Effects of Mandibular Advancement Splints on upper airway physiology in obstructive sleep apnoea

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

Download Full-text

Increasing the Use of an Anti-snoring Mouth Guard (Mandibular Advancement Appliance) to Prevent Upper Airway Collapse During Sleep in Patients With Obstructive Sleep Apnoea.

Case Medical Research ◽

10.31525/ct1-nct04092660 ◽

2019 ◽

Author(s):

Keyword(s):

Obstructive Sleep Apnoea ◽

Upper Airway ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Airway Collapse ◽

Upper Airway Collapse ◽

Obstructive Sleep ◽

Mandibular Advancement Appliance

Download Full-text

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

European Respiratory Review ◽

10.1183/16000617.0069-2017 ◽

2017 ◽

Vol 26 (146) ◽

pp. 170069 ◽

Cited By ~ 26

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.

Download Full-text

The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea

Thorax ◽

10.1136/thx.2009.131094 ◽

2010 ◽

Vol 65 (8) ◽

pp. 726-732 ◽

Cited By ~ 154

Author(s):

A. S. L. Chan ◽

K. Sutherland ◽

R. J. Schwab ◽

B. Zeng ◽

P. Petocz ◽

...

Keyword(s):

Obstructive Sleep Apnoea ◽

Upper Airway ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Upper Airway Structure

Download Full-text

The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea

Clinical Physiology and Functional Imaging ◽

10.1111/j.1475-097x.2007.00714.x ◽

2007 ◽

Vol 27 (1) ◽

pp. 47-53 ◽

Cited By ~ 41

Author(s):

Ama Johal ◽

Gulsharondip Gill ◽

Anthony Ferman ◽

Kieron McLaughlin

Keyword(s):

Obstructive Sleep Apnoea ◽

Muscle Activity ◽

Upper Airway ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Masticatory Muscle ◽

Obstructive Sleep ◽

Mandibular Advancement Appliances ◽

Masticatory Muscle Activity

Download Full-text

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

SLEEP Advances ◽

10.1093/sleepadvances/zpab014.125 ◽

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.

Download Full-text