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

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 Oral Appliances in Obstructive Sleep Apnea

Healthcare ◽  
2019 ◽  
Vol 7 (4) ◽  
pp. 141 ◽  
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.

scholarly journals Treatment of obstructive sleep apnea patients using oral appliances: Our experiences

2014 ◽  
Vol 71 (7) ◽  
pp. 623-626 ◽  
Author(s):  
Dusan Miljus ◽  
Ljiljana Tihacek-Sojic ◽  
Aleksandra Milic-Lemic ◽  
Marko Andjelkovic
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Heart Diseases ◽  
Treatment Success ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Oral Appliances ◽  
Obstructive Sleep ◽  
Custom Made

Background/Aim. Obstructive sleep apnea (OSA) is one of the most prevalent sleep disorders. It is recognized as a serious risk factor for car and workplace accidents due to daytime sleepiness, and factor for coronary heart diseases and stroke. The aim of this study was to examine the effectiveness of oral appliances for mandibular advance in treating mild to moderate OSA. Methods. A total of 15 patients were included in this study, all diagnosed with mild or moderate OSA. Oral appliances were custom made for each patient in protrusive position at 50% of maximum mandibular advancement. The patients were given instructions not to sleep on their backs and avoid alcohol consumption during the study as these are the factors that can contribute to symptoms progression. Results. Complete and partial treatment success was achieve in 14 of the patients. Apnea-hypopnea index values were significantly lower (p < 0.05) at the end of a 6-month observation period compared to those at the treatment beginning. A great improvement in symptoms was observed, with daytime sleepiness index values significantly reduced already within the first month of the treatment. Conclusion. Treatment of obstructive sleep apnea with oral appliances has proven successful. Patients were comfortable using oral appliances and were ready to wear them for prolonged period of time. Use of oral appliances is very common in the world and should not be discarded. They are also very comfortable, practical and affordable comparing to continuous positive airway pressure (CPAP) apparatus, not to mention surgery. Use of oral appliances is safe and very well tolerated, and ought to be offered to patients with OSA.

scholarly journals The Most Effective Amount of Forward Movement for Oral Appliances for Obstructive Sleep Apnea: A Systematic Review

2019 ◽  
Vol 16 (18) ◽  
pp. 3248 ◽  
Author(s):  
Yuki Sakamoto ◽  
Akifumi Furuhashi ◽  
Eri Komori ◽  
Hiroyuki Ishiyama ◽  
Daichi Hasebe ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Side Effects ◽  
Sleep Stage ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Oral Appliances ◽  
Forward Movement ◽  
Obstructive Sleep

This systematic review clarifies the amount of effective protrusion in mandibular advancement devices of oral appliances required for obstructive sleep apnea (OSA). The systematic review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Review Manager 5 and GRADEpro were used to combine trials and analyze data. The present review included three studies. In mild to moderate OSA cases, measured using the apnea–hypopnea index (AHI), 50% protrusion was more effective than 75% protrusion. However, 75% protrusion was more effective for severe cases. Sleep stage, Epworth Sleepiness Scale (ESS), snoring index, and side effects significantly differed between the groups. Additionally, 75% protrusion was more effective (AHI: 0.38, 95% CI: −0.89 to 1.65, p = 0.56; sleep stage 3: −1.20, 95% CI: 9.54–7.14, p = 0.78; ESS: 1.07, 95% CI: −0.09 to 2.24, p = 0.07; snoring index: 0.09, 95% CI: 0.05–0.13, p < 0.05; side effects: RR: 1.89, 95% CI: 0.36–9.92, p = 0.45). As per the AHI, 75% protrusion was effective in severe cases, whereas 50% protrusion was effective in moderate cases. Analysis of different surrogate outcomes indicated that 75% protrusion was more effective. Further, well-designed, larger trials should determine the benefits for patients. Additionally, investigations of adherence and side effects with long-term follow-up are needed.

Obstructive Sleep apnea Therapy

2008 ◽  
Vol 87 (9) ◽  
pp. 882-887 ◽  
Author(s):  
A. Hoekema ◽  
B. Stegenga ◽  
P.J. Wijkstra ◽  
J.H. van der Hoeven ◽  
A.F. Meinesz ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Confidence Interval ◽  
Severe Disease ◽  
Lower Boundary ◽  
Oral Appliance ◽  
Apnea Hypopnea Index ◽  
Cpap Therapy ◽  
Oral Appliance Therapy ◽  
Obstructive Sleep

In clinical practice, oral appliances are used primarily for obstructive sleep apnea patients who do not respond to continuous positive airway pressure (CPAP) therapy. We hypothesized that an oral appliance is not inferior to CPAP in treating obstructive sleep apnea effectively. We randomly assigned 103 individuals to oral-appliance or CPAP therapy. Polysomnography after 8–12 weeks indicated that treatment was effective for 39 of 51 persons using the oral appliance (76.5%) and for 43 of 52 persons using CPAP (82.7%). For the difference in effectiveness, a 95% two-sided confidence interval was calculated. Non-inferiority of oral-appliance therapy was considered to be established when the lower boundary of this interval exceeded −25%. The lower boundary of the confidence interval was −21.7%, indicating that oral-appliance therapy was not inferior to CPAP for effective treatment of obstructive sleep apnea. However, subgroup analysis revealed that oral-appliance therapy was less effective in individuals with severe disease (apnea-hypopnea index > 30). Since these people could be at particular cardiovascular risk, primary oral-appliance therapy appears to be supported only for those with non-severe apnea.

scholarly journals Efficacy of custom made oral appliance for treatment of obstructive sleep apnea

2015 ◽  
Vol 6 (3) ◽  
pp. 341 ◽  
Author(s):  
VR Cilil ◽  
NK Sapana Varma ◽  
Siby Gopinath ◽  
VV Ajith
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Oral Appliance ◽  
Obstructive Sleep ◽  
Custom Made

scholarly journals The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 16 (17) ◽  
pp. 3182 ◽  
Author(s):  
Hiroyuki Ishiyama ◽  
Daichi Hasebe ◽  
Kazumichi Sato ◽  
Yuki Sakamoto ◽  
Akifumi Furuhashi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Side Effects ◽  
Meta Analysis ◽  
Oral Appliance ◽  
Sleep Efficiency ◽  
Apnea Hypopnea Index ◽  
Arousal Index ◽  
Obstructive Sleep

Oral appliance (OAm) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OAm therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OAm versus Bi-block OAm) remained eligible after applying the exclusion criteria. When comparing Mono-block OAm and Bi-block OAm, Mono-block OAm significantly reduced the apnea–hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; p = 0.0006), and patient preference for Mono-block OAm was significantly higher (2.06; 95%CI, 1.44 to 2.06; p < 0.0001). Lowest SpO2, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO2: −11.18; 95%CI, −26.90 to 4.54; p = 0.16, arousal index: 4.40; 95%CI, −6.00 to 14.80; p = 0.41, non-REM stage 3: −2.00; 95%CI, −6.00 to 14.80; p = 0.41, sleep efficiency: −1.42, 95%CI, −4.71 to 1.86; p = 0.40, ESS: 0.12; 95%CI, −1.55 to 1.79; p = 0.89, Snoring Scale: 0.55; 95%CI, −0.73 to 1.83, p = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, p = 1.00). In this systematic review, the use of Mono-block OAm was more effective than Bi-block OAm for OSA patients.

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