Role of craniofacial phenotypes in the response to oral appliance therapy for obstructive sleep apnea

Abstract

Background: Mandibular advancement device (MAD) is a good alternative for patients with obstructive sleep apnea (OSA). However, the treatment response varies amongst individuals.Objective: This study aimed to explore the role of craniofacial features in the response to MADs to improve prognostication and patient selection. Methods:The retrospective trial contained 42 males aged 41.5 ± 9.0 years, and with an apnea-hypopnea index (AHI) of 21.5 ± 13.8 events/h. According to the mandibular plane angle, participants were divided into three groups: low angle (n = 13), average angle (n = 14) and high angle (n = 15). Under the monitoring of home sleep testing, adjustable MADs were used to titrate the mandible forward from 0 mm with an increment of 0.5 mm every day. The polysomnography outcomes, mandibular protrusion amounts, changes in upper airway MRI measurements and nasal resistance were compared amongst the three groups. Results:The normalisation rate (AHI <5 /h) was 92.3%, 57.1% and 46.7%, respectively, in the low-, average-and high-angle groups (p = .027). The effective protrusion where AHI was reduced by half was 20 (11.3 ~ 37.5) %, 31.3 (23.6 ~ 50) % and 50 (36.9 ~ 64.9) % of the maximal mandibular protrusion, in the low-, average-and high-angle groups (p = .004). Multivariate logistic regression revealed that increased gonion angle (OR = 0.878) and baseline AHI(OR = 0.868) can reduce the probability of normalisation. Conclusion:The high mandibular plane angle might be an unfavourable factor to MAD treatment and more protrusion was needed to achieve a 50% reduction in AHI.Vertical craniofacial pattern (gonion angle) and baseline AHI constituted the model for predicting the effect of MADs.

Salivary Biomarkers and Temporomandibular Disorders: A Systematic Review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions

“…Similar results were also supported by multiple articles 44‐46 . By contrast, other studies have demonstrated a significant positive correlation between salivary cortisol levels in both the case and the CG 47‐51 . These discrepancies in the literature suggest that individual variations in stress thresholds may contribute to the diverse findings across studies 52‐54 …”

“…4 4-46 By contrast, other studies have demonstrated a significant positive correlation between salivary cortisol levels in both the case and the CG. [47][48][49][50][51] These discrepancies in the literature suggest that individual variations in stress thresholds may contribute to the diverse findings across studies. [52][53][54] Regarding IL-1, Ce et al 32 reported significantly higher levels in patients with TMD alone compared to the CG, irrespective of fibromyalgia assessment.…”

Post‐traumatic stress, prevalence of temporomandibular disorders in war veterans: Systematic review with meta‐analysis

“…Of note, the study by Mottaghi et al revealed that regardless of diagnosis of PTSD, war exposure was associated with a higher prevalence of TMD sign and symptoms. This is the only study exploring the association between war and TMD, regardless any comorbidity 33 …”

“…This is the only study exploring the association between war and TMD, regardless any comorbidity. 33 The physical and psychological effects of war are not always easy to detect, but they can be far-reaching and long-lasting. 5 One of the most common and serious of these effects is the development of chronic diseases.…”

Prevalence of temporomandibular disorders in clear aligner patients using orthodontic intermaxillary elastics assessed with diagnostic criteria for temporomandibular disorders (DC/TMD) axis II evaluation: A cross‐sectional study

“…1,16 According to a study conducted by Sambataro et al, elastics have an impact not only on the teeth but also on the TMJ position. [17][18][19][20][21][22][23][24][25] Moreover, a study conducted by Tanaka et al demonstrated that the elastic modulus of the TMJ disk exhibits an increase with age. 26 The mechanical loading that the TMJ structures experience depends significantly on the disk's stiffness.…”