Sex differences in mandibular repositioning device therapy effectiveness in patients with obstructive sleep apnea syndrome

Vecchierini, Marie-Françoise; Attali, Valérie; Collet, Jean-Marc; d’Ortho, Marie-Pia; Goutorbe, F.; Kerbrat, Jean-Baptiste; Léger, Damien; Lavergne, Florent; Monaca, Christelle; Monteyrol, Pierre-Jean; Morin, Laurent; Mullens, Eric; Pigearias, B.; Martín, F García; Khemliche, Hauria; Lerousseau, Lionel; Meurice, J.-C.; Abedipour, Darius; Allard-Redon, Aurélie; Aranda, Alexandre; Bavozet, Frédérique; Becu, Martine; Beruben, Wally; Bessard, J.; Bonafe, Isabelle; Boukhana, Mohammed; Chabrol, Bruno; Chatté, G.; Lebret, Chauvel; Coste, Olivier; Dumont, Nathalie; Durand-Amat, Sophie; Elbaum, Jean Marc; Santerre, O. Gallet de; Goutorbes, Frédéric; Grandjean, Thierry; Guyot, Wilma; Hammer, Doniphan; Havasi, Carmen; Huet, Pascal; Kerbrat, J.B.; Koltes, Christian; Lacassagne, L.; Laur, Xavier; Liard, Olivier; Loisel, Christophe; Longuet, Matthieu; Mallart, A.; Beral, Frédéric Merle; Meurice, J.-C.; Mokhtari, Zoubida; Monteyrol, Pierre Jean; Muir, Jean-François; Muller, Dominique; Paoli, Charles; Petit, François Xavier; Pradines, Marc; Prigent, Arnauld; Putterman, Gil; Rey, Marc; Samama, Mickael; Tamisier, Renaud; Tiberge, M.; Tison, Cyrille; Tordjman, Fabienne; Triolet, Bernard; Vacher, C.; Verain, A

doi:10.1007/s11325-018-1766-8

Cited by 28 publications

(15 citation statements)

References 36 publications

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“…These therapies have been assessed in both women and men, although the literature lacks studies involving the female population (Garg et al, 2016 ; Wray and Thaler, 2016 ). However, two studies have suggested that MRS use is more efficient in women compared to men (Marklund et al, 2004 ; Vecchierini et al, 2019 ). In fact, obese men or men that gain weight during MRS treatment exhibit a reduced efficacy of their treatment with this device, and were often followed up with other OSA treatments like CPAP.…”

Section: Therapies On Metabolic Control and Osamentioning

confidence: 99%

Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases

Martins

Conde

2021

Front. Physiol.

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The relationship between obstructive sleep apnea (OSA) and endocrine and metabolic disease is unequivocal. OSA, which is characterized by intermittent hypoxia and sleep fragmentation, leads to and exacerbates obesity, metabolic syndrome, and type 2 diabetes (T2D) as well as endocrine disturbances, such as hypothyroidism and Cushing syndrome, among others. However, this relationship is bidirectional with endocrine and metabolic diseases being considered major risk factors for the development of OSA. For example, polycystic ovary syndrome (PCOS), one of the most common endocrine disorders in women of reproductive age, is significantly associated with OSA in adult patients. Several factors have been postulated to contribute to or be critical in the genesis of dysmetabolic states in OSA including the increase in sympathetic activation, the deregulation of the hypothalamus-pituitary axis, the generation of reactive oxygen species (ROS), insulin resistance, alteration in adipokines levels, and inflammation of the adipose tissue. However, probably the alterations in the hypothalamus-pituitary axis and the altered secretion of hormones from the peripheral endocrine glands could play a major role in the gender differences in the link between OSA-dysmetabolism. In fact, normal sleep is also different between men and women due to the physiologic differences between genders, with sex hormones such as progesterone, androgens, and estrogens, being also connected with breathing pathologies. Moreover, it is very well known that OSA is more prevalent among men than women, however the prevalence in women increases after menopause. At the same time, the step-rise in obesity and its comorbidities goes along with mounting evidence of clinically important sex and gender differences. Metabolic and cardiovascular diseases, seen as a men's illness for decades, presently are more common in women than in men and obesity has a higher association with insulin-resistance-related risk factors in women than in men. In this way, in the present manuscript, we will review the major findings on the overall mechanisms that connect OSA and dysmetabolism giving special attention to the specific regulation of this relationship in each gender. We will also detail the gender-specific effects of hormone replacement therapies on metabolic control and sleep apnea.

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Section: Therapies On Metabolic Control and Osamentioning

confidence: 99%

Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases

Martins

Conde

2021

Front. Physiol.

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“…Although major efforts are now being directed towards more accurate prediction of the required mandibular protrusion, at present there is unfortunately still no clinical routine protocol allowing this [27]. Obesity, older age and male sex relate to a poorer outcome, although with some variability in results [21,28,29]. However, early treatment might be beneficial in order to reduce the risk for systemic hypertension as a consequence of untreated OSA [30].…”

Section: Introductionmentioning

confidence: 99%

Update on oral appliance therapy

2019

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Oral appliances are increasingly recommended for selected patients with obstructive sleep apnoea (OSA) and those who do not tolerate nor prefer continuous positive airway pressure. The most commonly used oral appliance advances the lower jaw during sleep, the so-called mandibular advancement device (MAD). Patients seek treatment because of disturbing snoring, daytime symptoms, apnoeas that disturb sleep and the longer term consequences with regard to cardiovascular risks. MADs reduce the apnoea–hypopnoea index, although to various degrees among patients. Effects on daytime sleepiness have been observed mainly among the more severe OSA patients. Blood pressure may be reduced in MAD-treated OSA patients. There is, however, uncertainty about which patients will respond to this therapy in terms of apnoea reductions, decreased sleepiness and other symptoms, and reduced risk for future impaired health. The occurrence of side-effects also remains difficult to predict at present. The majority of sleep apnoea patients suffer from various comorbidities in terms of cardiovascular diseases, type 2 diabetes and depression. The most recent findings indicate that phenotyping of patients, considering various aspects of this multifaceted disease, will shed more light on the indications for MADs in patients with nightly sleep breathing disturbances. This review summarises the most recent knowledge about MAD treatment.

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“…Effective treatment across both mandibular advancement groups was more often documented in females compared to males. Vecchierini et al ( 2019 ) reported that OA therapy was effective in females with OSA of any severity, with response rates being significantly higher compared to males, especially in severe OSA. Similar to previous studies, our results also suggest that sex differences are predictors of effective treatment.…”

Section: Discussionmentioning

confidence: 99%

The comparison of two different mandibular positions for oral appliance therapy in patients with obstructive sleep apnea

Makihara

Watanabe

Ogusu

et al. 2022

Clinical & Exp Dental Res

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Background: An oral appliance (OA) can alleviate upper airway obstruction by pulling the mandible forward during sleep. While a large mandibular advancement with an OA decreases the number of apnea and hypopnea events, long-term use may cause side effects, such as toothache, stiffness, and pain in the temporomandibular joint.Objetives: This study aimed to evaluate the effectiveness of different mandibular positions for obstructive sleep apnea (OSA) and determine the optimal therapeutic mandibular position.Methods: Thirty-two patients (17 males and 15 females) with mild to moderate OSA participated in this prospective study. All patients were randomly allocated to receive a 50% mandibular advancement or a 75% mandibular advancement with an OA. The pre-and posttreatment apnea-hypopnea index (AHI), apnea index (AI), and Epworth Sleepiness Scale (ESS) were compared. Treatment effectiveness and treatment success were compared between groups.Results: AHI improved significantly in both groups, and AI improved significantly in the group with 50% mandibular advancement. No significant improvements in the ESS were observed in either group. There was no significant difference in treatment effectiveness between groups. In the proportion of females and males whose treatment was effective in the two groups, females were significantly greater than males.Conclusions: For patients with mild to moderate OSA, 50% mandibular advancement is recommended as the initial therapeutic mandibular position. It was suggested that gender differences also affect treatment effectiveness.

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Sex differences in mandibular repositioning device therapy effectiveness in patients with obstructive sleep apnea syndrome

Cited by 28 publications

References 36 publications

Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases

Gender Differences in the Context of Obstructive Sleep Apnea and Metabolic Diseases

Update on oral appliance therapy

The comparison of two different mandibular positions for oral appliance therapy in patients with obstructive sleep apnea

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