Craniomandibular Practice
K Gjerde, S Lehmann, I F Naterstad, M E Berge, A Johansson
The aim of this study was to test whether digitally registered use of a mandibular advancement device (MAD) by a built-in thermal sensor was reliable compared to a self-reported diary of MAD use. Eighty consecutive patients referred to a specialist outpatient sleep medicine clinic (HUS) were recruited. Patients of both genders, aged from 25 to 70 years with a diagnosis of mild, moderate or severe, were included. All participants signed a written informed consent when they received the MAD. For the purpose of this reliability study, we found it sufficient to include the first 30 nights of MAD use in the reliability analysis...
February 2018: Journal of Oral Rehabilitation
Anders Storesund, Anders Johansson, Bjørn Bjorvatn, Sverre Lehmann
BACKGROUND: Studies show that the therapeutic CPAP pressure is associated with oral appliance (OA) treatment outcome in obstructive sleep apnea (OSA) patients. However, these studies included either CPAP adherent patients using fixed pressure devices, or partly CPAP non-adherent patients using fixed pressure or auto-adjusting (auto-CPAP) devices. In many countries, auto-CPAP is predominately used, and only those non-adherent to therapy need a change to OA. Therefore, studies examining the relationship between CPAP pressures and OA treatment outcome should focus on patients non-adherent to auto-CPAP...
October 24, 2017: Sleep & Breathing, Schlaf & Atmung
Yolanda Castillo, Dolores Blanco-Almazan, James Whitney, Barry Mersky, Raimon Jane
Obstructive sleep apnea (OSA) is a highly prevalent chronic disease, especially in elderly and obese populations. Despite constituting a serious health, social and economic problem, most patients remain undiagnosed and untreated due to limitations in current equipment. In this work, we propose a novel method to diagnose OSA and monitor therapy adherence and effectiveness at home in a non-invasive and inexpensive way: combining acoustic analysis of breathing and snoring sounds with oral appliance therapy (OA)...
July 2017: Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society
Luciana B M Godoy, Luciana Palombini, Dalva Poyares, Cibele Dal-Fabbro, Thaís Moura Guimarães, Priscila Calixto Klichouvicz, Sergio Tufik, Sonia Maria Togeiro
Objectives: To evaluate the long term effects of an oral appliance on clinical symptoms, respiratory sleep parameters, sleep quality and sustained attention in patients with Upper Airway Resistance Syndrome (UARS) compared with placebo. Methods: This study was a randomized placebo-controlled clinical trial. Thirty UARS patients were randomized in two groups: placebo and mandibular advancement device (MAD) groups. UARS criteria were presence of sleepiness (Epworth Sleepiness Scale ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time...
October 17, 2017: Sleep
Kun-Ying Yeh, Chao-Chi Yeh, Chun-Chang Wu, Kuan Tang, Jyun-Yi Wu, Yun-Ting Chen, Ming-Xin Xu, Yunn-Jy Chen, Yao-Joe Yang, Shey-Shi Lu
Sleep apnea is a serious sleep disorder, and the most common type is obstructive sleep apnea (OSA). Untreated OSA will cause lots of potential health problems. Oral appliance therapy is an effective and popular approach for OSA treatment, but making a perfect fit for each patient is time-consuming and decreases its efficiency considerably. This paper proposes a System-on-a-Chip (SoC) enabled sleep monitoring system in a smart oral appliance, which is capable of intelligently collecting the physiological data about tongue movement through the whole therapy...
October 16, 2017: Sensors
M Marklund
PURPOSE OF REVIEW: The majority of the adult population is affected by obstructive sleep apnea (OSA), according to recent epidemiological research. Oral appliance (OA) therapy is increasingly recommended, particularly for patients with milder OSA. This review updates the evidence in favor of OA therapy. RECENT FINDINGS: A high level of evidence shows that OA is effective in the treatment of OSA, but continuous positive airway pressure (CPAP) is more efficient. Higher adherence with OAs may compensate for this difference...
2017: Current Sleep Medicine Reports
Masayuki Hideshima
Sleep apnea syndrome(SAS)was revealed to be a modern disease because of the skeletal morphology, lifestyle habit and mental stress of modern humans. Approximately 400 thousand SAS patients have been diagnosed and treated in Japan and numbers of potential SAS patients were estimated at more than 5 millions. Contemporary therapy for SAS is continuous positive airway pressure(CPAP)therapy in medical for moderate or severe SAS and oral appliance(OA)therapy in dental for mild SAS patients. However recent study shows OA therapy is effective even for moderate or severe SAS...
2017: Clinical Calcium
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