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Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea

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Abstract

Rationale

Temporomandibular disorder (TMD) has been the most common contraindication for mandibular advancement device (MAD) as a treatment for obstructive sleep apnea syndrome (OSAS). Exercising the mandible is a recommended form of therapy for TMD.

Objectives

To assess the efficacy of mandibular exercises in the control of pain, changes of quality of life and to assess the impact of MAD compliance in OSAS patients with previously diagnosed TMD.

Methods

A blind, randomized, and controlled trial was used to evaluate 29 OSAS patients with TMDs were divided in two groups: the exercise support therapy (ST) and placebo therapy (PT), who were evaluated prior to and 120 days after MAD treatment. Treatment outcomes were measured using the Fletcher and Luckett sleep questionnaire, Epworth sleepiness scale, SF-36 inventory of quality of life, polysomnography, diary of MAD usage, and the research diagnostic criteria for TMD.

Measurements and main results

ST group showed significant improvement in their sleep quality and life quality when compared to the PT group (p < 0.05). Higher number of patients with persistent pain was observed in the PT group (p = 0.01). There was a reduction of pain intensity in the ST group, but not in the PT group (p < 0.05). Higher MAD compliance was observed in the ST group (p < 0.05).

Conclusions

Mandibular exercises enable patients with TMD to use MAD; exercises were found to be effective in reducing pain and increasing MAD compliance and produced a significant improvement in the quality of life and quality of sleep.

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Acknowledgements

The authors would like to thank the Fundacao de Amparo a Pesquisa do Estado de Sao Paulo (FAPESP, number 2006/04488-4), the FAPESP-Centros de Pesquisa, Inovação e Difusão (CEPID), and the Associacao Fundo de Incentivo a Psicofarmacologia (AFIP) for their support and funding. Sergio Tufik and Lia Rita Azeredo Bittencourt are principal investigators of FAPESP and researchers of Conselho Nacional de Desenvolvimento Científico e Tecnológico.

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Authors and Affiliations

  1. Department of Dentistry, Universidade Federal do Parana, Rua Cel. Napoleao Marcondes Franca, 360, 80.040-270, Curitiba, PR, Brazil

    Paulo Afonso Cunali

  2. Sleep Medicine and Biology Discipline, Psichobiology Department, Universidade Federal Sao Paulo, St. Paul, SP, Brazil

    Paulo Afonso Cunali, Camila D. Santos, Natália Y. Valdrichi, Liliane S. Nascimento, Cibele Dal-Fabbro, Sérgio Tufik & Lia Rita A. Bittencourt

  3. Department of Oral Health Sciences, University of British Columbia, Vancouver, Canada

    Fernanda R. Almeida

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  1. Paulo Afonso Cunali
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Correspondence to Paulo Afonso Cunali.

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Cunali, P.A., Almeida, F.R., Santos, C.D. et al. Mandibular exercises improve mandibular advancement device therapy for obstructive sleep apnea. Sleep Breath 15, 717–727 (2011). https://doi.org/10.1007/s11325-010-0428-2

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