PDF herunterladen
CC BY 4.0 · Eur J Dent 2022; 16(03): 564-572
DOI: 10.1055/s-0041-1735933
Original Article

Effectiveness of a Uniquely Designed Oral Appliance on Obstructive Sleep Apnea Control: A Pilot Study

Denise Fernandes Barbosa 
1   Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
,
Miguel Meira e Cruz 
2   Sleep Unit, Centro Cardiovascular da Universidade de Lisboa, Lisbon School of Medicine, Lisbon, Portugal
3   Research Laboratory on the Neuroimmune Interface of Pain São Leopoldo Mandic College, Campinas, São Paulo, Brazil
,
Marcelo Corrêa Alves 
4   ESALQ, University of Sao Paolo, Piracicaba, São Paulo, Brazil
,
Edilson Zancanella 
1   Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
,
Fausto Berzin 
5   Department of Odontology, FOP – UNICAMP, Piracicaba, São Paulo, Brazil
,
Almiro José Machado Júnior 
1   Division of Surgical Sciences, Department of Otorhinolaryngology, School of Medical Sciences, University of Campinas, UNICAMP, São Paulo, Brazil
› Institutsangaben Funding None.
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

Abstract

Objectives Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OAm) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OAm is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OAm use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures.

Materials and Methods A retrospective longitudinal study of 33 OSA patient treated with a different OAm, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance.

Results Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters.

Conclusion In this pilot study, DIORS OAm as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.

Keywords

obstructive sleep apnea syndrome - oral appliance therapy - upper airway


Publikationsverlauf

Artikel online veröffentlicht:
18. Februar 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Drager LF, Genta PR, Pedrosa RP. et al. Characteristics and predictors of obstructive sleep apnea in patients with systemic hypertension. Am J Cardiol 2010; 105 (08) 1135-1139
    CrossrefPubMedGoogle Scholar
  • 2 Kheirandish-Gozal L, Gozal D. Obstructive sleep apnea and inflammation: proof of concept based on two illustrative cytokines. Int J Mol Sci 2019; 20 (03) 459
    CrossrefPubMedGoogle Scholar
  • 3 Senaratna CV, Perret JL, Lodge CJ. et al. Prevalence of obstructive sleep apnea in the general population: a systematic review. Sleep Med Rev 2017; 34: 70-81
    CrossrefPubMedGoogle Scholar
  • 4 Sateia MJ. International Classification of Sleep Disorders. 3rd edition.. Chest; 2014
    Google Scholar
  • 5 Flemons WW, Buysse D, Redline S. et al. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999; 22 (05) 667-689
    CrossrefPubMedGoogle Scholar
  • 6 Zancanella E, Haddad FM, Oliveira LAMP. et al; Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial, Academia Brasileira de Neurologia, Sociedade Brasileira de Cardiologia, Sociedade Brasileira de Pediatria, Sociedade Brasileira de Pneumologia e Tisiologia. Obstructive sleep apnea and primary snoring: diagnosis. Rev Bras Otorrinolaringol (Engl Ed) 2014; 80 (1, Suppl 1): S1-S16
    CrossrefGoogle Scholar
  • 7 Meira E Cruz M, Soca R, Kryger M. How much is too much after all? Primary snoring as a remaining unsolved issue. J Clin Sleep Med 2020; 16 (06) 991
    CrossrefPubMedGoogle Scholar
  • 8 Ramar K, Dort LC, Katz SG. et al. Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: An update for 2015. J Clin Sleep Med 2015; 11 (07) 773-827
    CrossrefPubMedGoogle Scholar
  • 9 Alkhader M, Saadeh R. The knowledge of sleep medicine among dental interns in Northern Jordan. Eur J Dent 2021; 15 (02) 193-196
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 10 Premaraj TS, Stadiem J, Premaraj SA, Davies CR, Dennis M, Harrington JJ. Continuous positive airway pressure-mandibular advancement device combination therapy for moderate-to-severe obstructive sleep apnea: a preliminary study. Eur J Dent 2021; ;10.1055/s-0040-1719220 DOI: 10.1055/s-0040-1719220.
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 11 Gungor AY, Turkkahraman H, Yilmaz HH, Yariktas M. Cephalometric comparison of obstructive sleep apnea patients and healthy controls. Eur J Dent 2013; 7 (01) 48-54
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 12 Aly P, Mohsen C. Comparison of the accuracy of three-dimensional printed casts, digital, and conventional casts: an in vitro study. Eur J Dent 2020; 14 (02) 189-193
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 13 Kurt G, Sisman C, Akin E, Akcam T. Cephalometric comparison of pharyngeal airway in snoring and non-snoring patients. Eur J Dent 2011; 5 (01) 84-88
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Sutherland K, Deane SA, Chan ASL. et al. Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea. Sleep (Basel) 2011; 34 (04) 469-477
    CrossrefPubMedGoogle Scholar
  • 15 Lim J, Lasserson TJ, Fleetham J, Wright JJ. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 2006; 2006 (01) CD004435
    PubMedGoogle Scholar
  • 16 Ngiam J, Balasubramaniam R, Darendeliler MA, Cheng AT, Waters K, Sullivan CE. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea. Aust Dent J 2013; 58 (04) 408-419
    CrossrefPubMedGoogle Scholar
  • 17 Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 2006; 29 (02) 244-262
    CrossrefPubMedGoogle Scholar
  • 18 Liu C, Kang W, Zhang S. et al. Mandibular advancement devices prevent the adverse cardiac effects of obstructive sleep apnea-hypopnea syndrome (OSAHS). Sci Rep 2020; 10 (01) 3394
    CrossrefPubMedGoogle Scholar
  • 19 Scherr SC, Dort LC, Almeida FR. et al. Definition of an effective oral appliance for the treatment of obstructive sleep apnea and snoring. J Dent Sleep Med 2014; 1 (01) 39-50
    Google Scholar
  • 20 Almeida FR, Vanderveken OM, Cistulli PA. et al. ORal appliance network on global effectiveness (ORANGE): start-up and design description. J Dent Sleep Med 2014; 1 (01) 17-20
    Google Scholar
  • 21 Marklund M. Update on oral appliance therapy for OSA. Curr Sleep Med Rep 2017; 3 (03) 143-151
    CrossrefPubMedGoogle Scholar
  • 22 Marklund M, Braem MJA, Verbraecken J. Update on oral appliance therapy. Eur Respir Rev 2019; 28 (153) 190083
    CrossrefPubMedGoogle Scholar
  • 23 Venugopalan SK, SatishBabu CL, Rani MS. Determination of the relative parallelism of occlusal plane to three ala-tragal lines in various skeletal malocclusions: a cephalometric study. Indian J Dent Res 2012; 23 (06) 719-725
    CrossrefPubMedGoogle Scholar
  • 24 Bamagoos AA, Cistulli PA, Sutherland K. et al. Dose-dependent effects of mandibular advancement on upper airway collapsibility and muscle function in obstructive sleep apnea. Sleep (Basel) 2019; 42 (06) 1-10
    Google Scholar
  • 25 Bérzin F. Electromyographic analysis of the sternohyoid muscle and anterior belly of the digastric muscle in head and tongue movements. J Oral Rehabil 1995; 22 (11) 825-829
    CrossrefPubMedGoogle Scholar
  • 26 Ahrens A, McGrath C, Hägg U. A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod 2011; 33 (03) 318-324
    CrossrefPubMedGoogle Scholar
  • 27 Haviv Y, Bachar G, Aframian DJ, Almoznino G, Michaeli E, Benoliel R. A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study. Oral Dis 2015; 21 (03) 386-392
    CrossrefPubMedGoogle Scholar
  • 28 Schwartz M, Acosta L, Hung YL, Padilla M, Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Sleep Breath 2018; 22 (03) 555-568
    CrossrefPubMedGoogle Scholar
  • 29 Barbosa DF, Giannasi LC, Ferreira LMDB, Cruz MME, Alves MC, Berzin F. A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients. Dental Press J Orthod 2020; 25 (05) 44-50
    CrossrefPubMedGoogle Scholar
  • 30 Chan ASL, Lee RWW, Cistulli PA. Dental appliance treatment for obstructive sleep apnea. Chest 2007; 132 (02) 693-699
    CrossrefPubMedGoogle Scholar
  • 31 Guilleminault C, Riley R, Powell N. Obstructive sleep apnea and abnormal cephalometric measurements. Implications for treatment. Chest 1984; 86 (05) 793-794
    CrossrefPubMedGoogle Scholar
  • 32 Lowe AA, Ono T, Ferguson KA, Pae EK, Ryan CF, Fleetham JA. Cephalometric comparisons of craniofacial and upper airway structure by skeletal subtype and gender in patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop 1996; 110 (06) 653-664
    CrossrefPubMedGoogle Scholar
  • 33 Cunha TCA, Guimarães TM, Schultz TCB. et al. Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome. Braz Oral Res 2017; 31: e37
    PubMedGoogle Scholar
  • 34 Segù M, Cosi A, Santagostini A, Scribante A. Efficacy of a trial oral appliance in OSAS management: a new protocol to recognize responder/nonresponder patients. Int J Dent 2021; 2021: 8811700
    CrossrefPubMedGoogle Scholar
  • 35 Mediano O, Romero-Peralta S, Resano P. et al. Obstructive sleep apnea: emerging treatments targeting the genioglossus muscle. J Clin Med 2019; 8 (10) 1754 DOI: 10.3390/jcm8101754.
    CrossrefPubMedGoogle Scholar
  • 36 Stavrou VT, Vavougios GD, Astara K, Siachpazidou DI, Papayianni E, Gourgoulianis KI. The 6-minute walk test and anthropometric characteristics as assessment tools in patients with obstructive sleep apnea syndrome. a preliminary report during the pandemic. J Pers Med 2021; 11 (06) 563
    CrossrefPubMedGoogle Scholar
  • 37 Schwab RJ, Pasirstein M, Pierson R. et al. Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003; 168 (05) 522-530
    CrossrefPubMedGoogle Scholar