scholarly journals Obstructive sleep apnea treated with custom-made bibloc and monobloc oral appliances: a retrospective comparative study

2016 ◽  
Vol 21 (1) ◽  
pp. 93-100 ◽  
Author(s):  
Göran Isacsson ◽  
Clara Fodor ◽  
Magnus Sturebrand
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Comparative Study ◽  
Oral Appliances ◽  
Obstructive Sleep ◽  
Custom Made ◽  
Retrospective Comparative Study

Custom-Made Oral Appliances for the Treatment of Obstructive Sleep Apnea: Outcomes in Thai Patients

2021 ◽  
Vol 104 (4) ◽  
pp. 571-575
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Patient Characteristics ◽  
Oral Appliance ◽  
Relevant Information ◽  
Apnea Hypopnea Index ◽  
Moderate Degree ◽  
Oral Appliances ◽  
Obstructive Sleep ◽  
Custom Made

Objective: To evaluate the outcomes of custom-made oral appliances (OAs) for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: A retrospective review of polysomnography (PSG) results and relevant information, including patient characteristics, visual analog scale (VAS) of sleep-associated symptoms, and Epworth Sleepiness Scale (ESS) of patients treated with an OA between January 2010 and January 2018 was done at Siriraj Hospital, Thailand. Inclusion criteria were OSA patients aged 18 years or older who underwent diagnostic and therapeutic PSG with a custom-made OA. Exclusion criteria were patients who were lost to follow-up or had incomplete PSG data. Results: Sixty-seven OSA patients were recruited. The median apnea-hypopnea index (AHI) was significantly decreased from 16.5 (11.5, 27.8) to 5.1 (2.8, 11.3) events per hour (p<0.001) and the median minimal oxygen saturation increased from 82.0 (77.0, 86.0) to 87.0 (80.0, 90.0) with OA treatment (p<0.001). ESS scores decreased from 9 (6, 13) to 7 (4, 9) (p<0.001) and the VAS of snoring loudness and frequency as rated by family members or bed partners decreased from 6 (4, 7.5) to 3.3 (2, 5) and from 5.5 (3.2, 7.6) to 3.4 (2, 5.3), respectively (p<0.001). Forty-one patients (61%) had a 50% reduction of AHI, and an AHI of less than 15 events per hour after treatment, which were considered good responses. Common adverse effects of the treatment included temporomandibular joint discomfort, dry mouth, excessive salivation, gingival pain, and toothache, but these occurred to only a mild-to-moderate degree and were tolerable. Conclusion: Custom-made OA is an effective alternative treatment for OSA in selected Thai patients, particularly for those with a mild-to-moderate degree. Keywords: Custom-made oral appliance, Obstructive sleep apnea, OA, OSA, Thai

scholarly journals cardiovascular effects of oral appliances in obstructive sleep apnea

2018 ◽  
Vol 24 (4) ◽  
pp. 396-405
Author(s):  
M. V. Agaltsov
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiovascular Diseases ◽  
Oral Appliances ◽  
Upper Respiratory Tract ◽  
Cpap Therapy ◽  
Sleep Related Breathing Disorders ◽  
Breathing Disorders ◽  
Obstructive Sleep ◽  
Custom Made

Oral  appliances  (ОА)  are  one  of  the  leading  methods  of  effective  treatment  of  sleep-related  breathing disorders. Obstructive sleep apnea (OSA) is a widespread disturbance in the general population. It is closely associated with many cardiovascular diseases (hypertension, cardiac arrhythmias, chronic heart failure, ischemic heart disease). Timely detection and treatment of OSA is an important task in the process of reducing the number of cardiac complications. Modern devices for the treatment of OSA are custom-made devices which allow to change the position of the mandible and its extension providing personalized treatment of snoring and sleep apnea. Changing the degree of the mandible extension, the ОА retains the upper respiratory tract in open position and indirectly stimulates the muscles, determining their tone. The effectiveness of the ОА is evaluated by the complete elimination of all respiratory events (snoring, upper airway resistance syndrome, OSA and hypopnea), as well as the influence on the sleep structure and the wakefulness functioning (excessive daytime sleepiness). The effects of ОА on cardiovascular diseases are of great importance, as they showed a decrease in both systolic and diastolic blood pressure, as well as a positive effect on the impaired endothelial function. Among all the treatment options, ОА take the leading positions, only slightly inferior in effectiveness to noninvasive ventilation, so called CPAP therapy. Regarding the long-term adherence to therapy (which is especially important in the cardiovascular prevention) оral appliances exceed CPAP therapy. Thus, the OA therapy is one of the leading therapeutic directions in modern sleep medicine for obstructive sleep-related breathing disorders.

scholarly journals Oral Appliances in Obstructive Sleep Apnea

Healthcare ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 141 ◽  
Author(s):  
Dieltjens ◽  
Vanderveken
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Oral Appliances ◽  
Invasive Treatment ◽  
Oral Appliance Therapy ◽  
Obstructive Sleep ◽  
Custom Made ◽  
Mandibular Advancement Devices

Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

scholarly journals Treatment of obstructive sleep apnea patients using oral appliances: Our experiences

2014 ◽  
Vol 71 (7) ◽  
pp. 623-626 ◽  
Author(s):  
Dusan Miljus ◽  
Ljiljana Tihacek-Sojic ◽  
Aleksandra Milic-Lemic ◽  
Marko Andjelkovic
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Heart Diseases ◽  
Treatment Success ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Oral Appliances ◽  
Obstructive Sleep ◽  
Custom Made

Background/Aim. Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders. It is recognized as a serious risk factor for car and workplace accidents due to daytime sleepiness, and factor for coronary heart diseases and stroke. The aim of this study was to examine the effectiveness of oral appliances for mandibular advance in treating mild to moderate OSA. Methods. A total of 15 patients were included in this study, all diagnosed with mild or moderate OSA. Oral appliances were custom made for each patient in protrusive position at 50% of maximum mandibular advancement. The patients were given instructions not to sleep on their backs and avoid alcohol consumption during the study as these are the factors that can contribute to symptoms progression. Results. Complete and partial treatment success was achieve in 14 of the patients. Apnea-hypopnea index values were significantly lower (p < 0.05) at the end of a 6-month observation period compared to those at the treatment beginning. A great improvement in symptoms was observed, with daytime sleepiness index values significantly reduced already within the first month of the treatment. Conclusion. Treatment of obstructive sleep apnea with oral appliances has proven successful. Patients were comfortable using oral appliances and were ready to wear them for prolonged period of time. Use of oral appliances is very common in the world and should not be discarded. They are also very comfortable, practical and affordable comparing to continuous positive airway pressure (CPAP) apparatus, not to mention surgery. Use of oral appliances is safe and very well tolerated, and ought to be offered to patients with OSA.

Obstructive Sleep Apnea: Diagnosis and Management

2020 ◽  
Author(s):  
Diane C Lim ◽  
Richard J Schwab
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Nerve Stimulation ◽  
Airway Pressure ◽  
Hypoglossal Nerve ◽  
Positive Airway Pressure ◽  
Oral Appliances ◽  
Craniofacial Abnormalities ◽  
Obstructive Sleep ◽  
Line Of Therapy

As part 2 of three chapters on sleep disordered breathing, this chapter reviews obstructive sleep apnea (OSA) diagnosis and management. OSA should be considered in all patients who have loud habitual snoring, excessive daytime sleepiness, and witnessed apneas. On physical examination, craniofacial abnormalities that can lead to sleep apnea include retrognathia, micrognathia, a narrow hard palate, nasal obstruction, an overjet, and an overbite. Enlargement of the upper airway soft tissue structures (the tongue, soft palate, lateral walls, and parapharyngeal fat pads) also increases the risk of OSA. The gold standard for making the diagnosis of OSA is overnight polysomnography, but home sleep apnea tests (HSAT) are rapidly gaining acceptance, especially in patients with a high probability of OSA. The first line of therapy for OSA remains positive airway pressure (PAP), with the second line of therapy being oral appliances. Another alternative to PAP therapy is hypoglossal nerve stimulation, which has been shown to decrease the Apnea-Hypopnea index by 67.4%. This review contains 6 figures, 3 tables, and 52 references. Key Words: craniofacial abnormalities, Epworth Sleepiness Scale, home sleep apnea test, hypoglossal nerve stimulation, obstructive sleep apnea, oral appliances, oral pharyngeal crowding, polysomnography, positive airway pressure, STOP-BANG

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