scholarly journals Usefulness of a Titratable Mandibular Positioner During Sleep Endoscopy as a Prediction Tool for Treatment Outcome with Mandibular Advancement Devices: DISE-SAM Protocol

2021 ◽  
Author(s):  
Patricia Fernández-Sanjuán ◽  
Juan José Arrieta ◽  
Jaime Sanabria ◽  
Marta Alcaraz ◽  
Gabriela Bosco ◽  
...  
Keyword(s):  
Positive Relationship ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
Respiratory Disorder ◽  
Sleep Endoscopy ◽  
Multiple Treatment ◽  
Mandibular Advancement Devices ◽  
Mandibular Protrusion ◽  
The Relationship ◽  
Jaw Thrust Maneuver

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. However, different maneuvers have been performed during the performance of drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response, and to determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, a BMI of 27.90 (SD = 4.19) kg/m2 and a mean AHI of 26.51 (SD = 21.23). Results showed no relationship between severity and MAD recommendation. Also, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the inter-examiner bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

scholarly journals P149 The role of OSA pathophysiological traits on mandibular advancement treatment response and efficacy of a novel mandibular advancement device

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A70-A70
Author(s):  
B Tong ◽  
A Osman ◽  
C Bull ◽  
A Chiang ◽  
M Donegan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Gold Standard ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
The Novel ◽  
Oral Airway ◽  
Respiratory Events ◽  
Mandibular Advancement Devices ◽  
Pressure Catheter

Abstract Mandibular advancement devices (MAD) are an effective therapy for OSA. However, treatment response is difficult to predict. Recent studies have investigated the influence of OSA endotypes on MAD outcomes albeit using simplified endotyping methods. We aimed to prospectively quantify and compare OSA pathophysiological traits between responders and non-responders to a novel MAD using gold-standard endotyping methodology. Data from 30 OSA patients (AHI>10events/h) are analysed to date. OSA was confirmed via in-laboratory polysomnography. Next, a detailed physiology night was conducted before MAD therapy. Participants were instrumented with EEG, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular genioglossus electrodes to quantify baseline OSA pathophysiological traits. Pcrit was quantified via CPAP drops and non-anatomical traits from naturally occurring respiratory events. Participants were fitted with a novel MAD with a built-in oral airway (Oventus O2Vent Optima™) and titrated to ≥75% of maximum mandibular advancement. A treatment efficacy PSG followed therapy acclimatisation. OSA severity decreased by 41±30% (25.1[16.3,39.2] vs. 12.1[7.3,20.0] events/h P<0.001) with MAD therapy. Similar reductions occurred in participants with high nasal resistance. OSA pathophysiological traits measured by gold-standard methodology were similar between responders and non-responders to MAD (residual AHI>10events/h). MAD responders had less collapsible airways at baseline when measured using simple estimates (Vpassive: 92.5[86.3,97.0] vs. 72.5[43.0,91.3] %Veupnea, P=0.022). The novel MAD reduced OSA severity by ~40% including in those with nasal obstruction. The upper airway was less collapsible in responders to MAD when estimated but not when directly measured. Simple estimates of OSA pathophysiological traits may be used to predict responses to MAD.

Investigation of the relationship between snoring sounds features and response to the mandibular advancement devices

2019 ◽  
Vol 64 ◽  
pp. S331
Author(s):  
S. Saha ◽  
G. Gruenspan ◽  
M.M. Kabir ◽  
N. Montazeri ◽  
M. Hafezi ◽  
...  
Keyword(s):  
Mandibular Advancement ◽  
Mandibular Advancement Devices ◽  
The Relationship

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

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).

scholarly journals A Procedure for Analyzing Mandible Roto-Translation Induced by Mandibular Advancement Devices

Materials ◽  
2020 ◽  
Vol 13 (8) ◽  
pp. 1826 ◽  
Author(s):  
Giovanni Bruno ◽  
Alberto De Stefani ◽  
Edoardo Conte ◽  
Manila Caragiuli ◽  
Marco Mandolini ◽  
...  
Keyword(s):  
Mouth Opening ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Dental Arch ◽  
Invasive Treatment ◽  
Sleep Related Breathing Disorders ◽  
Local Reference System ◽  
Local Reference ◽  
Mandibular Advancement Devices

Background: Sleep-Related Breathing Disorders are characterized by repeated episodes of complete or partial obstruction of the upper airway during sleep. Mandibular advancement devices represent a non-invasive treatment in reducing the number of respiratory events and in decreasing symptoms. The advancement extent of these devices is responsible for the mandibular roto-translation and its effects on the temporomandibular joint. Methods: This study defined a systematic method to assess the mandible roto translation that is caused by MADs according to a scan-to-CAD approach. Starting from a closed mouth position and simulating the oral appliance at different settings it was possible to define a local reference system that is useful for the evaluation of the mandibular roto-translation. This latter was then applied to evaluate the movements of the condyle and the mandibular dental arch. Results: MAD1 resulted in a reduced mouth opening and protrusion, while MAD2 enabled a higher degree of motion of the mandible useful for patients who need an important protrusion. Conclusions: The two devices present different dynamics. Results that are achievable employing this method can be directly used by practitioners in comparing MADs, as well as by researchers in evaluating MADs effects.

scholarly journals An evaluation of two different mandibular advancement devices on craniofacial characteristics and upper airway dimensions of Chinese adult obstructive sleep apnea patients

2015 ◽  
Vol 85 (6) ◽  
pp. 962-968 ◽  
Author(s):  
Finn Geoghegan ◽  
Anika Ahrens ◽  
Colman McGrath ◽  
Urban Hägg
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Hyoid Bone ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
Twin Block ◽  
Chinese Adult ◽  
Obstructive Sleep ◽  
Mandibular Advancement Devices ◽  
Airway Dimensions

ABSTRACT Objectives: To evaluate the effects of two different mandibular advancement devices (MADs) on craniofacial characteristics and upper airway dimensions of Chinese adult patients with obstructive sleep apnea (OSA). Materials and Methods:  Forty-five patients with OSA were recruited as part of a prospective randomized crossover trial for treatment with two different MADs. Lateral cephalograms were taken, and the Epworth Sleepiness Scale and the Sleep Apnea Quality of Life Index were completed at baseline. Results:  The Apnea-Hypoxia Index was highly significantly reduced with the monoblock (P &lt; .001) and significantly reduced with the twin block (P &lt; .01). The monoblock demonstrated a superior result than the twin block (P &lt; .05). A significant reduction was found in the distances between the hyoid bone to retrognathia (monoblock, P &lt; .01; twin block, P &lt; .001) as well as the distance between the hyoid bone and mandibular plane angle (P &lt; .001). Furthermore, soft palate length increased significantly (P &lt; .05) with both MADs. However, the changes did not differ in favor of either MAD. Conclusion:  Monoblock was the better MAD to improve OSA severity. No difference could be found in changes of subjective OSA indicators. Significant but similar cephalometric changes were observed, indicating both MADs alter the position of the surrounding musculature and improve upper airway patency. Therefore, the different design features of the MADs suggest an impact on some OSA indicators.

scholarly journals Drug-induced Sleep Endoscopy: Are there Predictors for Failure of Oral Appliance Treatment?

2021 ◽  
Author(s):  
Christianne C.A.F.M. Veugen ◽  
Rineke M.C. Sanders ◽  
Robert J. Stokroos ◽  
Marcel P. Copper
Keyword(s):  
Oral Appliance ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Sleep Endoscopy ◽  
Evaluation Tool ◽  
Drug Induced ◽  
Failure Group ◽  
Drug Induced Sleep Endoscopy ◽  
Obstructive Sleep ◽  
Jaw Thrust Maneuver

Abstract Introduction In the literature, evidence is lacking on the predictive value of drug-induced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] > 10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or > 50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI < 30 events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI < 30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p < 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

scholarly journals The relationship between specific nasopharyngoscopic features and treatment deterioration with mandibular advancement devices: a prospective study

2020 ◽  
Vol 16 (7) ◽  
pp. 1189-1198 ◽  
Author(s):  
Eli Van de Perck ◽  
Sara Op de Beeck ◽  
Marijke Dieltjens ◽  
Anneclaire V. Vroegop ◽  
Annelies E. Verbruggen ◽  
...  
Keyword(s):  
Prospective Study ◽  
Mandibular Advancement ◽  
Mandibular Advancement Devices ◽  
A Prospective Study ◽  
The Relationship

Relationship of Love, Affect and Wellbeing

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Dr. Thiyam Kiran Singh ◽  
Aastha Dhingra
Keyword(s):  
Positive Affect ◽  
Positive Emotions ◽  
Positive Relationship ◽  
Interpersonal Relationship ◽  
Significant Positive Relationship ◽  
Young Females ◽  
Close Friendship ◽  
Major Facilitator ◽  
Relationship Of ◽  
The Relationship

Love is more than a close friendship. It acts as a major facilitator of interpersonal relationship. Love is positive in nature and leaves a positive affect on every individual. An individual in love not only feels positive but spreads positivity around. They smile, be kind to other people, behave compassionately with everyone. If the person is happy then he is likely to be psychologically and emotionally healthy. The current study aimed at understanding the relationship between love, affect and wellbeing among young females aged between 20-25 years. The study reported a significant positive relationship between love and positive affect with the significant correlation of 0.29 at 0.05 levels (p<0.05). It was also found a significant positive relationship between love and wellbeing with the significant correlation of 0.58 at 0.01 level (p<0.01). This means that people in love experience positive emotions and healthy wellbeing. The correlation between love and negative affect came out to be insignificant. The correlation turned out to be -0.13. This means that people in love do not experience negative emotions.

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