Predictors of Side Effects With Long-Term Oral Appliance Therapy for Obstructive Sleep Apnea

Minagi, Hitomi Ono; Okuno, Kentaro; Nohara, Kanji; Sakai, Takayoshi

doi:10.5664/jcsm.6896

Cited by 27 publications

(31 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this study, lateral cephalometric radiographs CX150WT (Asahi, Kyoto, Japan) were obtained to analyse the craniofacial morphology at baseline. The film was taken when the subject sat upright with Frankfort plane parallel to the ground, naturally closed lips, and the bite in intercuspal occlusion with relaxation of the tongue and perioral muscles as previously described . To analyse the cephalograms, all distances and angles were manually measured by image analysis software (ImageJ; http://imagej.nih.gov/ij/).…”

Section: Methodsmentioning

confidence: 99%

The efficacy of nasal airway stent (Nastent) on obstructive sleep apnoea and prediction of treatment outcomes

Okuno

Minagi

Ikai

et al. 2018

J of Oral Rehabilitation

Self Cite

View full text Add to dashboard Cite

Summary Background Obstructive sleep apnoea (OSA) is characterised by recurrent episodes of partial or complete upper airway collapse during sleep and is highly prevalent in the general population. The nasopharyngeal airway stent (Nastent) is a specifically designed, preformed silicone tube that intends to maintain the upper airway patency during sleep and reduce snoring and sleep apnoea. Objective(s) The purpose of this study was to determine the efficacy of Nastent treatment and examine predictors for Nastent treatment outcomes in patients with OSA. Methods Consecutive thirty patients were enrolled in this study. Cephalometric radiographs were obtained to analyse the pharyngeal and craniofacial morphology. Before and after Nastent treatment, we evaluated OSA using a portable sleep study. Results Twenty‐nine subjects completed this study. There were significant decreases in the respiratory event index (REI) (22.4 ± 14.1 to 15.7 ± 10.4, P < 0.01) and a significant increase in the lowest SpO2 (81.9 ± 7.5 to 86.6 ± 4.8, P < 0.01) by Nastent treatment. Subjects were divided into responders and non‐responders based on reduction in REI of >50% compared with baseline REI. We evaluated the ratio of inferior airway width and middle airway width (IAW/MAW) on cephalograms as the index of the narrowest airway site. The IAW/MAW was significantly higher in responders than in non‐responders (1.4 ± 0.9 vs 0.9 ± 0.4, P < 0.01) and predicted treatment responders with high accuracy (sensitivity: 90.9%, specificity: 88.9%, when IAW/MAW was set at 1.10). Conclusions The Nastent device improved OSA, and a narrower velopharynx than hypopharynx predicted treatment response with a good sensitivity and specificity.

show abstract

Section: Methodsmentioning

confidence: 99%

The efficacy of nasal airway stent (Nastent) on obstructive sleep apnoea and prediction of treatment outcomes

Okuno

Minagi

Ikai

et al. 2018

J of Oral Rehabilitation

Self Cite

View full text Add to dashboard Cite

show abstract

“…However, sometimes these symptoms are more severe and continuous, resulting in cessation of the therapy. The major long-term adverse effects are occlusal changes with prolonged MAD use, but these changes have not been reported as being related to treatment withdrawal [42][43][44][45][46][47][48]. Conversely, skeletal or postural changes were negligible.…”

Section: Side Effectsmentioning

confidence: 99%

Oral Appliances in Obstructive Sleep Apnea

Dieltjens

Vanderveken

2019

Healthcare

View full text Add to dashboard Cite

Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

show abstract

“…The morphology of the pharyngeal airway on the lateral cephalogram is known to be largely affected by the skeleton, body type, posture, and respiratory phase; the comparative reproducibility of the upper airway morphology cannot be considered to be high [ 26 ]. Therefore, the subjects were placed in an upright position with the Frankfurt plane parallel to the floor, and photographed in the end-tidal position [ 27 ]. A cephalometric analysis was carried out as previously described ( Figure 3 ) [ 28 ].…”

Section: Methodsmentioning

confidence: 99%

Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study

Ishiyama

Hideshima

Inukai

et al. 2021

JCM

View full text Add to dashboard Cite

The aim of this study was to determine the utility of respiratory resistance as a predictor of oral appliance (OA) response in obstructive sleep apnea (OSA). Twenty-seven patients with OSA (mean respiratory event index (REI): 17.5 ± 6.5 events/h) were recruited. At baseline, the respiratory resistance (R20) was measured by impulse oscillometry (IOS) with a fitted nasal mask in the supine position, and cephalometric radiographs were obtained to analyze the pharyngeal airway space (SPAS: superior posterior airway space, MAS: middle airway space, IAS: inferior airway space). The R20 and radiographs after the OA treatment were evaluated, and the changes from the baseline were analyzed. A sleep test with OA was carried out using a portable device. The subjects were divided into Responders and Non-responders based on an REI improvement ≥ 50% from the baseline, or REI < 5 after treatment, and the R20 reduction rate between the two groups were compared. The subjects comprised 20 responders and 7 non-responders. The R20 reduction rate with OA in responders was significantly greater than it was in non-responders (14.4 ± 7.9 % versus 2.4 ± 9.8 %, p < 0.05). In responders, SPAS, MAS, and IAS were significantly widened and R20 was significantly decreased with OA (p < 0.05). There was no significant difference in non-responders (p > 0.05). A logistic multiple regression analysis showed that the R20 reduction rate was predictive for OA treatment responses (2% incremental odds ratio (OR), 24.5; 95% CI, 21.5–28.0; p = 0.018). This pilot study confirmed that respiratory resistance may have significant clinical utility in predicting OA treatment responses.

show abstract

Predictors of Side Effects With Long-Term Oral Appliance Therapy for Obstructive Sleep Apnea

Abstract: A commentary on this article appears in this issue on page 7.

Cited by 27 publications

References 32 publications

The efficacy of nasal airway stent (Nastent) on obstructive sleep apnoea and prediction of treatment outcomes

The efficacy of nasal airway stent (Nastent) on obstructive sleep apnoea and prediction of treatment outcomes

Oral Appliances in Obstructive Sleep Apnea

Evaluation of Respiratory Resistance as a Predictor for Oral Appliance Treatment Response in Obstructive Sleep Apnea: A Pilot Study

Contact Info

Product

Resources

About