Comparison of a Custom-made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea

Vanderveken, Olivier M.; Devolder, A.; Marklund, Marie; Boudewyns, An; Braem, M; Okkerse, W.; Verbraecken, Johan; Franklin, Karl A.; Backer, Wilfried A. De; Heyning, Paul Van de

doi:10.1164/rccm.200701-114oc

Cited by 227 publications

(266 citation statements)

References 38 publications

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“…We advanced the mandible manually, aiming to achieve an optimal effect under pharyngoscopic guidance. This technique was chosen after failure of a thermoplastic oral appliance to produce adequate tongue advancement in preliminary trials, in accordance with a recent publication (28). Although the manual technique could be unstable, we found no evidence for consistent instability, and considered the necessity to obtain optimal MA to evaluate the effect of GG-ES at this condition more important.…”

Section: Discussionmentioning

confidence: 80%

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Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

Oliven¹,

Tov²,

Odeh³

et al. 2009

Journal of Applied Physiology

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Oliven A. Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea. J Appl Physiol 106: 1668-1673, 2009. First published February 19, 2009 doi:10.1152/japplphysiol.91501.2008 and stimulation of the genioglossus (GG) have been shown to improve upper airway patency, but neither one achieves the effect of continuous positive airway pressure (CPAP) treatment. In the present study we assessed the combined effect of MA and GG stimulation on the relaxed pharynx in patients with obstructive sleep apnea (OSA). We evaluated responses of upper airway pressure-flow relationships and endoscopically determined pharyngeal cross-sectional area to MA and electrical stimulation of the GG in 14 propofol-anesthetized OSA patients. Measurements were undertaken at multiple levels of CPAP, enabling calculation of the critical closing pressure (Pcrit), upstream resistance (Rus), and pharyngeal compliance. GG stimulation, MA, and the combination of both shifted the pressure:flow relationships toward higher flow levels, resulting in progressively lower Pcrit (from baseline of 2.9 Ϯ 2.2 to 0.9 Ϯ 2.5, Ϫ1.4 Ϯ 2.9, and Ϫ4.2 Ϯ 3.3 cmH2O, respectively), without significant change in Rus. ⌬Pcrit during GG stimulation was significantly larger during MA than under baseline conditions (Ϫ2.8 Ϯ 1.4 vs. Ϫ2.0 Ϯ 1.4 cmH 2O, P ϭ 0.011). Combining the effect of GG stimulation with MA lowered Pcrit below 0 in all patients and restored pharyngeal patency to a level that enabled flow above the hypopnea level in 10/14 of the patients. Velopharyngeal compliance was not affected by either manipulation. We conclude that the combined effect of MA and GG stimulation is additive and may act in synergy, preventing substantial flow limitation of the relaxed pharynx in most OSA patients.

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Section: Discussionmentioning

confidence: 80%

“…MA has been shown to decrease Pcrit during sleep (9) and muscle paralysis (11) and to enlarge both the oro-and velopharynx (11). However, MA produces only a partial clinical effect in OSA, even when custom-made devices are used (28).…”

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confidence: 99%

Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

Oliven¹,

Tov²,

Odeh³

et al. 2009

Journal of Applied Physiology

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“…26 We are aware of one previous study which addressed the feasibility of using MAS as an adjunct treatment in patients previously established on CPAP. 12 The study used a non-adjustable MAS at 75% of mandibular advancement.…”

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confidence: 99%

Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

Almeida

Mulgrew

Ayas

et al. 2013

Journal of Clinical Sleep Medicine

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MAS are now widely used for the treatment of OSA both as a primary therapy and as an alternative for patients with severe OSA who are unwilling or unable to tolerate CPAP. 5 MAS are a simple, reversible, quiet, and cost effective therapy for selected patients with OSA. study objectives: CPAP is used as the fi rst-line treatment for patients with severe OSA, but this machine is not always feasible to use on the long term. We performed a clinical trial to determine whether patients with OSA could use a mandibular advancement splint (MAS) as a short-term treatment alternative to CPAP. Methods: Twenty-two patients adherent with CPAP therapy were recruited to the study. Each patient used the MAS for approximately 4 months. The transition between CPAP to MAS was gradual, and patients were asked to start using MAS together with CPAP during the MAS titration until subjective improvement or maximum mandibular advancement was achieved. Sleepiness (ESS), quality of life (SAQLI), and polysomnography were recorded prior to and after MAS titration. Patients recorded CPAP or MAS usage for the following 3 months. Results: Seven women and 12 men with a mean age of 53.8 (± 12.1) years and mean body mass index of 28.1 (± 4.8) kg/m 2 completed the clinical trial. Prior to MAS, CPAP adherence was 5.8 h/night. AHI decreased signifi cantly with MAS use compared to baseline (30.7 ± 23.1 vs 13.2 ± 11; p < 0.01). Fourteen patients (74%) had > 50% decrease in their AHI, while 2 patients had an increase in their AHI. There were no signifi cant differences in SAQLI between MAS and CPAP treatment, while ESS decreased signifi cantly on MAS. MAS self-reported usage was correlated with treatment effi cacy (r = 0.52; p < 0.05). Seventy-fi ve percent of the patients reported being suffi ciently satisfi ed with MAS to continue to use it as an alternative short-term therapy. s C I e N t I F I C I N V e s t I g A t I o N sO bstructive sleep apnea (OSA) is a common syndrome that is characterized by recurrent episodes of partial or complete upper airway obstruction during sleep. OSA is associated with reduced quality of life, decreased cardiovascular health and increased healthcare utilization, car crashes, and mortality.1,2 There are a variety of treatment options currently available for OSA including lifestyle modifi cations, continuous positive airway pressure (CPAP), mandibular advancement splints (MAS), and corrective upper airway surgery. CPAP is the most effi cient treatment for OSA and has been demonstrated to improve daytime symptoms and reduce cardiovascular disease and car crashes. 3,4 Despite improvements in the portability of CPAP machines, many patients fi nd this treatment not feasible when away from home. CPAP machines require access to a reliable electrical source while asleep. This can sometimes be provided by a battery, but is quite cumbersome and needs periodic recharging. Many patients faced with short-term diffi culties complying with CPAP during periods of travel or vacation stop treatment in these circumstances. Current knowle...

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“…3 In addition, failure rates with thermoplastic appliances appear to be very high when compared to custom-made appliances. 4 Direct comparisons of OAs use, CPAP therapy, or behavioral modifications (such as improved sleep hygiene and weight loss) suggest that only CPAP and OAs are effective in significantly reducing the ApneaHypopnea Index (AHI). In mild subjects (AHI 5-15), both CPAP and OAs exhibit significant improvements in AHI, sleepiness, and functional status.…”

Section: Dentistry's Role In Sleep-disordered Breathingmentioning

confidence: 99%

Dentistry’s Role in Sleep-Disordered Breathing

Lowe¹

2013

CRANIO®

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Comparison of a Custom-made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea

Cited by 227 publications

References 38 publications

Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

Mandibular Advancement Splint as Short-Term Alternative Treatment in Patients with Obstructive Sleep Apnea Already Effectively Treated with Continuous Positive Airway Pressure

Dentistry’s Role in Sleep-Disordered Breathing

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