scholarly journals Clinical Evidence in the Treatment of Obstructive Sleep Apnoea with Oral Appliances: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Andrea Rossi ◽  
Antonino Lo Giudice ◽  
Camilla Di Pardo ◽  
Alberto Teodoro Valentini ◽  
Francesca Marradi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Assessment Tool ◽  
Sleep Apnoea ◽  
Common Finding ◽  
Control Group ◽  
Oral Appliances ◽  
Inclusion Criteria ◽  
Obstructive Sleep ◽  
Definition Of

Background. Recent clinical guidelines have extended indications for oral appliances to subjects affected by moderate-to-severe obstructive sleep apnoea (OSA). The aim of this systematic review covering this important issue for public health is twofold: updating and summarizing the best available scientific evidence by selecting RCTs of quality only, and identifying the therapeutic pathways that can be transferred to the current clinical practice. Methods. All the abstracts which were published before February 18, 2019, have been identified in three electronic databases (PubMed, Web of Science, and Cochrane). The Cochrane Collaboration’s tool for assessing risk of bias was used as an assessment tool in order to evaluate the quality of the selected studies. Results. The search strategy yielded 2,260 studies. After removing duplicates and studies that did not comply with the inclusion criteria, 32 full-text articles were assessed for eligibility, and 17 RCTs were finally included in the qualitative synthesis. The 17 selected studies were very heterogeneous in the type of included RCTs in terms of patient inclusion criteria, sample size, distribution of the two genders in the various groups, duration of treatment, and definition of primary and secondary outcomes, without any restriction on the definition of the control group. A common finding was the positive responsiveness of oral appliance treatment in subjects affected by mild-to-moderate OSA with some evidence for cases of severe OSA. Conclusion. Higher-quality studies are needed in order to provide additional useful guidelines for dental clinicians for OSA management.

Upper airway volumetric changes of obstructive sleep apnoea patients treated with oral appliances: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Vasileios K Dontsos ◽  
Athina Chatzigianni ◽  
Moschos A Papadopoulos ◽  
Evangelia Nena ◽  
Paschalis Steiropoulos
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Cochrane Library ◽  
Apnea Hypopnea Index ◽  
Oral Appliances ◽  
Volume Increase ◽  
Obstructive Sleep

Summary Background Obstructive sleep apnoea (OSA) is a common sleep-related breathing disorder, attributed to the collapse of the pharyngeal walls and the subsequent complete or partial upper airway obstruction. Among different treatment options for OSA, Continuous Positive Airway Pressure, and oral appliances (OAs) have been used, with various outcomes and side effects. Objective The aim of this study was to summarize current knowledge in an evidence-based manner regarding the upper airway volume increase of OSA patients while treated with OAs. Search methods Electronic search was conducted in Pubmed, Cochrane Library, and Scopus, up to May 2020. Selection criteria Studies were selected after the application of predetermined eligibility criteria. Data collection and analysis Mean airway volume differences and the corresponding 95% confidence intervals were calculated, using the random effects model. Sensitivity, exploratory, and meta-regression analyses were also implemented. Results Eleven studies filled the inclusion criteria and were included in the systematic review, while 10 of them were suitable for meta-analysis. In total, 291 patients were included, with mean upper airway volume increase of 1.95 cm3 (95% CI, 1.37–2.53; P < 0.001) with Mandibular Advancement Devices in place. In all studies, post-treatment Apnea Hypopnea Index (AHI) was either <10 events/hour or was reduced by more than 50% from baseline levels. A greater increase of the velopharynx volume was observed, regarding airway compartments. Conclusions Treatment with OAs in OSA may lead to a significant increase of the upper airway volume with a subsequent decrease of AHI. The velopharynx seems to be affected the most from OA therapy.

Immediate Effect of Acupuncture on the Sleep Pattern of Patients with Obstructive Sleep Apnoea

2010 ◽  
Vol 28 (3) ◽  
pp. 115-119 ◽  
Author(s):  
Anaflávia O Freire ◽  
Gisele C M Sugai ◽  
Sônia Maria Togeiro ◽  
Luiz Eugênio Mello ◽  
Sérgio Tufik
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Placebo Treatment ◽  
Acute Effect ◽  
Sham Acupuncture ◽  
Sleep Apnoea ◽  
Sleep Pattern ◽  
Control Group ◽  
Respiratory Events ◽  
Obstructive Sleep ◽  
Before And After

Background Most patients with obstructive sleep apnoea (OSA) do not tolerate treatment with nasal continuous positive airway pressure, the ‘gold standard’ treatment for this condition. It was shown in a pilot study that acupuncture was more effective than placebo treatment (sham acupuncture) in producing significant changes in the respiratory events assessed by polysomnography (PSG). Objectives To investigate the immediate effect of manual acupuncture (MA) and electroacupuncture (EA) on the sleep pattern of patients presenting with moderate OSA. Methods 40 patients with an Apnoea–Hypopnoea Index (AHI) of 15–30/h were randomly allocated to MA treatment (n=10), EA 10 Hz treatment (n=10), EA 2 Hz treatment (n=10) and a no-treatment control group (n=10). The patients received MA or EA (2 or 10 Hz) just before the PSG study at 20:00. Results The AHI (p=0.005; p=0.005), the Apnoea Index (p=0.038; p=0.009) and the respiratory events (p=0.039; p=0.014) decreased significantly in the MA and EA 10 Hz groups, respectively (AHI (21.9, 11.2), Apnoea Index (5.15, 0.7), respiratory events (120.5, 61.0) in the MA group before and after. AHI (20.6, 9.9), Apnoea Index (8.2, 0.3), respiratory events (117.0, 56.0) in the EA 10 Hz group before and after). The micro-arousals decreased only in the MA group (146.0 vs 88.5, p=0.0002). There were no significant changes in the EA 2 Hz group or in the control group. Conclusion A single session of either MA or EA 10 Hz had an acute effect in reducing the AHI as well as the number of nocturnal respiratory events of patients presenting with moderate OSA.

scholarly journals Does obstructive sleep apnoea contribute to obesity, hypertension and kidney dysfunction in children? A systematic review protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e039342
Author(s):  
Sara Rodriguez-Lopez ◽  
Stefan Palkowski ◽  
Christopher Gerdung ◽  
Diana Keto-Lambert ◽  
Meghan Sebastianski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Blood Pressure ◽  
Kidney Function ◽  
Obstructive Sleep Apnoea ◽  
Systemic Blood Pressure ◽  
Sleep Apnoea ◽  
Cochrane Library ◽  
Systemic Blood ◽  
Obstructive Sleep ◽  
Obesity Hypertension

IntroductionChildhood obstructive sleep apnoea (OSA) is a highly prevalent disorder that may directly contribute to the development of obesity, hypertension and renal injury. Although those associations seem to be clearer in adults, studies in children have revealed conflicting results and updated synthesis of the evidence is lacking. The aim of this systematic review is to summarise the available evidence on the effect of OSA on obesity, systemic blood pressure and kidney function, to help to elucidate whether respiratory interventions to correct OSA would have the potential to improve those outcomes.Methods and analysisA systematic literature review search was created by a medical librarian and peer-reviewed by a second librarian prior to running. Ovid Medline, Ovid Embase, CINAHL via EbscoHOST, Wiley Cochrane Library and ProQuest Dissertations and Theses Global were searched on 25 February 2020. Titles and abstracts will be screened by two independent reviewers for inclusion, followed by full-text screening of relevant articles. Studies in children will be included if they report data on OSA and weight, systemic blood pressure or kidney parameters. The extracted data will be combined for analysis and the information subcategorised in groups based on outcome. Risk of bias will be determined using tools specific to study methodology and certainty of the evidence using the Grading of Recommendations, Assessment, Development and Evaluations approach.Ethics and disseminationThis study will provide essential information for healthcare professionals to better understand the relationship between childhood OSA and changes in body mass index, systemic blood pressure and kidney function indicators. Our findings will be disseminated through conferences and publications. The results of this review may guide the initiation of new strategies and the development of future research studies. This research did not involve human subjects and therefore did not undergo research ethical review.PROSPERO registration numberCRD42020171186.

scholarly journals Effect of ventilation therapy on mortality rate among obesity hypoventilation syndrome and obstructive sleep apnoea patients

2020 ◽  
Vol 6 (2) ◽  
pp. 00101-2019 ◽  
Author(s):  
Hanna-Riikka Kreivi ◽  
Tuomas Itäluoma ◽  
Adel Bachour
Keyword(s):  
Body Mass Index ◽  
Mortality Rate ◽  
Body Mass ◽  
Obstructive Sleep Apnoea ◽  
Sleep Apnoea ◽  
Control Group ◽  
Obesity Hypoventilation Syndrome ◽  
Obstructive Sleep ◽  
Hypoventilation Syndrome ◽  
Obesity Hypoventilation

IntroductionThe prevalence of obesity is continually increasing worldwide, which increases the incidence of obesity hypoventilation syndrome (OHS) and its consequent mortality.MethodsWe reviewed the therapy mode, comorbidity and mortality of all OHS patients treated at our hospital between 2005 and 2016. The control group consisted of randomly selected patients with obstructive sleep apnoea (OSA) treated during the same period.ResultsWe studied 206 OHS patients and 236 OSA patients. The OHS patients were older (56.3 versus 52.3 years, p<0.001) and heavier (body mass index 46.1 versus 32.2 kg·m−2, p<0.001), and the percentage of women was higher (41.2% versus 24.2%, p<0.001), respectively. The OHS patients had more hypertension (83% versus 61%, p<0.001) and diabetes (62% versus 31%, p<0.001) than the OSA patients, but no higher stroke (4% versus 8%, p=0.058) or ischaemic heart disease (14% versus 15%, p=0.437) incidence. The 5- and 10-year, unadjusted survival rates were lower among the OHS patients than among the OSA patients (83% versus 96% and 74% versus 91%, respectively; p<0.001). Differences in mortality rates were not related to age, sex or body mass index; covariates such as Charlson Comorbidity Index and ventilation therapy predicted survival. The mortality rate decreased significantly (p<0.001) both in OHS and OSA patients even after adjusting for covariates.ConclusionsThe mortality rate in OHS was significantly higher than that in OSA patients even after adjusting for covariates. Ventilation therapy by continuous positive airway pressure or noninvasive ventilation have reduced mortality significantly in all patients.

Rhinological interventions for obstructive sleep apnoea – a systematic review and descriptive meta-analysis

2019 ◽  
Vol 133 (03) ◽  
pp. 168-176 ◽  
Author(s):  
S Sharma ◽  
J C R Wormald ◽  
J M Fishman ◽  
P Andrews ◽  
B T Kotecha
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnoea ◽  
Surgical Intervention ◽  
Meta Analysis ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Current Evidence ◽  
Nasal Surgery ◽  
Surgical Interventions ◽  
Obstructive Sleep

AbstractObjectivesObstructive sleep apnoea is a common chronic sleep disorder characterised by collapse of the upper airway during sleep. The nasal airway forms a significant part of the upper airway and any obstruction is thought to have an impact on obstructive sleep apnoea. A systematic review was performed to determine the role of rhinological surgical interventions in the management of obstructive sleep apnoea.MethodsA systematic review of current literature was undertaken; studies were included if they involved comparison of a non-surgical and/or non-rhinological surgical intervention with a rhinological surgical intervention for treatment of obstructive sleep apnoea.ResultsSixteen studies met the selection criteria. The pooled data suggest that there are reductions in the apnoea/hypopnea index and respiratory disturbance index following nasal surgery. However, the current body of studies is too heterogeneous for statistically significant meta-analysis to be conducted.ConclusionNasal surgery may have limited benefit for a subset of patients based on current evidence.

scholarly journals Alternative Applications of Trans-Oral Robotic Surgery (TORS): A Systematic Review

2020 ◽  
Vol 9 (1) ◽  
pp. 201 ◽  
Author(s):  
Giovanni Cammaroto ◽  
Luigi Marco Stringa ◽  
Henry Zhang ◽  
Pasquale Capaccio ◽  
Francesco Galletti ◽  
...  
Keyword(s):  
Systematic Review ◽  
Robotic Surgery ◽  
English Literature ◽  
Sleep Apnoea ◽  
Obstructive Sleep Apnoea Syndrome ◽  
Electronic Database ◽  
Inclusion Criteria ◽  
Benign Pathology ◽  
Obstructive Sleep

Background: The role of robotic surgery in the field of oncology has been widely described, in particular for the tumours of the oropharynx and larynx, but its efficacy for benign pathology is inconsistent. Methods: An exhaustive review of the English literature on trans-oral robotic surgery (TORS) for benign conditions was performed using PubMed electronic database. Results: The research was performed in March 2019 and yielded more than eight hundred articles, with 103 meeting the inclusion criteria and considered in the present study. Conclusions: The application of TORS for the treatment of obstructive sleep apnoea syndrome seems to be particularly well documented. Additionally, there exists a special interest in its use where high precision in limited anatomic space is required. There are still different structural and economic limitations for the application of TORS, however, the progressive technologic innovations and the increasing adoption of robotic surgery seem to encourage the uptake of this technique.

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