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).

Changes in Upper Airway Volume in Edentulous Obstructive Sleep Apnea Patients Treated with Modified Mandibular Advancement Device

2015 ◽  
Vol 25 (6) ◽  
pp. 453-458 ◽  
Author(s):  
Arvind Tripathi ◽  
Ashutosh Gupta ◽  
Sabyasachi Sarkar ◽  
Suryakant Tripathi ◽  
Narendra Gupta
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Obstructive Sleep

Mandibular Advancement Device use for therapy of simple snoring: mini review

2021 ◽  
Vol 11 (41) ◽  
pp. 30-33
Author(s):  
Erdem Atalay Cetinkaya
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Treatment Modalities ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
Surgical Methods ◽  
Simple Snoring

AbstractOral devices that treat obstructive sleep apnea are an easy and influential option to protect the upper airways from sleep obstructions. One example is the mandibular advancement device (MAD), which is a non-invasive apparatus specified in adults with simple snoring and mild obstructive sleep apnea. Recently, due to the constraints of other therapies, like positive airway pressure treatment and surgical methods, there has been growing interest in the use of oral appliance for simple snoring patients. MAD is managed to improve the upper airway volume, minimize upper airway collapse and reduce snoring. On the other hand, it remains inferior to CPAP in the reduction of the apnea-hypopnea scores, with therapy success varying from 24% to 72%. The treatment modalities include skilled physicians and multidisciplinary strategies to treat patients with snoring and obstructive sleep apnea (OSA) effectively. Some researchers also suggest potential predictors of progress in care, but specific criteria for patient selection and predictive clinical principles for effectiveness in all treatment modalities are still needed. The aim of this brief clinical Study is to review MAD brief history, design, indications, contraindications, therapy efficiency, side effects, and current perspectives.

scholarly journals Treatment Success with Titratable Thermoplastic Mandibular Advancement Devices for Obstructive Sleep Apnea: A Comparison of Patient Characteristics

2017 ◽  
Vol 96 (3) ◽  
pp. E25-E32 ◽  
Author(s):  
Tang-Chuan Wang ◽  
Yung-An Tsou ◽  
Yi-Fan Wu ◽  
Chia-Chang Huang ◽  
Wesley Wen-Yang Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Visual Analogue Scale ◽  
Sleep Quality ◽  
Analogue Scale ◽  
Treatment Success ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Mandibular Advancement Devices

A titratable thermoplastic mandibular advancement devices (MAD) is clearly an effective treatment option in some patients with obstructive sleep apnea (OSA). Determining which patients may be more likely to respond to treatment with thermoplastic MADs and to adhere to treatment would be of obvious clinical relevance. This was an experimental descriptive study (N = 60). Patients with OSA were instructed to wear a titratable thermoplastic MAD for 3 months. Treatment success was defined as a ≥50% reduction from baseline in the apnea-hypopnea index (AHI) or AHI <10 when wearing MAD. Adherence was defined as MAD use ≥5 nights/week. Treatment was successful in 66.7% of patients and 60.0% were adherent. All Polysomnographic parameters and visual analogue scale scores (sleep quality, snoring, waking refreshed) were significantly improved after treatment. The patients in whom treatment failed had significantly higher neck circumferences (39.3 cm vs. 37.5 cm, p = 0.014), higher baseline AHI values (26.6 vs. 18.0, p = 0.016), and smaller AHI reduction (-31.8 vs -53.1, p < 0.001) than those in the group in whom treatment succeeded. There were no significant differences in Polysomnographic, cephalometric, or visual analogue scale measures between patients for whom treatment was and was not successful, regardless of baseline values or the change rates after the MAD was placed. Titratable thermoplastic MADs can improve indicators of sleep quality, even in patients in whom treatment is considered to have failed.

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 Management of Obstructive Sleep Apnea in an Edentulous Lower Jaw Patient with a Mandibular Advancement Device

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Filiz Keyf ◽  
Bülent Çiftci ◽  
Selma Fırat Güven
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oral Appliance ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Clinical Report ◽  
Oral Appliances ◽  
Lower Jaw ◽  
Obstructive Sleep ◽  
Mandibular Advancement Devices

Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder with periodic reduction or cessation of airflow during sleep. It is associated with loud snoring, disrupted sleep, and witnessed apneas. Treatment of OSA varies from simple measures such as oral appliances and nasal continuous positive airway pressure (CPAP) to surgical procedures like uvulopalatopharyngoplasty and tracheostomy. Oral appliances are a viable nonsurgical treatment alternative in patients with OSA, of which mandibular advancement devices are most common. Edentulism which contributes to the worsening of OSA reduces the number of available therapeutic strategies and is considered a contraindication to oral appliance therapy. This clinical report describes the treatment of a 63-year-old edentulous OSA patient for whom a mandibular advancement device was designed.

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 Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices

2021 ◽  
Vol 18 (5) ◽  
pp. 2393
Author(s):  
Giulio Gasparini ◽  
Gianmarco Saponaro ◽  
Mattia Todaro ◽  
Gabriele Ciasca ◽  
Lorenzo Cigni ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Prognostic Indicator ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Upper Airways ◽  
Obstructive Sleep ◽  
Group A ◽  
Group B

Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.

Sign in / Sign up

Export Citation Format

Share Document