scholarly journals Efficacy of Somnodent® Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients Somnodent® OAs for Moderate to Severe OSAHS

2021 ◽  
Vol 3 (3) ◽  
pp. 01-07
Author(s):  
Guillaume Buiret ◽  
Frederic Chidiac
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Reduction Rate ◽  
Oral Appliance ◽  
Dropout Rate ◽  
Apnea Hypopnea Index ◽  
Severe Obstructive Sleep Apnea ◽  
Oral Appliances ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome

Objective: Oral appliances are one of the treatments of obstructive sleep apnea hypopnea syndrome. The main objective of the study was to determine the efficacy of the Somnodent® oral appliance on Apnea-Hypopnea Index. The secondary objective was to measure the efficacy on other oxymetric parameters and to determine its tolerance and dropout rate. Methods: Efficacy results of the oral appliances based on the apnea hypopnea index, the oxygen desaturation index and the lower oxygen saturation reduction, appliance complications and dropout rates were retrospectively collected from 25 patients with a moderate to severe obstructive sleep apnea hypopnea syndrome treated by a Somnodent® oral appliance. The procedure was entirely performed by otolaryngologists. Results: The AHI with OA was more significantly reduced in patients with a higher initial apnea hypopnea index and a higher initial body mass index but reduction was not related to age and not proportional to degree of mandibular advancement. The 50%-AHI reduction rate after OA was 55.6%, the AHI ≤5/h rate after OA was 22.2%. The OA significantly reduced the mean apnea-hypopnea index (-14.3/h, p<10-5). No patient had his AHI increased with oral appliance. One patient stopped using OA mainly because of nausea. Conclusions: Somnodent® is an effective and well-tolerated treatment for moderate to severe obstructive sleep apnea hypopnea syndrome.

scholarly journals Dysfunction of Nrf2-ARE Signaling Pathway: Potential Pathogenesis in the Development of Neurocognitive Impairment in Patients with Moderate to Severe Obstructive Sleep Apnea-Hypopnea Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-15 ◽  
Author(s):  
Li Zhou ◽  
Ruoyun Ouyang ◽  
Hong Luo ◽  
Yating Peng ◽  
Ping Chen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Signaling Pathway ◽  
Neurocognitive Impairment ◽  
Apnea Hypopnea Index ◽  
Heme Oxygenase 1 ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
Hypopnea Syndrome ◽  
Nrf2 Protein

The present study investigated the nuclear factor erythroid 2-related factor 2- (Nrf2-) antioxidant response element (ARE) signaling pathway in patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS). Their correlation with neurocognitive impairment metrics was investigated to explore potential pathogenesis in OSAHS. Forty-eight patients with OSAHS and 28 controls underwent testing with the Epworth Sleep Scale (ESS), MATRICS Consensus Cognitive Battery (MCCB), Stroop Color and Word Test, polysomnography (PSG), and measurements of the concentration of plasma superoxide dismutase (SOD) and thioredoxin (Trx). Further, 20 pairs of matched patients with OSAHS and controls were selected for measurement of the expression (protein and mRNA) of Nrf2 and of its downstream antioxidase, heme oxygenase-1 (HO-1), in peripheral mononuclear cells (PBMCs). Finally, correlations between neurocognitive impairment and the above metrics were analyzed. Expression of Nrf2 and HO-1 mRNA and protein in the PBMCs, as well as plasma SOD and Trx levels, were significantly reduced in patients with OSAHS. After adjusting for education, sex, age, and smoking index, the expression of Nrf2-ARE signaling pathway proteins (or mRNA) was closely correlated with sleep respiratory parameters. An inverse relationship was demonstrated between the expression of nuclear Nrf2 in PBMCs, concentration of plasma SOD and Trx, and apnea-hypopnea index (AHI) in patients with OSAHS. Trx, nuclear Nrf2 protein, and HO-1 protein were also negatively correlated with the percent of time that SaO2 was less than 90% (TSat90). Total Nrf2 protein level was positively correlated with AHI and TSat90 and negatively correlated with minimum SaO2 (LSaO2), while nuclear Nrf2 protein and HO-1 protein were positively correlated with LSaO2. Moreover, significant positive correlations were found between maze scores and expression of nuclear Nrf2 protein, HO-1 protein, and SOD and Trx levels. Furthermore, inverse relationships between total Nrf2 protein in PBMCs and HVLT-R and maze scores were found. Multiple linear regression showed plasma Trx concentration as a potential predictor of maze and BVMT-R scores. In conclusion, the expression of Nrf2-ARE molecules and related antioxidases is significantly decreased in patients with OSAHS and is correlated with neurocognitive dysfunction. The Nrf2-ARE signaling pathway may play a crucial role in neurocognitive impairment in patients with moderate to severe OSAHS. Further studies are needed to explore the exact mechanisms and potential treatment interventions.

Custom-Made Oral Appliances for the Treatment of Obstructive Sleep Apnea: Outcomes in Thai Patients

2021 ◽  
Vol 104 (4) ◽  
pp. 571-575
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Patient Characteristics ◽  
Oral Appliance ◽  
Relevant Information ◽  
Apnea Hypopnea Index ◽  
Moderate Degree ◽  
Oral Appliances ◽  
Obstructive Sleep ◽  
Custom Made

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

Predictive Factors for Efficacious Oral Appliance Therapy in Moderate to Severe Obstructive Sleep Apnea Patients

2021 ◽  
Author(s):  
Guillaume Buiret ◽  
Maroun Bechara ◽  
Isabelle Plouin‐Gaudon ◽  
Frederique Bavozet ◽  
Olivia Dancea ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Predictive Factors ◽  
Oral Appliance ◽  
Severe Obstructive Sleep Apnea ◽  
Oral Appliance Therapy ◽  
Obstructive Sleep

scholarly journals Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study

2021 ◽  
Vol 10 (6) ◽  
pp. 1255
Author(s):  
Hiroyuki Ishiyama ◽  
Masayuki Hideshima ◽  
Shusuke Inukai ◽  
Meiyo Tamaoka ◽  
Akira Nishiyama ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Pilot Study ◽  
Reduction Rate ◽  
Oral Appliance ◽  
Respiratory Resistance ◽  
Obstructive Sleep ◽  
Respiratory Event ◽  
Significant Difference ◽  
Treatment Responses

The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, p < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA (p < 0.05). There was no significant difference in non-responders (p > 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5–28.0; p = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.

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