Impact Of Mandibular Advancement Device Associated With CPAP Interface On Upper Airway Mechanical Properties Assessed By Phrenic Nerve Stimulation In Patients With Obstructive Sleep Apnea

AbstractOral devices that treat obstructive sleep apnea are an easy and influential option to protect the upper airways from sleep obstructions. One example is the mandibular advancement device (MAD), which is a non-invasive apparatus specified in adults with simple snoring and mild obstructive sleep apnea. Recently, due to the constraints of other therapies, like positive airway pressure treatment and surgical methods, there has been growing interest in the use of oral appliance for simple snoring patients. MAD is managed to improve the upper airway volume, minimize upper airway collapse and reduce snoring. On the other hand, it remains inferior to CPAP in the reduction of the apnea-hypopnea scores, with therapy success varying from 24% to 72%. The treatment modalities include skilled physicians and multidisciplinary strategies to treat patients with snoring and obstructive sleep apnea (OSA) effectively. Some researchers also suggest potential predictors of progress in care, but specific criteria for patient selection and predictive clinical principles for effectiveness in all treatment modalities are still needed. The aim of this brief clinical Study is to review MAD brief history, design, indications, contraindications, therapy efficiency, side effects, and current perspectives.

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Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices

Journal of Clinical Medicine ◽

10.3390/jcm10225255 ◽

2021 ◽

Vol 10 (22) ◽

pp. 5255

Author(s):

Sara Camañes-Gonzalvo ◽

Rocío Marco-Pitarch ◽

Andrés Plaza-Espín ◽

Javier Puertas-Cuesta ◽

Rubén Agustín-Panadero ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Oxygen Saturation ◽

Upper Airway ◽

Mandibular Advancement Device ◽

Mandibular Advancement ◽

Apnea Hypopnea Index ◽

Percentage Increase ◽

Obstructive Sleep ◽

Mandibular Advancement Devices

Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).

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853 Severe Obstructive Sleep Apnea after Treatment with Phrenic Nerve Implant for Central Sleep Apnea: A Case for Dual Stimulation?

SLEEP ◽

10.1093/sleep/zsab072.850 ◽

2021 ◽

Vol 44 (Supplement_2) ◽

pp. A332-A332

Author(s):

Sarah Sussman ◽

Ashwin Ananth ◽

Elie Fares ◽

Colin Huntley ◽

Maurits Boon ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Nerve Stimulation ◽

Phrenic Nerve ◽

Hypoglossal Nerve ◽

Central Sleep Apnea ◽

Implantable Devices ◽

Nerve Stimulator ◽

Phrenic Nerve Stimulation ◽

Obstructive Sleep

Abstract Introduction The remedē® system is a transvenous phrenic nerve stimulator used to treat central sleep apnea (CSA). It is a safe and effective implantable device that has demonstrated significant improvements in objective sleep and quality of life. While complex sleep apnea represents development of central sleep apnea during treatment with continuous positive airway pressure (CPAP) for obstructive sleep apnea, and has been well-described in the literature, we present a novel case of predominantly central sleep apnea treated with phrenic nerve stimulation with augmentation of obstructive events thereafter. This patient is, at the time of submission, being evaluated for hypoglossal nerve stimulation. Report of case(s) A 63-year-old male patient with a past medical history of hypertension, atrial fibrillation, asthma, chronic obstructive pulmonary disease, GERD, obesity, and prior pulmonary embolism presented to the sleep medicine clinic with complaints of difficulty initiating and maintaining sleep, snoring, multiple nocturnal awakenings, excessive daytime sleepiness, and physical fatigue. On exam, BMI was 30.4, and airway classification was Mallampati 4. Split night polysomnography revealed severe mixed sleep apnea with an overall apnea hypopnea index (AHI) of 58.6 and a central AHI of 53.8 per hour after successful PAP titration at 7 cm H2O. He underwent phrenic nerve stimulator implantation and activation without complications. Phrenic nerve stimulation titration study four months after activation showed a normal central AHI of 4.6 per hour at a therapeutic voltage of 1.6 to 1.9mA, but significantly worse OSA with obstructive AHI of 53.1. In follow up, he reported intolerance of CPAP due to significant nasal congestion as well as asthma. Presently, he is scheduled for drug induced sleep endoscopy to visualize airway obstruction and is being evaluated for Inspire hypoglossal nerve stimulation and nasal surgery. Conclusion The treatment of sleep apnea has recently evolved rapidly with the development of implantable devices to treat both central and obstructive sleep apnea. We present a novel case of the first known patient to be considered for dual nerve stimulation for sleep apnea. Further study needs to be done to determine the safety and efficacy of concurrent implantable devices for the simultaneous treatment of OSA and CSA. Support (if any):

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