The aim was to analyze whether or not weight gain influences the treatment outcome of patients with obstructive sleep apnea (OSA) treated with mandibular advancement devices (MAD).
As a part of a follow-up study among OSA patients treated with MAD in primary oral health care, a group of 28 patients reporting worsening of daytime or nighttime symptoms of OSA was given closer examination. Altogether, 21 subjects had a complete set of recordings and were enrolled into the study.
Only three subjects had lost weight during the study period. The mean weight gain of 3.6 kg ± 7.1 kg was significant (p = 0.035). According to linear regression, weight gain was independently significantly associated with lower mean peripheral oxygen saturation 92.4 (SD 1.8 (% per hour) (p = 0.019)) and lowest oxygen saturation 80.1 (SD 7.2 (%) (p = 0.024)) scores.
Weight gain is detrimentally associated with MAD treatment in patients with OSA. These findings suggest that regular follow-up by an experienced dentist is advisable to assess for possible worsening of OSA. Patient support to encourage weight control may be an important adjunct to MAD treatment for OSA.
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Jordan AS, McSharry DG, Malhotra A (2014) Adult obstructive sleep apnoea. Lancet 383:736–747
Peppard PE, Young T, Barnet JH, Palta M, Hagen EW, Hla KM (2013) Increased prevalence of sleep-disordered breathing in adults. Am J Epidemiol 177:1006–1014
Giles TL, Lasserson TJ, Smith B, White J, Wright JJ, Cates CJ (2006) Continuous positive airway pressure for obstructive sleep apnoea in adults Cochrane Database Syst Rev CD001106
Epstein LJ, Kristo D, Strollo PJ, Friedman M, Malhotra A, Patil SP et al (2009) Adult obstructive sleep apnea task force of the American Academy of Sleep Medicine. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 5:263–276
Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262
Ramar K, Dort LC, Katz SG, Lettieri CJ, Harrod CG, Thomas SM, Chervin RD (2015) Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy: an update for 2015. J Clin Sleep Med 11:773–827
Aarab G, Lobbezoo F, Hamburger HL, Naeije M (2010) Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respir 81:411–419
Nikolopoulou M, Byraki A, Ahlberg J, Heymans MW, Hamburger HL, De Lange J et al (2017) Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea syndrome: a randomized, placebo-controlled trial on self-reported symptoms of common sleep disorders and sleep-related problems. J Oral Rehabil 44:452–460
Aarab G, Lobbezoo F, Heymans MW, Hamburger HL, Naeije M (2011) Long-term follow-up of a randomized controlled trial of oral appliance therapy in obstructive sleep apnea. Respir 82:162–168
Kuhn E, Schwarz EI, Bratton DJ, Rossi VA, Kohler M (2017) Effects of CPAP and mandibular advancement devices on health-related quality of life in OSA: a systematic review and meta-analysis. Chest 151:786–794
Gjerde K, Lehmann S, Berge ME, Johansson AK, Johansson A (2016) Oral appliance treatment in moderate and severe obstructive sleep apnoea patients non-adherent to CPAP. J Oral Rehabil 43:249–258
Malhotra A, White DP (2002) Obstructive sleep apnea. Lancet 360:237–245
Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Mullany EC, Biryukov S, Abbafati C, Abera SF, Abraham JP, Abu-Rmeileh NME, Achoki T, AlBuhairan FS, Alemu ZA, Alfonso R, Ali MK, Ali R, Guzman NA, Ammar W, Anwari P, Banerjee A, Barquera S, Basu S, Bennett DA, Bhutta Z, Blore J, Cabral N, Nonato IC, Chang JC, Chowdhury R, Courville KJ, Criqui MH, Cundiff DK, Dabhadkar KC, Dandona L, Davis A, Dayama A, Dharmaratne SD, Ding EL, Durrani AM, Esteghamati A, Farzadfar F, Fay DFJ, Feigin VL, Flaxman A, Forouzanfar MH, Goto A, Green MA, Gupta R, Hafezi-Nejad N, Hankey GJ, Harewood HC, Havmoeller R, Hay S, Hernandez L, Husseini A, Idrisov BT, Ikeda N, Islami F, Jahangir E, Jassal SK, Jee SH, Jeffreys M, Jonas JB, Kabagambe EK, Khalifa SEAH, Kengne AP, Khader YS, Khang YH, Kim D, Kimokoti RW, Kinge JM, Kokubo Y, Kosen S, Kwan G, Lai T, Leinsalu M, Li Y, Liang X, Liu S, Logroscino G, Lotufo PA, Lu Y, Ma J, Mainoo NK, Mensah GA, Merriman TR, Mokdad AH, Moschandreas J, Naghavi M, Naheed A, Nand D, Narayan KMV, Nelson EL, Neuhouser ML, Nisar MI, Ohkubo T, Oti SO, Pedroza A, Prabhakaran D, Roy N, Sampson U, Seo H, Sepanlou SG, Shibuya K, Shiri R, Shiue I, Singh GM, Singh JA, Skirbekk V, Stapelberg NJC, Sturua L, Sykes BL, Tobias M, Tran BX, Trasande L, Toyoshima H, van de Vijver S, Vasankari TJ, Veerman JL, Velasquez-Melendez G, Vlassov VV, Vollset SE, Vos T, Wang C, Wang XR, Weiderpass E, Werdecker A, Wright JL, Yang YC, Yatsuya H, Yoon J, Yoon SJ, Zhao Y, Zhou M, Zhu S, Lopez AD, Murray CJL, Gakidou E (2014) The GBD 2013 Obesity Collaboration. Global, regional and national prevalence of overweight and obesity in children and adults 1980–2013: a systematic analysis. Lancet 384:766–781
Berger G, Berger A, Oksenberg A (2009) Progression of snoring and obstructive sleep apnoea: the role of increasing weight and time. Eur Respir J 33:338–345
Peppard PE, Young T, Palta M, Dempsey J, Skatrud J (2000) Longitudinal study of moderate weight change and sleep-disordered breathing. JAMA 284:3015–3021
Tuomilehto H, Seppä J, Partinen M, Peltonen M, Gylling H, Tuomilehto J, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, Soini EJ, Randell J, Tukiainen H, Uusitupa M, Kuopio Sleep Apnea Group (2009) Lifestyle intervention with weight reduction – first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med 179:320–327
Kajaste S, Brander PE, Telakivi T, Partinen M, Mustajoki P (2004) A cognitive-behavioral weight reduction program in the treatment of obstructive sleep apnea syndrome with or without initial nasal CPAP: a randomized study. Sleep Med 5:125–131
Kulkas A, Leppänen T, Sahlman J, Tiihonen P, Mervaala E, Kokkarinen J, Randell J, Seppä J, Töyräs J, Tuomilehto H (2014) Weight loss alters severity of individual nocturnal respiratory events depending on sleeping position. Physiol Meas 35:2037–2052
Gries RE, Brooks LJ (1996) Normal oxyhemoglobin saturation during sleep. How low does it go? Chest 110:1489–1492
Vuorjoki-Ranta TR, Lobbezoo F, Vehkalahti M, Tuomilehto H, Ahlberg J (2016) Treatment of obstructive sleep apnoea patients in community dental care: knowledge and attitudes among general dental practitioners and specialist dentists. J Oral Rehabil 43:937–942
Muraja-Murro A, Nurkkala J, Tiihonen P, Hukkanen T, Tuomilehto H, Kokkarinen J, Mervaala E, Töyräs J (2012) Total duration of apnea and hypopnea events and average desaturation show significant variation in patients with a similar apnea-hypopnea index. J Med Eng Tech 36:393–398
Pavi E, Kay EJ, Murray K, Stephen KW (1992) A programme of preventive dentistry in field conditions carried out in Glasgow, Scotland. Community Dent Health 9:249–259
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The authors declare that they have no conflict of interest.
For this type of study, formal consent is not required.
Informed consent was obtained from all individual participants included in the study.
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Vuorjoki-Ranta, T., Aarab, G., Lobbezoo, F. et al. Weight gain may affect mandibular advancement device therapy in patients with obstructive sleep apnea: a retrospective study. Sleep Breath 23, 531–534 (2019). https://doi.org/10.1007/s11325-018-1728-1
- Obstructive sleep apnea
- Mandibular advancement device
- Primary health care