Predictors of Obstructive Sleep Apnea-Hypopnea Treatment Outcome (original) (raw)
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American Journal of Orthodontics and Dentofacial Orthopedics, 2006
Introduction: This retrospective study compared cephalometric variables between responders and nonresponders to a titratable oral appliance (OA) in a group of subjects matched for sex, pretreatment age, and body mass index (BMI). Methods: Nine nonresponders as defined by an improvement in the apnea hypopnea index (AHI; Ͻ20%) and their individually matched responders were selected for this study. The difference in age for each matched pair was Ϯ5 years, and, for BMI, the difference was Ϯ15%. The pretreatment AHI was matched to the same category (moderate, Ͼ15 to Յ30; severe I, Ͼ30 to Յ45; and severe II, Ͼ45 AHI). Results: Middle and inferior airway space and oropharyngeal airway cross-sectional area were significantly larger in the nonresponders. Position of the mandible relative to the cervical spine was the only significant skeletal variable and was larger in nonresponders. Changes in BMI between the groups were statistically significant; the averages were a 2.9% increase in the nonresponders and a 0.5% decrease in responders. The wider airway in nonresponders might reflect an enhanced neuromuscular compensation while awake. The weight gain in nonresponders was relatively small, but it might have reduced the effectiveness of the OA. Conclusion: When treating OSA patients with OA therapy, clinicians should pay particular attention to airway size and weight changes. (Am J Orthod Dentofacial Orthop 2006;129:222-9)
American Journal of Orthodontics and Dentofacial Orthopedics, 2006
Introduction: Side effects observed in the occlusion and dental arches of patients using an oral appliance (OA) to treat snoring or sleep apnea for more than 5 years have not yet been investigated. Methods: Stone casts trimmed in centric occlusion before appliance placement and after an average of 7.4 Ϯ 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists. Results: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class II Division 1 and Class II Division 2 malocclusions were more likely to have favorable or no changes. More favorable changes in overbite occurred in subjects with large baseline overbites. A greater baseline overjet and more distal mandibular canine relationship were correlated to favorable changes. A greater initial overjet was correlated to a more favorable change, a decrease in mandibular crowding, a smaller change in anterior crossbite, and a greater change in overjet. Conclusions: OA wear after a mean of 7.4 years induces clinically relevant changes in the dental arch and the occlusion. (Am J Orthod Dentofacial Orthop 2006;129:205-13)
Predictors of Side Effects With Long-Term Oral Appliance Therapy for Obstructive Sleep Apnea
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine, 2018
The aim of this study was to investigate the predictors of dental changes associated with long-term treatment with oral appliances (OAs) in patients with obstructive sleep apnea (OSA). This was a retrospective study to investigate Japanese patients with OSA receiving long-term treatment with OAs. Comparisons of cephalometric analysis were carried out between the initial and follow-up assessments of dental and skeletal changes. Based on dental changes, predictors that may cause side effects were investigated. A total of 64 patients (average age at start of treatment: 57.7 ± 14.2 years, 44 males) were included in this study. The average duration of treatment was 4.3 ± 2.1 years. Over the total treatment period, there was a significant reduction in overjet (OJ) (1.5 ± 1.3 mm) and overbite (0.90 ± 1.5 mm), and an increase in the lower incisor line to the mandibular plane (3.1 ± 5.4°). A larger reduction in OJ of ≥ 1 mm was associated with treatment duration, use frequency, and mandibula...
American Journal of Orthodontics and Dentofacial Orthopedics, 2001
The purpose of this study was to investigate whether any physiologic or cephalometric parameters could be used to predict the efficacy of an adjustable mandibular advancement appliance for treating obstructive sleep apnea (OSA). Forty-two male and 5 female patients with OSA were recruited on the basis of baseline polysomnography with a documented Apnea and Hypopnea Index (AHI) greater than 15 per hour. Repeat polysomnography was performed with the appliance in place. Baseline cephalometry was performed for each patient, and follow-up cephalometry was completed for 19 of the subjects. The subjects were divided into 3 groups on the basis of the degree of change in the AHI with oral appliance therapy: good response (> 75% decrease in AHI), moderate response (25% to 75% decrease in AHI), and poor response (< 25% decrease in AHI). Patients with a good response were younger and had smaller upper airways. In a linear regression analysis, the change in AHI (%) was associated with physiologic (age and body mass index), cephalometric (overjet, height of the maxillary molars, vertical height of the hyoid bone), and airway variables. However, changes in either overbite or overjet were not related to changes in any of the polysomnographic variables for the 19 subjects. A stepwise regression analysis revealed a better treatment response with the adjustable mandibular advancement appliance in patients who were younger and had a lower body mass index, a longer maxilla, a smaller oropharynx, a smaller overjet, less erupted maxillary molars, and a larger ratio of vertical airway length to the cross-sectional area of the soft palate.
2010
Objectives This study aimed to assess possible dental side effects associated with long-term use of an adjustable oral appliance compared with continuous positive airway pressure (CPAP) in patients with the obstructive sleep apnea syndrome and to study the relationship between these possible side effects and the degree of mandibular protrusion associated with oral appliance therapy. Materials and methods As part of a previously conducted RCT, 51 patients were randomized to oral appliance therapy and 52 patients to CPAP therapy. At baseline and after a 2-year follow-up, dental plaster study models in full occlusion were obtained which were thereupon analyzed with respect to relevant variables. Results Long-term use of an oral appliance resulted in small but significant dental changes compared with CPAP. In the oral appliance group, overbite and overjet decreased 1.2 (±1.1) mm and 1.5 (±1.5) mm, respectively. Furthermore, we found a significantly larger anterior-posterior change in the occlusion (−1.3±1.5 mm) in the oral appliance group compared to the CPAP group (−0.1±0.6 mm). Moreover, both groups showed a significant decrease in number of occlusal contact points in the (pre)molar region. Linear regression analysis revealed that the decrease in overbite was associated with the mean mandibular protrusion during follow-up [regression coefficient (β)0−0.02, 95 % confidence interval (−0.04 to −0.00)]. Conclusions Oral appliance therapy should be considered as a lifelong treatment, and there is a risk of dental side effects to occur. Clinical relevance Patients treated with the oral appliance need a thorough follow-up by a dentist or dental-specialist experienced in the field of dental sleep medicine.
European Journal of Dentistry
Objectives Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OAm) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OAm is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OAm use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures. Materials and Methods A retrospective longitudinal study of 33 OSA patient treated with a different OAm, that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questi...
American journal of respiratory and critical care medicine, 2016
Oral appliances (OA) are commonly utilized as an alternative treatment to continuous positive airway pressure for obstructive sleep apnea (OSA) patients. However, OA have variable success at reducing the apnea-hypopnea index (AHI) and predicting responders is challenging. Understanding this variability may lie with the recognition that OSA is a multifactorial disorder and that OA may affect more than just upper-airway anatomy/collapsibility. The objectives of this study were to determine 1) how OA alters AHI and four phenotypic traits (upper-airway anatomy/collapsibility and muscle function, loop gain, arousal threshold) and 2) baseline predictors of which patients gain the greatest benefit from therapy. In a randomized cross-over study, 14 OSA patients attended 2 sleep studies with and without their OA. Under each condition, AHI and the phenotypic traits were assessed. Multiple linear regression was used to determine independent predictors of the reduction in AHI. OA therapy reduce...
Journal of Clinical Sleep Medicine, 2014
The prevalence of supine-dependent obstructive sleep apnea (sdOSA) in a general population ranges from 20% to 60%, depending on the criteria used. Currently, the prevalence and evolution of sdOSA once oral appliance therapy with a mandibular advancement device (OA m ) has started is unknown. In addition, literature on the correlation between sdOSA and treatment success with OA m is not unequivocal. The fi rst purpose of this study was to assess the prevalence of sdOSA before and under OA m therapy. Second, the conversion rate from non-sdOSA to sdOSA during OA m therapy was evaluated. The third and fi nal goal was to analyze the correlation between sdOSA and treatment success with OA m therapy in the patient population. Methods: Two hundred thirty-seven consecutive patients (age 48 ± 9 years; male/female ratio 173/64; AHI 20.1 ± 14.7 events/h; BMI 27.2 ± 4.3 kg/m 2 ) starting OA m therapy were included.
American Journal of Orthodontics and Dentofacial Orthopedics, 2006
Introduction: Side effects observed in the occlusion and dental arches of patients using an oral appliance (OA) to treat snoring or sleep apnea for more than 5 years have not yet been investigated. Methods: Stone casts trimmed in centric occlusion before appliance placement and after an average of 7.4 Ϯ 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists. Results: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class II Division 1 and Class II Division 2 malocclusions were more likely to have favorable or no changes. More favorable changes in overbite occurred in subjects with large baseline overbites. A greater baseline overjet and more distal mandibular canine relationship were correlated to favorable changes. A greater initial overjet was correlated to a more favorable change, a decrease in mandibular crowding, a smaller change in anterior crossbite, and a greater change in overjet. Conclusions: OA wear after a mean of 7.4 years induces clinically relevant changes in the dental arch and the occlusion. (Am J Orthod Dentofacial Orthop 2006;129:205-13)