Effect of mandibular advancement splint treatment on tongue shape in obstructive sleep apnea

Ogawa, Takumi; Long, Jianlan; Sutherland, Kate; Chan, Andrew S. L.; Sasaki, Keiichi; Cistulli, Peter A.

doi:10.1007/s11325-014-1101-y

Cited by 20 publications

(14 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…; Ogawa et al . ). A greater rate of success with oral appliances have been reported among patients with primarily oropharyngeal collapse rather than velopharyngeal collapse (Ng et al .…”

Section: Discussionmentioning

confidence: 97%

“…Magnetic resonance imaging studies have shown that oral appliances induce anterior movement of the tongue base (Brown et al 2013;Ogawa et al 2015). A greater rate of success with oral appliances have been reported among patients with primarily oropharyngeal collapse rather than velopharyngeal collapse (Ng et al 2006;Bosshard et al 2011;Shen et al 2012).…”

Section: Posteriorly-located Tongue and Oral Appliance Therapymentioning

confidence: 99%

See 1 more Smart Citation

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Marques

Genta

Azarbarzin

et al. 2019

The Journal of Physiology

View full text Add to dashboard Cite

Key points •Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear. •In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances. •We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders). •The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy. Abstract A major limitation to the administration of oral appliance therapy for obstructive sleep apnoea (OSA) is that therapeutic responses remain unpredictable. In the present study, we tested the hypotheses that oral appliance therapy (i) reduces pharyngeal collapsibility preferentially in patients with posteriorly‐located tongue and (ii) is most efficacious (reduction in apnoea‐hypopnea index; AHI) in patients with a posteriorly‐located tongue and less‐severe baseline pharyngeal collapsibility. Twenty‐five OSA patients underwent upper airway endoscopy during natural sleep to assess tongue position (type I: vallecula entirely visible; type II: vallecula obscured; type III: vallecula and glottis obscured), as well as obstruction as a result of other pharyngeal structures (e.g. epiglottis). Additional sleep studies with and without oral appliance were performed to measure collapsibility (critical closing pressure; Pcrit) and assess treatment efficacy. Overall, oral appliance therapy reduced Pcrit by 3.9 ± 2.4 cmH2O (mean ± SD) and AHI by 69 ± 19%. Therapy lowered Pcrit by an additional 2.7 ± 0.9 cmH2O in patients with posteriorly‐located tongue (types II and III) compared to those without (type I) (P < 0.008). Posteriorly‐located tongue (p = 0.03) and lower collapsibility (p = 0.04) at baseline were significant determinants of (greater‐than‐average) treatment efficacy. Predicted responders (type II and III and Pcrit < 1 cmH2O) exhibited a greater reduction in the AHI (83 ± 9 vs. 48 ± 8% baseline, P < 0.001) and a lower treatment AHI (9 ± 6 vs. 32 ± 15 events h–1, P < 0.001) than predicted non‐responders. The site and severity of pharyngeal collapse combine to determine oral appliance efficacy. Specifically, patients with a posteriorly‐located tongue plus less‐severe collapsibility are the strongest candidates for oral appliance therapy.

show abstract

“…; Ogawa et al . ). A greater rate of success with oral appliances have been reported among patients with primarily oropharyngeal collapse rather than velopharyngeal collapse (Ng et al .…”

Section: Discussionmentioning

confidence: 97%

Section: Posteriorly-located Tongue and Oral Appliance Therapymentioning

confidence: 99%

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Marques

Genta

Azarbarzin

et al. 2019

The Journal of Physiology

View full text Add to dashboard Cite

show abstract

“…Several studies have demonstrated increased pharyngeal volume as a result of therapies with MAD using volumetric imaging [3,5,6,[14][15][16][17][18][19][20], but few studies have used this change in the pharynx (MAD in situ and baseline) as a predictor of success, or compare these changes in MAD responders and non-responders.…”

Section: Discussionmentioning

confidence: 99%

“…However,Gao et al (1999) found a positive association between changes in AHI and increased upper oropharynx area after MAD in eleven individuals using magnetic resonance imaging Chan et al (2010). showed increases in size in the upper airway after treatment with MAD only in responders (≥50% reduction in AHI) in 69 individuals using magnetic resonance imaging Ogawa et al (2015). found responders (≥50% reduction in AHI) decreased in relation to tongue length with MAD using magnetic resonance imaging in 68 individuals Lee et al (2010).…”

mentioning

confidence: 99%

Pharyngeal airway volume as a predictor of the efficacy of obstructive sleep apnea treatment with a mandibular advancement device

Guimarães¹,

Ferraz²,

Rossi³

et al. 2016

Int Arch Med

View full text Add to dashboard Cite

Background:The efficacy of mandibular advancement devices (MAD) in the treatment of obstructive sleep apnea (OSA) varies widely among patients, and at present it is difficult to predict success. Previous studies have shown a relationship between a gain in pharyngeal volume with MAD in situ and the success of the treatment. The aim of this study was to evaluate this change in volume of the upper airway using cone beam computed tomography (CBCT), measured at a baseline of maximum intercuspation (T0) and at maximum protrusion (T1) using a George Gauge to simulate a MAD produced protusion, and investigate whether this change in volume can be used to predict success with MAD.

show abstract

“…The key task of this system is to accurately detect the tongue position and record data on the timeline basis. The over time record of intraoral activities is indispensable to adjust physical structure of the device for fitting the requirement of each patient specifically [ 35 , 36 ]. First, the tunneling resistance of a stand-alone sensor array will be characterized by incremental forces.…”

Section: Methodsmentioning

confidence: 99%

A Wireless Monitoring System Using a Tunneling Sensor Array in a Smart Oral Appliance for Sleep Apnea Treatment

Yeh

et al. 2017

Sensors

View full text Add to dashboard Cite

Sleep apnea is a serious sleep disorder, and the most common type is obstructive sleep apnea (OSA). Untreated OSA will cause lots of potential health problems. Oral appliance therapy is an effective and popular approach for OSA treatment, but making a perfect fit for each patient is time-consuming and decreases its efficiency considerably. This paper proposes a System-on-a-Chip (SoC) enabled sleep monitoring system in a smart oral appliance, which is capable of intelligently collecting the physiological data about tongue movement through the whole therapy. A tunneling sensor array with an ultra-high sensitivity is incorporated to accurately detect the subtle pressure from the tongue. When the device is placed on the wireless platform, the temporary stored data will be retrieved and wirelessly transmitted to personal computers and cloud storages. The battery will be recharged by harvesting external RF power from the platform. A compact prototype module, whose size is 4.5 × 2.5 × 0.9 cm3, is implemented and embedded inside the oral appliance to demonstrate the tongue movement detection in continuous time frames. The functions of this design are verified by the presented measurement results. This design aims to increase efficiency and make it a total solution for OSA treatment.

show abstract

Effect of mandibular advancement splint treatment on tongue shape in obstructive sleep apnea

Cited by 20 publications

References 30 publications

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea

Pharyngeal airway volume as a predictor of the efficacy of obstructive sleep apnea treatment with a mandibular advancement device

A Wireless Monitoring System Using a Tunneling Sensor Array in a Smart Oral Appliance for Sleep Apnea Treatment

Contact Info

Product

Resources

About