Obstructive Sleep Apnoea in Orthodontics - A Review

Obstructive sleep apnoea (OSA) is a sleep associated breathing disorder and it affects the health and quality of life of individuals suffering from it. Orthodontists should be well aware of the symptoms of this disorder and competent enough to recognize its signs and symptoms. Orthodontics is well suited for the treatment of OSA patients due to their expertise and knowledge regarding growth and development of orofacial and dentofacial structures as well as orthopaedic, orthodontic, and surgical correction of the jaws and other supporting tissues. There are basically two types of sleep apnoea- Central sleep apnoea and obstructive sleep apnoea where obstructive sleep apnoea is the more common one. This disorder can be life threatening as the oxygen supply to various parts of the body is substantially reduced. Obstructive sleep apnoea is caused by an interplay between a variety of factors, including sleep related loss of muscle tone in the tissues supplied by the glossopharyngeal nerve, anatomical obstruction of the nasal passages, large tonsils, large tongue, a retrognathic mandible, obesity, alcohol, sedative medication, and allergies. Sleep apnoea can be caused due to many factors and many treatment modalities have been employed to correct this disorder including mandibular advancement appliances, polysomnographs, and surgical intervention. It can be treated using surgery, continuous positive airway pressure and oral appliances therapy. This article highlights the role the orthodontist plays in the diagnosis and treatment planning of OSA patients. KEY WORDS Orthodontics, Obstructive Sleep Apnoea, Sleep, Snoring

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Intervention to enhance adherence to mandibular advancement appliance in patients with obstructive sleep apnoea: study protocol for a randomised clinical trial

Trials ◽

10.1186/s13063-021-05582-1 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Harishri Tallamraju ◽

J. Tim Newton ◽

Padhraig S. Fleming ◽

Ama Johal

Keyword(s):

Social Support ◽

Clinical Trial ◽

Obstructive Sleep Apnoea ◽

Treatment Success ◽

Upper Airway ◽

Randomised Clinical Trial ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Treatment Modalities ◽

Obstructive Sleep

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

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Current principles in the management of obstructive sleep apnoea with mandibular advancement appliances

BDJ ◽

10.1038/sj.bdj.4801025a ◽

2001 ◽

Vol 190 (10) ◽

pp. 532-536 ◽

Cited By ~ 4

Author(s):

A. Johal ◽

J. Battagel

Keyword(s):

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Mandibular Advancement Appliances

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An Investigation into the Changes in Airway Dimension and the Efficacy of Mandibular Advancement Appliances in Subjects with Obstructive Sleep Apnoea

British Journal of Orthodontics ◽

10.1093/ortho/26.3.205 ◽

1999 ◽

Vol 26 (3) ◽

pp. 205-210 ◽

Cited By ~ 34

Author(s):

Amandeep Johal ◽

Joanna M. Battagel

Keyword(s):

Obstructive Sleep Apnoea ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Obstructive Sleep ◽

Mandibular Advancement Appliances

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Variations in funding for treatment of obstructive sleep apnoea in England

The Journal of Laryngology & Otology ◽

10.1017/s0022215121000906 ◽

2021 ◽

pp. 1-6

Author(s):

K Chaidas ◽

A Ashman

Keyword(s):

Continuous Positive Airway Pressure ◽

Obstructive Sleep Apnoea ◽

Clinical Assessment ◽

Airway Pressure ◽

Positive Airway Pressure ◽

Sleep Apnoea ◽

Mandibular Advancement ◽

Treatment Modalities ◽

National Guidelines ◽

Obstructive Sleep

Abstract Objectives This study aimed to review the funding policies of clinical commissioning groups for treatment of obstructive sleep apnoea in England. Methods Published policies from a randomly selected sample of 60 out of 190 clinical commissioning groups were reviewed. Results Continuous positive airway pressure was funded based on a clinical assessment or according to criteria that were in line with national guidelines in most clinical commissioning groups (49 of 60), with 11 clinical commissioning groups offering no policy. Mandibular advancement devices, tonsillectomy and nasal surgery were funded based on a clinical assessment or certain criteria in 16, 25 and 16 clinical commissioning groups, respectively. In contrast, only one clinical commissioning group provided funding for soft palate, tongue base or mandibular surgery. Hypoglossal nerve stimulation was not mentioned in any clinical commissioning group's policy. Conclusion Although most clinical commissioning groups provide funding for the use of continuous positive airway pressure, the availability of funding for other obstructive sleep apnoea treatment modalities is heterogeneous, leaving continuous positive airway pressure intolerant patients with limited therapeutic options in some regions.

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