scholarly journals Friedman Score in Relation to Compliance and Treatment Response in Nonsevere Obstructive Sleep Apnea

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Lars M. Berg ◽  
Torun K. S. Ankjell ◽  
Yi-Qian Sun ◽  
Tordis A. Trovik ◽  
Anders Sjögren ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Treatment Group ◽  
Treatment Compliance ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
Tongue Position ◽  
Sleep Recording

Nonsevere obstructive sleep apnea (OSA) is most often treated with a continuous positive airway pressure (CPAP) device or a mandibular advancement splint (MAS). However, patient compliance with these treatments is difficult to predict. Improvement in apnea-hypopnea index (AHI) is also somewhat unpredictable in MAS treatment. In this study, we investigated the association between Friedman tongue position score (Friedman score) and both treatment compliance and AHI improvement in patients with nonsevere OSA receiving CPAP or MAS treatment. 104 patients with nonsevere OSA were randomly allocated to CPAP or MAS treatment and followed for 12 months. Data were collected through a medical examination, questionnaires, sleep recordings from ambulatory type 3 polygraphic sleep recording devices, and CPAP recordings. Associations between Friedman score, treatment compliance, and AHI improvement were analysed with logistic regression analyses. Friedman score was not associated with treatment compliance (odds ratio [OR]: 0.85, 95% confidence interval [CI]: 0.59–1.23), or AHI improvement (OR: 1.05, 95% CI: 0.62–1.76) in the overall study sample, the CPAP treatment group, or the MAS treatment group. Adjustment for socioeconomic factors, body mass index, and tonsil size did not significantly impact the results. Although Friedman score may predict OSA severity and contribute to the prediction of success in uvulopalatopharyngoplasty, we found no association between Friedman score and treatment compliance in patients with nonsevere OSA receiving CPAP or MAS treatment, nor did we find any association between Friedman score and AHI improvement. Factors other than Friedman score should be considered when deciding whether a patient with nonsevere OSA should be treated with CPAP or MAS.

scholarly journals Comparison of Titratable Oral Appliance and Mandibular Advancement Splint in the Treatment of Patients with Obstructive Sleep Apnea

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Emel Sari ◽  
Steven Menillo
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Success Rate ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Similar Reduction ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep

Objective. To compare the effect of two intraoral devices (titratable oral appliance-Klearway (KW) and mandibular advancement splint (MAS)) in mild and moderate obstructive sleep apnea (OSA) patients. Method and Materials. The study group was comprised of twenty-four adult volunteer patients with OSA. Twelve subjects were fitted with a titratable oral appliance (group KW) protruding the mandible (85% of maximum protrusion). The other 12 subjects received MAS with 75% protrusion of the mandible (group MAS). Baseline, (“0.PSG”), first week (K1.PSG for KW group and M1.PSG for MAS group), and after the first month (K2.PSG for KW group and M2′. PSG for MAS group). Results. Both groups produced similar reduction in apnea-hypopnea index (AHI) from baseline till the end of the first week and first month (P<.05). However, the success rate of both groups at the end of the first month was found to be statistically different from the success rate of the first week (P<.05). The reduction in mean AHI of group KW-moderate (KW-mo) was significantly different from the mean AHI of group MAS-moderate (MAS-mo) at the end of the first month (P<.05). Conclusion. This study suggests that Klearway appliance was more effective in treating moderate OSA patients than MAS appliance. It was concluded that an appliance that provides 85% mandibular advancement to open the upper airway was more effective in reducing the number of high apneic events during sleep in comparison to the one which provides 75%.

scholarly journals Short-term efficacy of mandibular advancement splint in treatment of obstructive sleep apnea-hypopnea syndrome

2013 ◽  
Vol 18 (3) ◽  
pp. 118-123 ◽  
Author(s):  
Calliandra Moura Pereira de Lima ◽  
Laurindo Zanco Furquim ◽  
Adilson Luiz Ramos
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Long Term Effects ◽  
Short Term ◽  
Term Efficacy ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome

OBJECTIVE: The aim of the present study was to determine the short-term efficacy of treatment for snoring and obstructive sleep apnea-hypopnea syndrome (OSAHS) using a mandibular advancement splint. METHODS: The sample comprised 20 patients (13 men and 7 women; mean age = 48 years; mean body mass index = 27.07) with OSAHS. Polysomnograms were performed before and 60 days after mandibular advancement splint therapy. RESULTS: There was a significant reduction in the apnea-hypopnea index (AHI) following treatment (mean pretreatment AHI = 20.89 ± 17.9 versus mean posttreatment AHI = 4.43 ± 3.09) (p < 0.05). The snoring reduced and the sleep efficiency improved, as registered by polysomnograms (p<0.05). CONCLUSIONS: The sleep quality improved in patients using mandibular advancement splint. Further studies evaluating long-term effects are needed.

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)

Effect of mandibular advancement splint treatment on tongue shape in obstructive sleep apnea

2015 ◽  
Vol 19 (3) ◽  
pp. 857-863 ◽  
Author(s):  
Toru Ogawa ◽  
Jianlan Long ◽  
Kate Sutherland ◽  
Andrew S. L. Chan ◽  
Keiichi Sasaki ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Mandibular Advancement ◽  
Mandibular Advancement Splint ◽  
Obstructive Sleep

scholarly journals The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3248 ◽  
Author(s):  
Yuki Sakamoto ◽  
Akifumi Furuhashi ◽  
Eri Komori ◽  
Hiroyuki Ishiyama ◽  
Daichi Hasebe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Side Effects ◽  
Sleep Stage ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Oral Appliances ◽  
Forward Movement ◽  
Obstructive Sleep

This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed.

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