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.

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.

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 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.

Tongue-Based Procedures in Treating Refractory Obstructive Sleep Apnea in Down Syndrome Patients: A Systematic Review and Meta-Analysis

FACE ◽  
2021 ◽  
Vol 2 (1) ◽  
pp. 65-70
Author(s):  
Paul B. Lee ◽  
Michael T. Chung ◽  
Jared Johnson ◽  
Jordyn Lucas ◽  
Caitlin R. Priest ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Down Syndrome ◽  
Sleep Apnea ◽  
Nerve Stimulation ◽  
Hypoglossal Nerve ◽  
Meta Analysis ◽  
Apnea Hypopnea Index ◽  
Hypoglossal Nerve Stimulation ◽  
Obstructive Sleep

Objective: There is a high prevalence of obstructive sleep apnea (OSA) in pediatric and adult Down Syndrome (DS) patients that is refractory to adenotonsillectomy and continuous positive airway pressure. Newer treatment modalities have emerged with improved outcomes. The objective is to provide an updated systematic review and meta-analysis to analyze the clinical outcomes of OSA in pediatric and adult DS patients with hypoglossal nerve stimulation using Inspire, midline posterior glossectomy plus lingual tonsillectomy (MPG + LT), and combined genioglossus advancement plus radiofrequency (GGS + RF). Methods: A comprehensive literature search of PubMed and Google Scholar was performed followed by a meta-analysis. Studies with preoperative and post-operative Apnea Hypopnea Index (AHI) values were included with patients serving as their own control. Results: Across 5 studies, 56 patients were analyzed. The mean reduction in AHI was statistically significant before vs. after procedure ( P < .001 for hypoglossal nerve stimulation using Inspire with a paired 2-tailed t-test and P = .031 for MPG + LT). Although individual patient AHI values were unavailable in the GGS + RF study, the standard difference in mean AHI was also significant for GGS + RF with P = .001. Device malfunction was the most common complication for Inspire while postoperative bleeding was observed for MPG + LT and nasopharyngeal obstruction and retropalatal collapse were observed for GGS + RF. Conclusion: This review reveals significant improvement in AHI with Inspire, MPG + LT, and GGS + RF for DS patients with refractory OSA. Further investigation is needed for comparison between these 3 therapies.

scholarly journals Mandibular advancement appliances for the treatment of paediatric obstructive sleep apnea: a systematic review

2015 ◽  
Vol 37 (6) ◽  
pp. 618-626 ◽  
Author(s):  
Natasha Nazarali ◽  
Mostafa Altalibi ◽  
Samir Nazarali ◽  
Michael P. Major ◽  
Carlos Flores-Mir ◽  
...  
Keyword(s):  
Systematic Review ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Mandibular Advancement ◽  
Obstructive Sleep ◽  
Mandibular Advancement Appliances
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