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> 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.

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 Intervention to enhance adherence to mandibular advancement appliance in patients with obstructive sleep apnoea: study protocol for a randomised clinical trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Harishri Tallamraju ◽  
J. Tim Newton ◽  
Padhraig S. Fleming ◽  
Ama Johal
Keyword(s):  
Social Support ◽  
Clinical Trial ◽  
Obstructive Sleep Apnoea ◽  
Treatment Success ◽  
Upper Airway ◽  
Randomised Clinical Trial ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Treatment Modalities ◽  
Obstructive Sleep

Abstract Background Obstructive sleep apnoea (OSA) is a sleep-related breathing disorder characterised by the repeated episodic collapse of the upper airway during sleep, resulting in sleep deprivation, giving rise to apnoeas and hypopnoeas. Based on the severity of OSA, there are two primary treatment modalities, continuous positive airway pressure (CPAP) and mandibular advancement appliances (MAA); both are adherence-dependent. MAA is offered to those with mild to moderate OSA and is prescribed as an alternative to patients intolerable to CPAP. However, adherence to MAA treatment is variable and declines over time. Hence, the current study aims to assess the effectiveness of the stage-matched intervention, the Health Action Process Approach (HAPA), on adherence to MAA in patients with OSA. Methods A single-centre randomised clinical trial will be undertaken at Bart’s Health NHS Trust. Fifty-six participants with newly diagnosed OSA are planned to be enrolled in the study and randomised to intervention care (IC) and standardised care (SC) groups. Participants in the SC group will receive routine care whilst participants in the IC group will receive the stage-matched intervention, developed using the HAPA model. Data indicating MAA adherence will be collected both objectively and subjectively, from micro-sensors embedded in the MAA design and sleep diaries, respectively at 3, 6, 18 and 36 months. In addition, a range of questionnaires designed to assess risk perception, outcome expectancy, and self-efficacy (SEMSA) and quality of sleep (PSQI and ESS) and life (EQ-5DL), socio-economic and social support scales will be used. Discussion The currently available treatments for obstructive sleep apnoea depend entirely on the patient’s acceptance and use. There are several factors that affect cooperation and wear for example patients’ awareness of their condition, social support and psychological behaviour. In addition, mood, such as anxiety, stress, and depression, may affect wear. At the same time, we know that interventions involving more education and behaviour approaches can help patients adapt more easily to some treatments. As a result, the present trial aims to explore the potential role of these factors to maximise treatment success and minimise side effects. Trial registration ClinicalTrials.gov NCT04092660. Registered on September 6, 2019

scholarly journals Personalised medicine in sleep respiratory disorders: focus on obstructive sleep apnoea diagnosis and treatment

2017 ◽  
Vol 26 (146) ◽  
pp. 170069 ◽  
Author(s):  
Maria R. Bonsignore ◽  
Monique C. Suarez Giron ◽  
Oreste Marrone ◽  
Alessandra Castrogiovanni ◽  
Josep M. Montserrat
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Treatment Options ◽  
Personalised Medicine ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Lifestyle Changes ◽  
Mandibular Advancement ◽  
Considerable Proportion ◽  
Special Focus ◽  
Obstructive Sleep

In all fields of medicine, major efforts are currently dedicated to improve the clinical, physiological and therapeutic understanding of disease, and obstructive sleep apnoea (OSA) is no exception. The personalised medicine approach is relevant for OSA, given its complex pathophysiology and variable clinical presentation, the interactions with comorbid conditions and its possible contribution to poor outcomes. Treatment with continuous positive airway pressure (CPAP) is effective, but CPAP is poorly tolerated or not accepted in a considerable proportion of OSA patients. This review summarises the available studies on the physiological phenotypes of upper airway response to obstruction during sleep, and the clinical presentations of OSA (phenotypes and clusters) with a special focus on our changing attitudes towards approaches to treatment. Such major efforts are likely to change and expand treatment options for OSA beyond the most common current choices (i.e. CPAP, mandibular advancement devices, positional treatment, lifestyle changes or upper airway surgery). More importantly, treatment for OSA may become more effective, being tailored to each patient's need.

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.

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.

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