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Aarnoud Hoekema - One of the best experts on this subject based on the ideXlab platform.

  • cardiovascular effects of Oral Appliance therapy in obstructive sleep apnea a systematic review and meta analysis
    Sleep Medicine Reviews, 2017
    Co-Authors: Grietje E De Vries, Peter J Wijkstra, E J Houwerzijl, Huib A M Kerstjens, Aarnoud Hoekema
    Abstract:

    Obstructive sleep apnea (OSA) is associated with increased cardiovascular morbidity and mortality. This study systematically reviews the effects of Oral Appliance therapy (OAT) on a broad spectrum of cardiovascular outcomes. A literature search was performed up to December 31st 2016. Twenty-five relevant full-text articles were retrieved. Sixteen articles were considered methodologically sufficient, including 11 randomized controlled trials. Pooled data of the RCTs showed significant reductions in daytime systolic and diastolic blood pressure compared to baseline, but no significant reductions in heart rate, except for daytime heart rate when compared to inactive/placebo OAT. OAT and continuous positive airway pressure (CPAP) were equally effective in reducing blood pressure. Studies assessing the effect of OAT on heart rate variability, circulating cardiovascular biomarkers, and endothelial function and arterial stiffness, generally involved small numbers of patients, and were heterogeneous and inconclusive. Studies assessing the effect of OAT on cardiac function showed no effects on echocardiographic outcomes. One observational study showed that OAT was as effective as CPAP in reducing cardiovascular death. It could be speculated that OAT may lead to a reduction in long-term cardiovascular morbidity and mortality in OSA patients. However, further methodologically high quality, longitudinal studies are warranted to address this key question.

  • maxillomandibular advancement surgery as alternative to continuous positive airway pressure in morbidly severe obstructive sleep apnea a case report
    Cranio-the Journal of Craniomandibular Practice, 2013
    Co-Authors: Michiel H J Doff, J Jansma, Rutger H Schepers, Aarnoud Hoekema
    Abstract:

    AbstractObstructive sleep apnea syndrome (OSAS) is a sleep-related breathing disorder, characterized by disrupted snoring and repetitive upper airway obstructions. Oral Appliance therapy is an effective alternative to continuous positive airway pressure (CPAP) and is especially effective in mild and moderate OSAS cases. Successful Oral Appliance therapy has been suggested as a predictor for successful maxillomandibular advancement (MMA) surgery in OSAS patients. MMA surgery has gained increasing popularity in this field since this procedure is associated with an enlargement of the entire velo-oro-hypopharyngeal airway. The authors present an unusual case of a CPAP-intolerant morbidly obese female (body mass index (BMI)=40) with morbidly severe OSAS (apnea-hypopnea index (AHI)=139, lowest oxyhemoglobin saturation level = 73%), who underwent a successful combination of MMA surgery, a modified genioplasty and cervicomental liposuction after Oral Appliance therapy. The post-surgical AHI was 6, and the lowest ...

  • Oral Appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome a 2 year follow up
    Sleep, 2013
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, Johannes H Van Der Hoeven, James Huddleston J R Slater, Boudewijn Stegenga
    Abstract:

    Study Objectives: Oral Appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of Oral Appliance therapy and CPAP in patients with OSAS. Design: Cohort study of a previously conducted randomized clinical trial. Setting: University Medical Center, Groningen, The Netherlands. Patients or Participants: One hundred three patients with OSAS. Interventions: CPAP and Oral Appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA) Measurements and Results: Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was Conclusions: Oral Appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. Clinical Trial Information: The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: Oral Appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.

  • long term Oral Appliance therapy in obstructive sleep apnea syndrome a controlled study on dental side effects
    Clinical Oral Investigations, 2013
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, K J Finnema, Boudewijn Stegenga
    Abstract:

    Objectives This study aimed to assess possible dental side effects associated with long-term use of an adjustable Oral Appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with Oral Appliance therapy.

  • Long-term Oral Appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects
    Clinical Oral Investigations, 2012
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, Steffanie K. B. Veldhuis, James J. R. Huddleston Slater, Boudewijn Stegenga
    Abstract:

    The objective of this study was to assess variations in the occurrence of temporomandibular disorders (TMDs) and the risk of developing pain and function impairment of the temporomandibular complex in obstructive sleep apnea syndrome (OSAS) patients treated with either an Oral Appliance (mandibular advancement device) or continuous positive airway pressure (CPAP) in a 2-year follow-up study. In addition, we assessed the relationship between the mean mandibular protrusion and the frequency of wearing the Appliance during follow-up with the occurrence of pain and function impairment of the temporomandibular complex. Fifty-one patients were randomized to Oral Appliance therapy and 52 patients to CPAP therapy. TMDs (diagnosed according to the Axis I Research Diagnostic Criteria for TMD), pain intensity and disability and mandibular function impairment were recorded at baseline, after 2 months, 1 year and 2 years of therapy. Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher (24%) in the Oral Appliance group compared to CPAP (6%). Oral Appliance therapy furthermore resulted in more temporomandibular pain compared to CPAP (odds ratio 2.33, 95% confidence interval (1.22–4.43)). However, there were no limitations in mandibular function in both groups during the (entire) follow-up period. Although generally not serious and of transient nature, Oral Appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy. Oral Appliance therapy is associated with increased pain in the temporomandibular complex in the initial period of use. Because of the transient nature, this pain is not a reason to contra-indicate an Oral Appliance in OSAS patients. Moreover, TMDs and the risk of developing pain and function impairment of the temporomandibular complex appear limited with long-term Oral Appliance use.

Alan A Lowe - One of the best experts on this subject based on the ideXlab platform.

  • changes in headache characteristics with Oral Appliance treatment for obstructive sleep apnea
    Scientific Reports, 2021
    Co-Authors: Alan A Lowe, Ji Woon Park, Sujay Mehta, Sandra Fastlicht, Fernanda R Almeida
    Abstract:

    Changes in headache characteristics in obstructive sleep apnea (OSA) patients following Oral Appliance treatment was investigated for the first time. Thirteen OSA patients with headaches treated with a mandibular advancement device were investigated. Level I polysomnography and Migraine Disability Assessment Questionnaire were completed before and after treatment. Various headache characteristics and concomitant conditions were analyzed. The patient was considered a headache responder when ≥ 30% reduction in headache frequency following treatment. Differences in headache and polysomnographic parameters were compared between headache responder groups. Eight patients (62%) were headache responders. Eleven patients (85%) before and 7 (54%) after treatment reported morning headaches. Significantly more patients had bilateral headache in the responder group before treatment (P = 0.035). The severest headache intensity (P = 0.018) at baseline showed a significant decrease in the headache responder group after treatment. The time spent in N2 (r = - 0.663, P = 0.014), REM sleep (r = 0.704, P = 0.007) and mean oxygen saturation (r = 0.566, P = 0.044) showed a significant correlation with post-treatment average headache intensity. Pre-treatment lower PLM index (r = - 0.632, P = 0.027) and higher mean oxygen saturation levels (r = 0.592, P = 0.043) were significantly correlated with higher post-treatment severest headache intensity. Treatment with an Oral Appliance is beneficial for many OSA patients with headaches. It should be considered as an alternative treatment in headache patients with mild to moderate OSA.

  • side effects of boil and bite type Oral Appliance therapy in sleep apnea patients
    Sleep and Breathing, 2010
    Co-Authors: Hiroko Tsuda, Fernanda R Almeida, Shinichi Masumi, Alan A Lowe
    Abstract:

    Introduction Based on a mail-out questionnaire, this study analyzed compliance and side effects of one commonly used (TheraSnore) boil and bite Oral Appliance (OA) in patients with obstructive sleep apnea.

  • effect of 2 jaw exercises on occlusal function in patients with obstructive sleep apnea during Oral Appliance therapy a randomized controlled trial
    American Journal of Orthodontics and Dentofacial Orthopedics, 2009
    Co-Authors: Hiroshi Ueda, Fernanda R Almeida, Hui Chen, Alan A Lowe
    Abstract:

    Introduction The aim of this study was to compare the effects on objective occlusal function of 2 types of jaw exercises during Oral Appliance therapy in patients with obstructive sleep apnea (OSA). Methods Sixteen consecutive subjects with snoring or OSA undergoing Oral Appliance therapy were included in this study; the results were based on 10 patients who completed it. The patients were randomized to start with either a jig exercise or stretching movements for 1 month; after 1 month without exercise, they crossed over to the other exercise for 1 month. An occlusal diagnostic system that consisted of a pressure-sensitive sheet and an image scanner was used to evaluate occlusal contact area and bite force. Results Both exercises produced significant increases in occlusal contact area and bite force in the morning compared with the period of no exercise. At night, the molar region had significant improvements in occlusal contact area and bite force only during stretching movements. We found no significant differences between the 2 exercises, but stretching movements tended to be more effective in the molar region, whereas the jig exercise tended to be more effective in the anterior region. Conclusions Jaw exercises might help relieve masticatory muscle stiffness and accelerate the repositioning of the mandible to the normal position, in addition to inhibiting or minimizing the occlusal functional changes in predisposed patients.

  • a comparison of responders and nonresponders to Oral Appliance therapy for the treatment of obstructive sleep apnea
    American Journal of Orthodontics and Dentofacial Orthopedics, 2006
    Co-Authors: Ryo Otsuka, Alan A Lowe, Fernanda R Almeida, Frank Ryan
    Abstract:

    Introduction: This retrospective study compared cephalometric variables between responders and nonresponders to a titratable Oral Appliance (OA) in a group of subjects matched for sex, pretreatment age, and body mass index (BMI). Methods: Nine nonresponders as defined by an improvement in the apnea hypopnea index (AHI; 15 to ≤30; severe I, >30 to ≤45; and severe II, >45 AHI). Results: Middle and inferior airway space and oropharyngeal airway cross-sectional area were significantly larger in the nonresponders. Position of the mandible relative to the cervical spine was the only significant skeletal variable and was larger in nonresponders. Changes in BMI between the groups were statistically significant; the averages were a 2.9% increase in the nonresponders and a 0.5% decrease in responders. The wider airway in nonresponders might reflect an enhanced neuromuscular compensation while awake. The weight gain in nonresponders was relatively small, but it might have reduced the effectiveness of the OA. Conclusion: When treating OSA patients with OA therapy, clinicians should pay particular attention to airway size and weight changes.

  • long term sequellae of Oral Appliance therapy in obstructive sleep apnea patients part 2 study model analysis
    American Journal of Orthodontics and Dentofacial Orthopedics, 2006
    Co-Authors: Fernanda R Almeida, Alan A Lowe, Ryo Otsuka, Sandra Fastlicht, Maryam Farbood, Satoru Tsuiki
    Abstract:

    Introduction: Side effects observed in the occlusion and dental arches of patients using an Oral Appliance (OA) to treat snoring or sleep apnea for more than 5 years have not yet been investigated. Methods: Stone casts trimmed in centric occlusion before Appliance placement and after an average of 7.4 ± 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists. Results: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class II Division 1 and Class II Division 2 malocclusions were more likely to have favorable or no changes. More favorable changes in overbite occurred in subjects with large baseline overbites. A greater baseline overjet and more distal mandibular canine relationship were correlated to favorable changes. A greater initial overjet was correlated to a more favorable change, a decrease in mandibular crowding, a smaller change in anterior crossbite, and a greater change in overjet. Conclusions: OA wear after a mean of 7.4 years induces clinically relevant changes in the dental arch and the occlusion.

Boudewijn Stegenga - One of the best experts on this subject based on the ideXlab platform.

  • Oral Appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome a 2 year follow up
    Sleep, 2013
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, Johannes H Van Der Hoeven, James Huddleston J R Slater, Boudewijn Stegenga
    Abstract:

    Study Objectives: Oral Appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of Oral Appliance therapy and CPAP in patients with OSAS. Design: Cohort study of a previously conducted randomized clinical trial. Setting: University Medical Center, Groningen, The Netherlands. Patients or Participants: One hundred three patients with OSAS. Interventions: CPAP and Oral Appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA) Measurements and Results: Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was Conclusions: Oral Appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. Clinical Trial Information: The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: Oral Appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.

  • long term Oral Appliance therapy in obstructive sleep apnea syndrome a controlled study on dental side effects
    Clinical Oral Investigations, 2013
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, K J Finnema, Boudewijn Stegenga
    Abstract:

    Objectives This study aimed to assess possible dental side effects associated with long-term use of an adjustable Oral Appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with Oral Appliance therapy.

  • Long-term Oral Appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects
    Clinical Oral Investigations, 2012
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, Steffanie K. B. Veldhuis, James J. R. Huddleston Slater, Boudewijn Stegenga
    Abstract:

    The objective of this study was to assess variations in the occurrence of temporomandibular disorders (TMDs) and the risk of developing pain and function impairment of the temporomandibular complex in obstructive sleep apnea syndrome (OSAS) patients treated with either an Oral Appliance (mandibular advancement device) or continuous positive airway pressure (CPAP) in a 2-year follow-up study. In addition, we assessed the relationship between the mean mandibular protrusion and the frequency of wearing the Appliance during follow-up with the occurrence of pain and function impairment of the temporomandibular complex. Fifty-one patients were randomized to Oral Appliance therapy and 52 patients to CPAP therapy. TMDs (diagnosed according to the Axis I Research Diagnostic Criteria for TMD), pain intensity and disability and mandibular function impairment were recorded at baseline, after 2 months, 1 year and 2 years of therapy. Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher (24%) in the Oral Appliance group compared to CPAP (6%). Oral Appliance therapy furthermore resulted in more temporomandibular pain compared to CPAP (odds ratio 2.33, 95% confidence interval (1.22–4.43)). However, there were no limitations in mandibular function in both groups during the (entire) follow-up period. Although generally not serious and of transient nature, Oral Appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy. Oral Appliance therapy is associated with increased pain in the temporomandibular complex in the initial period of use. Because of the transient nature, this pain is not a reason to contra-indicate an Oral Appliance in OSAS patients. Moreover, TMDs and the risk of developing pain and function impairment of the temporomandibular complex appear limited with long-term Oral Appliance use.

  • long term Oral Appliance therapy in obstructive sleep apnea a cephalometric study of craniofacial changes
    Journal of Dentistry, 2010
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, G J Pruim, J Huddleston J R Slater, Boudewijn Stegenga
    Abstract:

    Objectives: The aim of this randomized controlled study was to cephalometrically assess possible changes in craniofacial morphology associated with long-term use of an adjustable Oral-Appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea/hypopnea syndrome (OSAHS). In addition, we wanted to study the relationship between these possible changes and the degree of mandibular protrusion associated with Oral-Appliance therapy. Methods: Fifty-one patients were randomized to Oral-Appliance therapy and 52 patients to CPAP therapy. At baseline and after follow-up (2.3 � 0.2 years), a lateral cephalogram of all patients was made in maximum intercuspation to determine relevant cephalometric variables. Both baseline and follow-up cephalograms were traced digitally whereupon cephalometric variables were compared. Changes in craniofacial morphology between the Oral-Appliance- and CPAP group were evaluated with a linear regression analysis. Results: Compared with CPAP, long-term use of an Oral-Appliance resulted in small but significant (dental) changes. Overbite and overjet decreased, 1.0 (� 1.5) mm and 1.7 (� 1.6) mm, respectively. Furthermore we found a retroclination (� 2.0 (� 2.8)8) of the upper incisors and a proclination (3.7 (� 5.4)8) of the lower incisors. Moreover, the lower- and total anterior facial height increased significantly, 0.8 (� 1.5) mm and 0.9 (� 1.4) mm, respectively. No changes in skeletal variables were found. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up (B = � 0.029, SE = 0.014, p < 0.05). Conclusions: Oral-Appliance therapy should be considered as a life long treatment, and there is a risk of craniofacial changes to occur. Therefore, patients treated with an Oral-Appliance, need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.

  • effects of a mandibular advancement device on the upper airway morphology a cephalometric analysis
    Journal of Oral Rehabilitation, 2009
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, L G M De Bont, G J Pruim, Van Der Johannes Hoeven, Boudewijn Stegenga
    Abstract:

    The aims of this study were to assess changes in the upper airway morphology associated with an Oral Appliance in situ in patients suffering from the obstructive sleep apnoea-hypopnoea syndrome and to relate these changes to treatment response. Changes in upper airway morphology as a result of an Oral Appliance were assessed in 52 patients with obstructive sleep apnoea-hypopnoea syndrome by means of cephalometric analysis. Lateral cephalograms were taken at baseline and after 2-3 months of treatment. Baseline and follow-up cephalograms were traced twice and cephalometric variables were compared. The predictive value of changes in upper airway morphology for the treatment response was evaluated in univariate and multivariate regression analyses. Oral Appliance therapy resulted in an increased posterior airway space at the level of the second vertebra, the uvular tip and the base of the tongue. The increase of the posterior airway space at the level of the second vertebra and the uvular tip were the best predictors for relative improvement of the apnoea-hypopnoea index. However, the predictive value for treatment response of these cephalometric upper airway changes should be interpreted with caution.

Peter A Cistulli - One of the best experts on this subject based on the ideXlab platform.

  • Oral Appliance treatment for obstructive sleep apnea an update
    Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2014
    Co-Authors: Kate Sutherland, Olivier M Vanderveken, Hiroko Tsuda, Marie Marklund, Frederic Gagnadoux, Clete A Kushida, Peter A Cistulli
    Abstract:

    Oral Appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.

  • cephalometry and prediction of Oral Appliance treatment outcome
    Sleep and Breathing, 2012
    Co-Authors: Ali M Darendeliler, Peter Petocz, Peter A Cistulli
    Abstract:

    Predicting which patients with obstructive sleep apnea (OSA) will be successfully treated with mandibular advancement splints (MAS) remains elusive. Developing simple daytime measurements and tests to predict treatment outcome would enhance MAS treatment. The purpose of this study was to assess the clinical utility of anthropomorphic measurements and cephalometric X-rays in the prediction of MAS treatment outcome in OSA. Anthropomorphic measurements and cephalometric X-rays from 72 OSA patients who had presented to a tertiary referral sleep clinic were analyzed retrospectively. Treatment response was defined as ≥50% reduction in Apnea/Hypopnea Index (AHI; criterion 1); ≥50% reduction and residual AHI less than 20/h (criterion 2); ≥50% reduction in AHI and residual AHI less than 10/h (criterion 3); and ≥50% reduction in AHI and residual AHI less than 5/h (criterion 4). This was done to reflect the differences in the clinical definition of treatment success in the literature. A good response occurred in 56% (40 patients) according to criterion 1; 54% (39 patients) according to criterion 2; 46% (33 patients) according to criterion 3; or 39% (28 patients) according to criterion 4. Age and gender were found to be significant predictors for criteria 1 and 2. Age and soft palate length were found to be significant predictors for criteria 3 and 4. Equations to predict MAS treatment response were derived as equations were to predict final AHI. Certain cephalometric and anthropomorphic measurements impact on MAS treatment outcome. This study adds to the current literature and implies that MAS success is (to some degree) related to anatomical characteristics.

  • Oral Appliance treatment for obstructive sleep apnea an update
    Current Opinion in Pulmonary Medicine, 2009
    Co-Authors: Andrew S L Chan, Peter A Cistulli
    Abstract:

    Purpose of reviewOral Appliances are an alternative to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Although CPAP is a highly efficacious treatment, there is a need for other treatment options because the clinical effectiveness of CPAP is often limit

  • influence of nasal resistance on Oral Appliance treatment outcome in obstructive sleep apnea
    Sleep, 2008
    Co-Authors: Ali M Darendeliler, Peter Petocz, Peter A Cistulli, Biao Zeng, Jin Qian
    Abstract:

    It has been recognized that nasal airway resistance (NAR) is elevated in patients with OSA. However, little is known regarding the influence of nasal resistance on mandibular advancement splint (MAS) treatment outcome in OSA patient. We hypothesized that nasal resistance differs between MAS responders and nonresponders and therefore may influence treatment outcome. Thirty-eight patients with known OSA underwent polysomnography while wearing a custom-made MAS. Treatment outcome was defined as follows: Responders (R) ≥50% reduction in AHI, and Nonresponders (NR) as <50% reduction in AHI. NAR was measured using posterior rhinomanometry in both sitting and supine positions, with and without MAS. The mean AHI in 26 responders was significantly reduced from 29.0 ± 2.9/h to 6.7 ± 1.2/h; P < 0.01). In 12 nonresponders there was no significant change in AHI (23.9 ± 3.0/h vs 22.0 ± 4.3/h; P=ns). Baseline NAR was significantly lower in responders in the sitting position compared to nonresponders (6.5 ± 0.5 vs 9.4 ± 1.0cm H2O; P < 0.01). There was no significant change in NAR (from baseline) with MAS in either response group while in the sitting position, but in the supine position NAR increased significantly with MAS in the nonresponder group (11.8 ± 1.5 vs 13.8 ± 1.6 cm H2O/L/s; P < 0.01). Logistic regression analysis revealed that NAR and BMI were the most important predictive factors for MAS treatment outcome. These data suggest that higher levels of NAR may negatively impact on treatment outcome with MAS. Citation: Zeng B; Ng AT; Qian J; Petocz P; Darendeliler MA; Cistulli PA. Influence of nasal resistance on Oral Appliance treatment outcome in obstructive sleep apnea. SLEEP 2008;31(4):543-547.

  • oropharyngeal collapse predicts treatment response with Oral Appliance therapy in obstructive sleep apnea
    Sleep, 2006
    Co-Authors: Jin Qian, Peter A Cistulli
    Abstract:

    STUDY OBJECTIVES To examine whether primary oropharyngeal collapse of the upper airway during sleep predicts treatment success with Oral Appliance therapy in patients with obstructive sleep apnea. DESIGN Prospective physiologic study. SETTING Multidisciplinary sleep disorders clinic in a university teaching hospital. PATIENTS Twelve treatment-naive adult patients with obstructive sleep apnea (apnea-hypopnea index > or = 10/h and at least 2 of the following symptoms: snoring, fragmented sleep, witnessed apneas, or daytime sleepiness). INTERVENTION Custom-made mandibular advancement splint (MAS). MEASUREMENTS AND RESULTS A baseline diagnostic polysomnogram confirmed AHI > or = 10 per hour. During the following acclimatization period, a custom-made adjustable MAS was incrementally advanced until maximum comfortable mandibular protrusion was reached. A second polysomnogram with MAS in situ determined efficacy. Following a 1-week washout period, a final sleep study was performed using multisensor catheters (with and without MAS, in random order during the same night) to determine upper-airway closing pressures and the site or sites of upper-airway collapse. MAS resulted in significant improvements, mean +/- SEM, in AHI (22.0 +/- 2.6 vs 9.2 +/- 1.9/h, p < .01) and upper-airway closing pressures during stage 2 non-rapid eye movement sleep (-1.1 +/- 0.3 vs -2.8 +/- 0.5 cm H2O, p < .01). All 4 patients with primary oropharyngeal collapse achieved an AHI < 5 per hour. Only 1 of the 8 patients with primary velopharyngeal collapse achieved an AHI < 5 per hour. Oropharyngeal collapse, compared with velopharyngeal collapse, predicted treatment success with MAS (p < .02). CONCLUSIONS These preliminary data suggest that primary oropharyngeal collapse of the upper airway during sleep is an important predictor of treatment outcome with MAS therapy.

L G M De Bont - One of the best experts on this subject based on the ideXlab platform.

  • Oral Appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome a 2 year follow up
    Sleep, 2013
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, Johannes H Van Der Hoeven, James Huddleston J R Slater, Boudewijn Stegenga
    Abstract:

    Study Objectives: Oral Appliance therapy has emerged as an important alternative to continuous positive airway pressure (CPAP) in treating patients with obstructive sleep apnea syndrome (OSAS). In this study we report about the subjective and objective treatment outcome of Oral Appliance therapy and CPAP in patients with OSAS. Design: Cohort study of a previously conducted randomized clinical trial. Setting: University Medical Center, Groningen, The Netherlands. Patients or Participants: One hundred three patients with OSAS. Interventions: CPAP and Oral Appliance therapy (Thornton Adjustable Positioner type-1, Airway Management, Inc., Dallas, TX, USA) Measurements and Results: Objective (polysomnography) and subjective (Epworth Sleepiness Scale, Functional Outcomes of Sleep Questionnaire, Medical Outcomes Study 36-item Short Form Health Survey [SF-36]) parameters were assessed after 1 and 2 years of treatment. Treatment was considered successful when the apnea-hypopnea index (AHI) was Conclusions: Oral Appliance therapy should be considered as a viable treatment alternative to continuous positive airway pressure (CPAP) in patients with mild to moderate obstructive sleep apnea syndrome (OSAS). In patients with severe OSAS, CPAP remains the treatment of first choice. Clinical Trial Information: The original randomized clinical trial, of which this study is a 2-year follow-up, is registered at ISRCTN.org; identifier: ISRCTN18174167; trial name: Management of the obstructive sleep apnea-hypopnea syndrome: Oral Appliance versus continuous positive airway pressure therapy; URL: http://www.controlled-trials.com/ISRCTN18174167.

  • long term Oral Appliance therapy in obstructive sleep apnea syndrome a controlled study on dental side effects
    Clinical Oral Investigations, 2013
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, K J Finnema, Boudewijn Stegenga
    Abstract:

    Objectives This study aimed to assess possible dental side effects associated with long-term use of an adjustable Oral Appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with Oral Appliance therapy.

  • Long-term Oral Appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects
    Clinical Oral Investigations, 2012
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, Peter J Wijkstra, L G M De Bont, Steffanie K. B. Veldhuis, James J. R. Huddleston Slater, Boudewijn Stegenga
    Abstract:

    The objective of this study was to assess variations in the occurrence of temporomandibular disorders (TMDs) and the risk of developing pain and function impairment of the temporomandibular complex in obstructive sleep apnea syndrome (OSAS) patients treated with either an Oral Appliance (mandibular advancement device) or continuous positive airway pressure (CPAP) in a 2-year follow-up study. In addition, we assessed the relationship between the mean mandibular protrusion and the frequency of wearing the Appliance during follow-up with the occurrence of pain and function impairment of the temporomandibular complex. Fifty-one patients were randomized to Oral Appliance therapy and 52 patients to CPAP therapy. TMDs (diagnosed according to the Axis I Research Diagnostic Criteria for TMD), pain intensity and disability and mandibular function impairment were recorded at baseline, after 2 months, 1 year and 2 years of therapy. Only in the initial period of treatment the occurrence of pain-related TMDs was considerably higher (24%) in the Oral Appliance group compared to CPAP (6%). Oral Appliance therapy furthermore resulted in more temporomandibular pain compared to CPAP (odds ratio 2.33, 95% confidence interval (1.22–4.43)). However, there were no limitations in mandibular function in both groups during the (entire) follow-up period. Although generally not serious and of transient nature, Oral Appliance therapy results in more pain-related TMDs in the initial period of use compared with CPAP therapy. Oral Appliance therapy is associated with increased pain in the temporomandibular complex in the initial period of use. Because of the transient nature, this pain is not a reason to contra-indicate an Oral Appliance in OSAS patients. Moreover, TMDs and the risk of developing pain and function impairment of the temporomandibular complex appear limited with long-term Oral Appliance use.

  • effects of a mandibular advancement device on the upper airway morphology a cephalometric analysis
    Journal of Oral Rehabilitation, 2009
    Co-Authors: Michiel H J Doff, Aarnoud Hoekema, L G M De Bont, G J Pruim, Van Der Johannes Hoeven, Boudewijn Stegenga
    Abstract:

    The aims of this study were to assess changes in the upper airway morphology associated with an Oral Appliance in situ in patients suffering from the obstructive sleep apnoea-hypopnoea syndrome and to relate these changes to treatment response. Changes in upper airway morphology as a result of an Oral Appliance were assessed in 52 patients with obstructive sleep apnoea-hypopnoea syndrome by means of cephalometric analysis. Lateral cephalograms were taken at baseline and after 2-3 months of treatment. Baseline and follow-up cephalograms were traced twice and cephalometric variables were compared. The predictive value of changes in upper airway morphology for the treatment response was evaluated in univariate and multivariate regression analyses. Oral Appliance therapy resulted in an increased posterior airway space at the level of the second vertebra, the uvular tip and the base of the tongue. The increase of the posterior airway space at the level of the second vertebra and the uvular tip were the best predictors for relative improvement of the apnoea-hypopnoea index. However, the predictive value for treatment response of these cephalometric upper airway changes should be interpreted with caution.

  • obstructive sleep apnea therapy
    Journal of Dental Research, 2008
    Co-Authors: Aarnoud Hoekema, Boudewijn Stegenga, Peter J Wijkstra, J H Van Der Hoeven, A F Meinesz, L G M De Bont
    Abstract:

    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.