scholarly journals Respiratory and Cardiovascular Parameters Evaluation in OSA Patients Treated with Mandibular Advancement Device

2020 ◽  
Vol 10 (22) ◽  
pp. 8175
Author(s):  
Ciavarella Domenico ◽  
Tepedino Michele ◽  
Burlon Giuseppe ◽  
Ferrara Donatella ◽  
Cazzolla Angela Pia ◽  
...  
Keyword(s):  
Cardiac Arrhythmias ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Cardiovascular Parameters ◽  
Cardiac Stress ◽  
Cardiovascular Comorbidities ◽  
Oxygen Desaturation Index ◽  
Obstructive Sleep ◽  
Important Sign

Obstructive sleep apnea (OSA) is associated with a number of cardiovascular comorbidities, including hypertension, heart rate (HR) alterations, cardiac arrhythmias, endothelial dysfunction and atherosclerosis. HR, in particular, is an important sign correlated with cardiac stress and survival. Previous investigations on the effects of mandibular advancement device (MAD) therapy on HR resulted in contradictory findings. The aim of the present retrospective cohort study was to evaluate the effects of MAD therapy with a fully customizable appliance on respiratory and cardiovascular parameters. Fifty adult consecutive cases with mild to severe OSA underwent split-night polysomnography (SN-PSG) at baseline (T0) and after three months of MAD treatment (T1), after appropriate titration. The apnea/hypopnea index (AHI), 4% oxygen desaturation index (ODI) and HR (average, minimum and maximum) values are recorded at T0 and at T1 and statistically compared. The AHI and ODI values improved after three months of MAD treatment. The minimum HR increased after treatment, while the maximum HR decreased after treatment. MAD treatment with a fully customizable appliance was effective in improving breathing and cardiovascular parameters in adult patients with mild to severe OSA.

scholarly journals Long Term Therapeutic Efficacy of a Soft Monobloc Mandibular Advancement Device in Adults with Obstructive Sleep Apnea

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Fabiana Ballanti ◽  
Salvatore Ranieri ◽  
Alberto Baldini ◽  
Paola Cozza
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Therapeutic Efficacy ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Stomatognathic System ◽  
Obstructive Sleep ◽  
T1 And T2

Aim. To evaluate the long term (48 months) therapeutic efficacy of a soft monobloc mandibular advancement device in adult patients with mild or moderate obstructive sleep apnea.Methods. The study population comprised 28 patients (6 female and 22 male, mean age52.2±6.8years) affected by obstructive sleep apnea. After a baseline medical and somnographic examination, a functional examination of the stomatognathic system, and a questionnaire focused on sleep-related qualities and a daytime somnolence, each patient received an individual device. Two follow-ups were made 6 months (T1) and 48 months (T2) after soft monobloc mandibular advancement device treatment had been initiated, and all initial examinations were repeated.Results. The statistical analysis showed a significant decrease in body mass index value between T1 and T2 (ρ= 0,012), an increase of Epworth sleepiness scale value between T1 and T2 (ρ= 0,012), and a significant improvement and decrease of apnea/hypopnea index between T0 and T1 (ρ= 0,010) and between T0 and T2 (ρ= 0,013).Conclusion. Treatment with the soft monobloc mandibular advancement device is a therapeutic solution with long term and stable effects (48 months) for patients suffering from mild or moderate obstructive sleep apnea.

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 Comparative Evaluation Of The Efficacy Of Customized Maxillary Oral Appliance With Mandibular Advancement Appliance As A Treatment Modality For Moderate Obstructive Sleep Apnea Patients- Protocol For A Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Vikram Murlidhar Belkhode ◽  
Surekha Godbole ◽  
Sharayu Vinod Nimonkar
Keyword(s):  
Randomized Controlled Trial ◽  
Pressure Transducer ◽  
Controlled Trial ◽  
Oral Appliance ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Nasal Airflow ◽  
Randomized Controlled ◽  
Obstructive Sleep

BACKGROUND Obstructive sleep apnea (OSA) is due to the obstruction of the upper airway during sleep. This condition is often associated with multiple symptoms and co-morbidities. There are many treatment options mentioned in the literature to manage OSA, among which interventional option of continuous positive airflow (CPAP) and non-interventional option i.e, Mandibular advancement device (MAD), which is an oral appliance (OA) are most preferred ones. OBJECTIVE To evaluate the efficacy of customized maxillary Oral appliance compared with mandibular advancement device in moderate OSA patients. METHODS A Prospective Interventional study with a randomized controlled trial will be carried out involving 40 participants (sample size), with an apnea-hypopnea index (AHI) >15–30, recorded on Polysomnography (PSG). Study participants will be randomly divided into following treatment groups: control group or group subjected to mandibular advancement device (MAD, n=20) and second group subjected to customized maxillary oral appliance (CMOA, n=20). Baseline assessment of Apnea/hypopnea index (AHI), oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth sleepiness scale will be done. Then both study group participants will receive their respective appliances. And after one month and three months of delivery of appliance, all the parameters i.e AHI, oxygen saturation in blood, percentage of rapid eye movement, electroencephalogram, electrocardiogram, oro-nasal airflow via a pressure transducer, and Epworth sleepiness scale will be re-evaluated and compared with the baseline measurements. RESULTS Descriptive and analytical statistics will be done. SPSS (Statistical Package for Social Sciences) Version 20.1 will be used as statistical software. The statistical significance between the two groups after one month and three months will be evaluated at p<0.05. We expect, customized maxillary oral appliance to be more efficient in managing moderate OSA, in comparison with MAD. CONCLUSIONS If the hypothesis of the present study is confirmed, then this customized maxillary appliance will be quoted as a “gold standard” for managing moderate OSA.

449 The Effects of Positional and Sleep Stage Dependency on Mandibular Advancement Device Treatment Outcome in Obstructive Sleep Apnea

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A177-A178
Author(s):  
Chien-Feng Lee ◽  
Yunn-Jy Chen ◽  
Yu-Ching Chen ◽  
Ming-Tzer Lin ◽  
Pei-Lin Lee ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sleep Stage ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Treatment Naïve ◽  
Osa Treatment ◽  
The Relationship

Abstract Introduction Mandibular advancement device (MAD) responder phenotype are not well understood in patients with obstructive sleep apnea (OSA). Recent studies have reported the association between MAD treatment response and polysomnographic phenotypes using positional and sleep stage dependency, but with inconsistent findings. Thus, the study aims to investigate the relationship between the two phenotypes and MAD response. Methods This retrospective study recruited patients with OSA (apnea-hypopnea index [AHI] &gt;10/h), who were 20 to 80 years old, treatment naïve, and received MAD treatment for more than three months from 2009 to 2017. AHIsupine/AHInon-supine ≥2 and &lt;2 meant supine predominant (supine-p) and non-positional OSA, respectively. REM-AHI/NREM-AHI ≥2, ≤0.5, and between 0.5 to 2 indicated REM-predominant (REM-p), NREM-predominant (NREM-p), and stage-independent (SI) OSA, respectively. Three criteria defined successful MAD treatment (i.e., criterion 1: residual AHI &lt;5/h with &gt;50% reduction; criterion 2: residual AHI 50% reduction; criterion 3: reduction &gt;50%). The association between the two phenotypes and the three treatment criteria was identified using multivariable logistic regression. Results A total of 218 patients with a median age of 52.5 years, body mass index (BMI) of 25.4 kg/m2, and AHI of 28.2/h were recruited. Supine-p OSA had lower waist circumferences than non-positional OSA. The REM-p group had lower AHI and more female than the NREM-p and SI group. Supine-p OSA had better response than non-positional OSA (criterion 1: 43.2% vs 34.1%; criterion 2: 63.6% vs 34.1%; criterion 3: 77.3% vs 51.2%). NREM-p OSA had lower response across all three criteria (REM-p vs NREM-p vs SI: criterion 1: 57.6% vs 0% vs 42.0%; criterion 2: 75.8% vs 16.7% vs 56.5%; criterion 3: 75.8% vs 33.3% vs 77.1%). The odds of MAD response for supine-p OSA was 3.78 (95% CI = 1.44–9.93) to 3.98 (95% CI = 1.58–9.99)-fold than non-positional OSA while the odds for NREM-p OSA were 0.06 (95% CI = 0.01–0.58) to 0.15 (95% CI = 0.03–0.67)-fold than SI OSA after adjusting demographics and clinical features affecting MAD response. Conclusion Positional and sleep stage dependency were associated with MAD response and could be indicators for personal-tailored OSA treatment. Support (if any) The Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-252)

scholarly journals Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

2021 ◽  
Author(s):  
Thyagaseely Sheela Premaraj ◽  
Jacob Stadiem ◽  
Shyamaly Arya Premaraj ◽  
Charles R. Davies ◽  
Matthew Dennis ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
The Mean

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

Cardiac arrhythmias and conduction disturbances in the obstructive sleep apnea syndrome

2018 ◽  
Vol 2 (47) ◽  
pp. 10-15
Author(s):  
Danuta Łoboda ◽  
Karolina Simionescu ◽  
Anna Szajerska-Kurasiewicz ◽  
Dorota Lasyk ◽  
Grzegorz Jarosiński ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cardiac Arrhythmias ◽  
Sleep Apnea Syndrome ◽  
The Body ◽  
Apnea Hypopnea Index ◽  
Premature Ventricular Contractions ◽  
Mortality And Morbidity ◽  
Conduction Disturbances ◽  
Obstructive Sleep

Cardiac arrhythmias during sleep are reported in almost half of the population suffering from obstructive sleep apnea (OSA). The most common are bradyarrhythmias and atrial fibrillation whereas premature ventricular contractions and nonsustained ventricular tachycardia are less frequent. The risk of arrhythmia is proportional to the body mass index (BMI), number of respiratory events per hour of sleep described with apnea/hypopnea index (AHI) and the level of oxygen desaturation during these episodes. Continuous positive airway pressure (CPAP) treatment in OSA reduces the incidence of cardiac arrhythmias therefore reduce mortality and morbidity from cardiovascular disease.

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