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DOI: 10.1055/s-2002-34313
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662
The Efficacy of a Mandibular Advancement Splint in Relation to Cephalometric Variables
Publication History
Publication Date:
23 September 2002 (online)
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ABSTRACT
The efficacy of a titratable mandibular advancement splint (MAS) for the management of obstructive sleep apnea (OSA) was investigated in relation to supine cephalometric variables. Fourteen adults with diagnosed OSA were recruited following an initial polysomnogram. Supine cephalographic radiographs were taken at baseline and subjects wore the MAS nightly for 6 to 8 weeks. The polysomnogram and cephalogram were repeated with the MAS at maximal titration. The MAS resulted in complete or partial treatment response in all subjects as measured by the improvement in mean apnea/hypopnea index (AHI) (baseline AHI 34 ± 22/hr, with MAS 10 ± 5/hr; p = 0.001). The perpendicular distance between the hyoid bone and the mandibular plane (HYML) measured in awake subjects decreased with the MAS (baseline HYML 25.3 ± 7.8 mm, with MAS 16.5 ± 9.6 mm; p = 0.002). Baseline HYML was the only cephalometric variable associated with a successful clinical outcome. It was strongly linked to improvements in AHI (adjusted R2 = 0.37, p = 0.012) and arousals (adjusted R 2 = 0.455, p = 0.005). We conclude that the MAS is an effective therapy for OSA and baseline HYML is an important predictor of improvement. Improvements in AHI may be explained by the MAS maintaining the new or existing relationship of the hyoid and its surrounding structures, thus preventing obstruction in the upper airway during sleep.
KEYWORDS
Obstructive sleep apnea - cephalometry - mandibular splint
REFERENCES
- 1 American Academy of Sleep Medicine. Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. Report of an American Academy of Sleep Medicine Task Force. Sleep . 1999; 22 667-689
- 2 Ferguson K A, Ono T, Lowe A A, Ryan C F, Fleetham J A. The relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest . 1995; 108 375-381
- 3 Pracharktam N, Nelson S, Hans M G. Cephalometric assessment in obstructive sleep apnea. Am J Orthod Dentofacial Orthop . 1996; 109 410-419
- 4 Solow B, Ovesen J, Nielsen P W, Wildschiodtz G, Tallgren A. Head posture in obstructive sleep apnoea. Eur J Orthod . 1993; 15 107-114
- 5 Ozbek M M, Miyamoto K, Lowe A A, Fleetham J A. Natural head posture, upper airway morphology and obstructive sleep apnoea severity in adults. Eur J Orthod . 1998; 20 133-143
- 6 Coltman R, Taylor D R, Whyte K, Harkness M. Craniofacial form and obstructive sleep apnea in Polynesian and Caucasian men. Sleep . 2000; 23 943-950
- 7 Liu Y, Lowe A A, Zeng X, Fu M, Fleetham J A. Cephalometric comparisons between Chinese and Caucasian patients with obstructive sleep apnea. Am J Orthod Dentofacial Orthop . 2000; 117 479-485
- 8 Sullivan C E, Issa F G, Berthon-Jones M, Eves L. Reversal of obstructive sleep apnoea by continuous positive airway pressure applied through the nares. Lancet . 1981; 1 862-865
- 9 American Sleep Disorders Association. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep . 1995; 18 511-513
- 10 Ferguson K A, Ono T, Lowe A A, Keenan S P, Fleetham J A. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest . 1996; 109 269-1275
- 11 Johal A, Battagel J M. An investigation into the changes in airway dimension and the efficacy of mandibular advancement appliances in subjects with obstructive sleep apnoea. Br J Orthod . 1999; 26 205-210
- 12 Schmidt-Nowara W. Recent developments in oral appliance therapy of sleep-disordered breathing. Sleep Breath . 1999; 3 103-106
- 13 Liu Y, Zeng X, Fu M, Huang X, Lowe A A. Effects of a mandibular repositioner on obstructive sleep apnea. Am J Orthod Dentofacial Orthop . 2000; 118 248-256
- 14 George P T. Selecting sleep-disordered breathing appliances. Biomechanical considerations. J Am Dent Assoc . 2001; 132 339-347
- 15 Mehta A, Qian J, Petocz P, Darendeliler M A, Cistulli P A. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med . 2001; 163 1457-1461
- 16 Clark G T, Arand D, Chung E, Tong D. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Review Respir Dis . 1993; 147 624-629
- 17 Eveloff S E, Rosenberg C L, Carlisle C C, Millman R P. Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med . 1994; 149(4 Pt 1) 905-909
- 18 Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea [comments]. Chest . 1999; 116 1511-1518
- 19 Schmidt-Nowara W, Lowe A, Wiegand L. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep . 1995; 18 501-510
- 20 Van de Graff B W, Gottfried S, Mitra J. Respiratory function of hyoid muscles and hyoid arch. J Appl Physiol . 1984; 57 197-204
- 21 Jamieson A, Guilleminault C, Partinen M, Quera-Salva M A. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep . 1986; 9 469-477
- 22 Schwab R J, Gefter W B, Hoffman E A, Gupta K B, Pack A I. Dynamic upper airway imaging during awake respiration in normal subjects and patients with sleep-disordered breathing. Am Rev Respir Dis . 1993; 148 1385-1400
- 23 Martin S E, Marshall I, Douglas N J. The effect of posture on airway caliber with the sleep-apnea/hypopnea syndrome. Am J Respir Crit Care Med . 1995; 152 721-724
- 24 L'Estrange P R, Battagel J M, Nolan P J, Harkness B, Jorgensen G I. The importance of a multidisciplinary approach to the assessment of patients with obstructive sleep apnea. J Oral Rehabil . 1996; 23 72-77
- 25 Ryan C F, Love L L, Peat D, Fleetham J A, Lowe A A. Mandibular advancement oral appliance therapy for obstructive sleep apnoea: effect on awake calibre of the velopharynx. Thorax . 1999; 54 972-977
- 26 Liu Y, Park Y-C, Lowe A A, Fleetham J A. Supine cephalometric analyses of an adjustable oral appliance used in the treatment of obstructive sleep apnea. Sleep Breath . 2000; 4 59-66
- 27 Robertson C J. Obstructive sleep apnoea. Part II: treatment with a customised dental appliance. N Z Dent J . 1997; 93 4-9
- 28 Battagel J M, Johal A, L'Estrange P R, Croft C B, Kotecha B. Changes in airway and hyoid position in response to mandibular protrusion in subjects with obstructive sleep apnoea (OSA). Eur J Orthod . 1999; 21 363-376
- 29 Johns M W. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep . 1991; 14 540-545
-
30 US Department of Health. A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. Rechtschaffen A, Kales A, eds. Bethesda, MD: National Institute of Neurological Disease and Blindness 1968
- 31 American Sleep Disorders Association. EEG arousals: scoring rules and examples: a preliminary report from the Sleep Disorders Atlas Task Force of the American Sleep Disorders Association. Sleep . 1992; 15 173-184
- 32 Broca M. Sur les projections de la tête, et sur un nouveau procédé de cephalometric. Bull Soc Anthrop Paris . 1862; 3 514-544
- 33 Solow B, Tallgren A. Natural head position in standing subjects. Acta Odont Scand . 1971; 29 591-607
- 34 Lowe A A, Sjoholm T T, Ryan C F. Treatment, airway and compliance effects of a titratable oral appliance. Sleep . 2000; S172-S178
- 35 Ferguson K A, Ono T, Lowe A A. A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax . 1997; 52 362-368
- 36 Hiyama S, Ono T, Ishiwata Y, Kuroda T. Supine cephalometric study on sleep-related changes in upper-airway structures in normal subjects. Sleep . 2000; 23 783-790
- 37 Clark G T, Sohn J W, Hong C N. Treating obstructive sleep apnea and snoring: assessment of an anterior mandibular positioning device. J Am Dent Assoc . 2000; 131 765-771