scholarly journals P002 Targeted non-CPAP combination therapy resolves obstructive sleep apnoea

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A22-A22
Author(s):  
A Aishah ◽  
B Tong ◽  
A Osman ◽  
M Donegan ◽  
G Pitcher ◽  
...  
Keyword(s):  
Combination Therapy ◽  
Obstructive Sleep Apnoea ◽  
Respiratory Control ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
High Loop ◽  
Expiratory Positive Airway Pressure ◽  
Viable Treatment

Abstract Introduction Mandibular advancement splint (MAS) therapy is an effective alternative to CPAP for many people with obstructive sleep apnoea (OSA) but ~50% have residual OSA. This study aimed to resolve OSA in these individuals by combining MAS with other targeted therapies based on OSA endotype characterisation. Methods Eleven people with OSA (apnoea-hypopnoea index (AHI): 35±13 events/h), not fully resolved with MAS alone (AHI>10 events/h) were recruited. Initially, OSA endotypes were assessed via a detailed physiology night. Step one of combination therapy focused on anatomical interventions including MAS plus an oral expiratory positive airway pressure valve (EPAP) and a supine-avoidance device. Participants with residual OSA (AHI>10 events/h) following the anatomical combination therapy night, were then given one or more targeted non-anatomical therapies according to endotype characterisation. This included oxygen (4L/min) to reduce unstable respiratory control (high loop gain), 10mg zolpidem to increase arousal threshold, or 80/5mg atomoxetine-oxybutynin (ato-oxy) for poor pharyngeal muscle responsiveness. Results OSA was successfully treated (AHI<10 events/h) in all participants with combination therapy. MAS combined with EPAP and supine-avoidance therapy resolved OSA in ~65% of participants (MAS alone vs. combination therapy: 17±4 vs. 5±3, events/h, n=7). For the remaining participants, OSA resolved with the addition of oxygen (n=2), one with 80/5mg ato-oxy and another required both oxygen and 80/5mg ato-oxy. Discussion Targeted combination therapy may be a viable treatment alternative for people with OSA who cannot tolerate CPAP or for those who have an incomplete therapeutic response with monotherapy.

Comparative effects of CPAP and mandibular advancement splint therapy on blood pressure variability in moderate to severe obstructive sleep apnoea

2021 ◽  
Vol 80 ◽  
pp. 294-300
Author(s):  
Hasthi U. Dissanayake ◽  
Kate Sutherland ◽  
Craig L. Phillips ◽  
Ronald R. Grunstein ◽  
Anastasia S. Mihailidou ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnoea ◽  
Blood Pressure Variability ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Splint Therapy ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep

scholarly journals P013 A pilot study for ultrasound examination of the pterygomandibular raphe to predict efficacy of mandibular advancement splint therapy in obstructive sleep apnoea

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A25-A26
Author(s):  
C Brereton ◽  
A Ferreira ◽  
L Juge ◽  
L Bilston ◽  
E Brown
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Ultrasound Examination ◽  
Predictive Marker ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Anatomical Landmarks ◽  
Splint Therapy ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
Healthy Participants

Abstract Background A lack of predictive indicators for mandibular advancement splint (MAS) efficacy limits their use in the treatment of obstructive sleep apnoea (OSA). The absence of a tendinous pterygomandibular raphe (PMR) in the lateral nasopharynx on MRI may predict MAS efficacy, however MRI is time and resource intensive. We aimed to assess the feasibility of ultrasound in determining PMR absence compared to MRI. Methods 10 healthy participants were recruited to undergo both MRI and ultrasound of the lateral airway. Surrounding anatomical landmarks were examined to establish the presence or absence of the PMR. These results will be compared to MRI to determine parameters on ultrasound which correlate to an absent PMR. Progress to date 8 of the 10 participants have undergone both MRI and ultrasound, of which half were women, mean age 53 years, mean BMI 28 and mean AHI 3. In all 8 participants so far parameters for assessment of the PMR were identified and described, including presence of anatomical landmarks, localisation and width of the PMR space, and presence of a hyperechoic structure within the space. Comparison of these parameters with MRI to determine predictors of PMR presence or absence is currently underway. Intended outcome and impact Validation of ultrasound in the assessment for presence or absence of a tendinous PMR will enable further study of this structure as a predictive marker for MAS efficacy in OSA. This could assist clinicians in identifying suitable patients for MAS therapy.

Mandibular advancement splint titration in obstructive sleep apnoea

2008 ◽  
Vol 13 (2) ◽  
pp. 157-162 ◽  
Author(s):  
A. J. Campbell ◽  
G. Reynolds ◽  
H. Trengrove ◽  
A. M. Neill
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep

scholarly journals Combination therapy with mandibular advancement and expiratory positive airway pressure valves reduces obstructive sleep apnea severity

SLEEP ◽  
2019 ◽  
Vol 42 (8) ◽  
Author(s):  
Victor Lai ◽  
Benjamin K Tong ◽  
Carolin Tran ◽  
Andrea Ricciardiello ◽  
Michelle Donegan ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Combination Therapy ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
Expiratory Positive Airway Pressure

AbstractStudy ObjectivesMandibular advancement splint (MAS) therapy is a well-tolerated alternative to continuous positive airway pressure for obstructive sleep apnea (OSA). Other therapies, including nasal expiratory positive airway pressure (EPAP) valves, can also reduce OSA severity. However, >50% of patients have an incomplete or no therapeutic response with either therapy alone and thus remain at risk of adverse health outcomes. Combining these therapies may yield greater efficacy to provide a therapeutic solution for many incomplete/nonresponders to MAS therapy. Thus, this study evaluated the efficacy of combination therapy with MAS plus EPAP in incomplete/nonresponders to MAS alone.MethodsTwenty-two people with OSA (apnea–hypopnea index [AHI] = 22 [13, 42] events/hr), who were incomplete/nonresponders (residual AHI > 5 events/hr) on an initial split-night polysomnography with a novel MAS device containing an oral airway, completed an additional split-night polysomnography with MAS + oral EPAP valve and MAS + oral and nasal EPAP valves (order randomized).ResultsCompared with MAS alone, MAS + oral EPAP significantly reduced the median total AHI, with further reductions with the MAS + oral/nasal EPAP combination (15 [10, 34] vs. 10 [7, 21] vs. 7 [3, 13] events/hr, p < 0.01). Larger reductions occurred in supine nonrapid eye movement AHI with MAS + oral/nasal EPAP combination therapy (ΔAHI = 23 events/hr, p < 0.01). OSA resolved (AHI < 5 events/hr) with MAS + oral/nasal EPAP in nine individuals and 13 had ≥50% reduction in AHI from no MAS. However, sleep efficiency was lower with MAS + oral/nasal EPAP versus MAS alone or MAS + oral EPAP (78 ± 19 vs. 87 ± 10 and 88 ± 10% respectively, p < 0.05).ConclusionsCombination therapy with a novel MAS device and simple oral or oro-nasal EPAP valves reduces OSA severity to therapeutic levels for a substantial proportion of incomplete/nonresponders to MAS therapy alone.Clinical TrialsName: Targeted combination therapy: Physiological mechanistic studies to inform treatment for obstructive sleep apnea (OSA)URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279 Registration: ACTRN12617000492358 (Part C)

scholarly journals P081 Assessment of Change in Palatoglossus Length with Mandibular Advancement and Relationship to Response to Mandibular Advancement Splint Therapy in Obstructive Sleep Apnoea

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A47-A47
Author(s):  
K Lim ◽  
E Brown
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Pharyngeal Wall ◽  
Mandibular Advancement Splint ◽  
Linear Distance ◽  
Obstructive Sleep ◽  
Significant Length ◽  
The Difference

Abstract Background The palatoglossus is a muscle of the soft palate extending from the palatine aponeurosis inferolaterally along the pharyngeal wall inserting at the posterolateral surface of the tongue. Palatoglossal stimulation dilates the retropalatal space in subjects with obstructive sleep apnoea (OSA). Whether there is alteration in palatoglossus length during mandibular advancement and how this relates to Mandibular Advancement Splint (MAS) outcomes is unknown. Methods Participants with OSA referred for MAS underwent upper airway MRI with and without mandibular advancement. The linear distance between the origin of the palatoglossus muscle at the palatine aponeurosis and its insertion at the tongue was measured to approximate palatoglossus length. The difference in measured lengths with and without mandibular advancement was calculated. Change in palatoglossus with advancement was compared to treatment outcomes. Progress to date 71 participants with mean±SD AHI 26.0±16.1 events/hr were included in our study. Mean±SD palatoglossus length was 49.58±5.74mm. With mandibular advancement, mean±SD palatoglossus length was 51.21±5.46mm this was a significant change in length of mean±SD 1.63±4.3mm. This was a mean±SD 4.79±9.08% alteration in length with mandibular advancement. Treatment response was not significantly related to change in palatoglossus length (p&gt; 0.05). Intended outcome and Impact Our intention was to demonstrate significant length alteration in palatoglossus with mandibular advancement and correlate this to treatment outcome. This may highlight palatoglossus as a target for MAS or other OSA therapies for future clinicians.

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