scholarly journals Efficacy of a Trial Oral Appliance in OSAS Management: A New Protocol to Recognize Responder/Nonresponder Patients

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Marzia Segù ◽  
Alessia Cosi ◽  
Antonio Santagostini ◽  
Andrea Scribante
Keyword(s):  
Low Cost ◽  
Oral Appliance ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Oxygen Desaturation Index ◽  
Obstructive Sleep ◽  
Treatment Responder ◽  
Variable Success ◽  
Diagnostic Trial

Oral appliances (OAs) of various types have shown variable success in the treatment of mild-to-moderate obstructive sleep apnoea (OSA). In an OSA sample, this study evaluated the efficacy of a diagnostic trial OA (myTAP™); the efficacy of a definitive custom-fitted mandibular advancement device (MAD) (SomnoDent Flex™); and whether a trial device can be used to distinguish treatment responder from nonresponder patients. Patients underwent overnight home sleep recordings prior to and after fitting of these appliances in order to objectively assess their sleep quality in terms of polysomnographic (PSG) respiratory measures: apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), and minimum oxygen saturation (LowSpO2). 40 patients with symptomatic OSAS were enrolled, 33 males and 7 females, with a mean age of 55.6 ± 12.73 years and an initial (T0) AHI of 26.51 ± 14.79. Trial devices were used in 16 patients (AHI: 29.9 ± 19.97, ODI: 21.06 ± 16.05, and LowSpO2: 82 ± 10.22 at T0) and definitive MADs in 28 (AHI: 23.90 ± 9.19, ODI: 16.27 ± 11.34, and LowSpO2: 82.87 ± 6.04 at T0). Statistically significant decreases in AHI (9.59 ± 8.94, p < 0.0023 ) and ODI (8.20 ± 9.67, p < 0.0129 ) were observed after treatment with the trial device. Only 8 of the patients in the trial device group went on to use the definitive device. Treatment with the definitive MAD produced statistically significant decreases in AHI (11.46 ± 9.65, p < 0.0001 ) and ODI (9.10 ± 8.47, p < 0.0016 ) and a significant improvement in LowSpO2 (85.09 ± 6.86, p < 0.0004 ). Thus, both types of device proved effective in improving the PSG parameters. This study showed that introducing an easy-to-make and low-cost trial device into the therapeutic pathway of OSAS patients can circumvent the problem of individual responses to treatment by allowing effective classification of patients: in short, it allows a first distinction to be drawn between responders and nonresponders to treatment.

scholarly journals Endoscopy evaluation to predict oral appliance outcomes in obstructive sleep apnoea

2016 ◽  
Vol 47 (5) ◽  
pp. 1410-1419 ◽  
Author(s):  
Kentaro Okuno ◽  
Yasuhiro Sasao ◽  
Kanji Nohara ◽  
Takayoshi Sakai ◽  
Benjamin T. Pliska ◽  
...  
Keyword(s):  
Obstructive Sleep Apnoea ◽  
Characteristic Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Oral Appliance ◽  
Expansion Ratio ◽  
Sleep Apnoea ◽  
Receiver Operator Characteristic Curve ◽  
Mandibular Advancement ◽  
Cross Sectional ◽  
Obstructive Sleep

The objective of this study was to determine the utility of nasoendoscopy of the upper airway as a predictor of the efficacy of oral appliance treatment in obstructive sleep apnoea (OSA).A total of 61 consecutive patients with moderate-to-severe polysomnographically diagnosed OSA were recruited for this study. Using nasoendoscopy, we prospectively assessed the velopharynx and oro/hypopharynx in each patient while awake and in the supine position. We measured cross-sectional area (CSA), and anteroposterior and lateral diameters of the airway before and after mandibular advancement, and expressed the changes in dimensions as expansion ratios (after/before). We then compared the measurements of responders and nonresponders with oral appliance treatment.The expansion ratio (median (interquartile range)) for the CSA was greater in responders compared with nonresponders in the velopharynx (2.9 (2.3–5.0)versus1.7 (1.5–1.9), p<0.001) and in the oro/hypopharynx (3.4 (2.5–5.6)versus2.4 (1.8–3.7), p<0.05). Baseline apnoea–hypopnoea index and the CSA expansion ratio of the velopharynx were independent predictors of oral appliance treatment outcome based on a multivariate logistic regression analysis. The estimated area under the receiver operator characteristic curve was 0.87 and the cut-off value of the expansion ratio was 2.00.These results indicate that nasoendoscopy may have significant clinical utility in predicting the success of oral appliance treatment.

scholarly journals Update on oral appliance therapy

2019 ◽  
Vol 28 (153) ◽  
pp. 190083 ◽  
Author(s):  
Marie Marklund ◽  
Marc J.A. Braem ◽  
Johan Verbraecken
Keyword(s):  
Positive Airway Pressure ◽  
Oral Appliance ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Cardiovascular Risks ◽  
Oral Appliance Therapy ◽  
Lower Jaw ◽  
Obstructive Sleep ◽  
Impaired Health

Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive airway pressure. The most commonly used oral appliance advances the lower jaw during sleep, the so-called mandibular advancement device (MAD). Patients seek treatment because of disturbing snoring, daytime symptoms, apnoeas that disturb sleep and the longer term consequences with regard to cardiovascular risks. MADs reduce the apnoea–hypopnoea index, although to various degrees among patients. Effects on daytime sleepiness have been observed mainly among the more severe OSA patients. Blood pressure may be reduced in MAD-treated OSA patients. There is, however, uncertainty about which patients will respond to this therapy in terms of apnoea reductions, decreased sleepiness and other symptoms, and reduced risk for future impaired health. The occurrence of side-effects also remains difficult to predict at present. The majority of sleep apnoea patients suffer from various comorbidities in terms of cardiovascular diseases, type 2 diabetes and depression. The most recent findings indicate that phenotyping of patients, considering various aspects of this multifaceted disease, will shed more light on the indications for MADs in patients with nightly sleep breathing disturbances. This review summarises the most recent knowledge about MAD treatment.

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

Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care

2021 ◽  
pp. 2101788
Author(s):  
Jean-Louis Pépin ◽  
Peter Eastwood ◽  
Danny J. Eckert
Keyword(s):  
Treatment Success ◽  
Clinical Manifestations ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Individual Risk ◽  
Future Research ◽  
Success Rates ◽  
Recent Advances ◽  
Obstructive Sleep

Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, “one size fits all”, trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.

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