EFFICACY OF CUSTOM-MADE ORAL APPLIANCE FOR TREATMENT OF OBSTRUCTIVE SLEEP APNEA

Objective: To evaluate the outcomes of custom-made oral appliances (OAs) for the treatment of obstructive sleep apnea (OSA) in Thai patients. Materials and Methods: A retrospective review of polysomnography (PSG) results and relevant information, including patient characteristics, visual analog scale (VAS) of sleep-associated symptoms, and Epworth Sleepiness Scale (ESS) of patients treated with an OA between January 2010 and January 2018 was done at Siriraj Hospital, Thailand. Inclusion criteria were OSA patients aged 18 years or older who underwent diagnostic and therapeutic PSG with a custom-made OA. Exclusion criteria were patients who were lost to follow-up or had incomplete PSG data. Results: Sixty-seven OSA patients were recruited. The median apnea-hypopnea index (AHI) was significantly decreased from 16.5 (11.5, 27.8) to 5.1 (2.8, 11.3) events per hour (p<0.001) and the median minimal oxygen saturation increased from 82.0 (77.0, 86.0) to 87.0 (80.0, 90.0) with OA treatment (p<0.001). ESS scores decreased from 9 (6, 13) to 7 (4, 9) (p<0.001) and the VAS of snoring loudness and frequency as rated by family members or bed partners decreased from 6 (4, 7.5) to 3.3 (2, 5) and from 5.5 (3.2, 7.6) to 3.4 (2, 5.3), respectively (p<0.001). Forty-one patients (61%) had a 50% reduction of AHI, and an AHI of less than 15 events per hour after treatment, which were considered good responses. Common adverse effects of the treatment included temporomandibular joint discomfort, dry mouth, excessive salivation, gingival pain, and toothache, but these occurred to only a mild-to-moderate degree and were tolerable. Conclusion: Custom-made OA is an effective alternative treatment for OSA in selected Thai patients, particularly for those with a mild-to-moderate degree. Keywords: Custom-made oral appliance, Obstructive sleep apnea, OA, OSA, Thai

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0690 An Evaluation Of Genioglossus Strengthening On Obstructive Sleep Apnea Treatment Outcomes

SLEEP ◽

10.1093/sleep/zsaa056.686 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A263-A263

Author(s):

M Maghsoudipour ◽

N Bosompra ◽

R Jen ◽

Y Li ◽

S Moore ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Upper Airway ◽

Oral Appliance ◽

Controlled Study ◽

Final Visit ◽

Muscle Training ◽

Definable Subset ◽

Obstructive Sleep ◽

Custom Made

Abstract Introduction Obstructive sleep apnea (OSA) is characterized by repetitive episodes of pharyngeal collapse. The genioglossus is a major upper airway dilator muscle thought to be important in OSA pathogenesis. Upper airway (UA) muscle training has reported benefits in some OSA patients. Our goal was to assess the effect of upper airway muscle training on OSA outcomes. Methods Sixty five patients with OSA (AHI>10/h) were divided in three subgroups: 1) Treated with auto-CPAP (n=21), 2) Previously failed or refused CPAP therapy (no treatment), (n=24), 3) Currently treated with an oral appliance who still have residual OSA (AHI>10/h), (n=20). All subjects were given a custom-made tongue strengthening device. Within each group we conducted a prospective, randomized, controlled study examining the effect of upper airway muscle training. In each subgroup, subjects were randomized to UA muscle training (volitional protrusion against resistance) or sham group (negligible resistance), with 1:1 ratio over 6 weeks of treatment (twice daily for 20 min/session). In the baseline and the final visit, subjects completed home sleep testing, questionnaires (ESS, PSQI), acoustic pharynogometry, Iowa Oral Performance Instrument (IOPI), and Psychomotor Vigilance Test (PVT). Results Results remain blinded; 33 patients received treatment Y and 32 patients received treatment Z. To date, we have not observed a main effect of treatment group on several measures of OSA severity. Some changes in subjective measures over time were observed but difficult to interpret until unblinding occurs. Conclusion Treatment of OSA using upper airway muscle training exercises requires further study. Whether muscle training is a viable approach for a definable subset of OSA patients remains unclear. Support R01HL085188-05A1 (U.S. NIH Grant/Contract)

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Oral Appliances in Obstructive Sleep Apnea

Healthcare ◽

10.3390/healthcare7040141 ◽

2019 ◽

Vol 7 (4) ◽

pp. 141 ◽

Cited By ~ 2

Author(s):

Dieltjens ◽

Vanderveken

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Oral Appliance ◽

Mandibular Advancement ◽

Oral Appliances ◽

Invasive Treatment ◽

Oral Appliance Therapy ◽

Obstructive Sleep ◽

Custom Made ◽

Mandibular Advancement Devices

Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

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