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Effect of mandibular advancement splint treatment on tongue shape in obstructive sleep apnea

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Abstract

Purpose

Mandibular advancement splints (MAS) can effectively treat obstructive sleep apnea (OSA); however, treatment response is variable, and the mechanisms behind differences in treatment outcomes are still not well understood. The aims of this study were (1) to assess the effects of MAS on tongue shape and (2) to compare tongue shape changes with MAS between treatment responders and nonresponders.

Methods

Sixty-eight adults with symptomatic mild to severe OSA were included. A custom-made MAS was provided to patients, and treatment outcome was determined by polysomnography. Two-dimensional tongue measurements were evaluated using sagittal and axial MRI image slices without and with MAS in situ. Tongue measurements of height, length, width, area, and shape (height/length) were collected. Additional measurements of surrounding upper airway structures, soft palate length width and area and upper airway area, length and minimum width were measured on sagittal image slices.

Results

Based on polysomnography with MAS in situ, 47 patients were classified as responders (≥50 % reduction in apnea-hypopnea index [AHI] from baseline), and 21 were nonresponders (<50 % AHI reduction). There was no change in sagittal tongue area with insertion of MAS, although there was a change in most of parameters of tongue shape. Responders showed a greater decrease in tongue length with MAS in situ compared to nonresponders (−0.64 ± 0.46 vs −0.32 ± 0.51 cm, p = 0.016).

Conclusion

This study reports a detailed two-dimensional analysis of tongue dimensions as well as assessment of adjacentsoft palate shape and upper airway structures without and with MAS treatment for OSA. Our finding suggests that MAS does induce changes in tongue shape. MAS treatment responders showed a greater decrease in tongue length (between the tongue tip and hyoid bone) with MAS in situ; whether differences in alteration of tongue position with MAS explain differences in treatment response requires further investigation.

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Acknowledgments

We would like to thank Dr Biao Zeng, Dr Jin Qian, Dr Andrew Ng, Dr Belinda Liu, and the sleep laboratory staff at St George and Royal North Shore Hospitals for their assistance, and Dr. Saeed Jafari from the Division of Orthodontic Dentistry, Tohoku University Graduate School of Dentistry for his support.

Funding

National Health and Medical Research Council of Australia. SomnoMed provided the oral appliances for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Author notes

    Authors and Affiliations

    1. Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan

      Toru Ogawa, Jianlan Long & Keiichi Sasaki

    2. Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia

      Toru Ogawa, Kate Sutherland, Andrew S. L. Chan & Peter A. Cistulli

    3. Woolcock Institute of Medical Research and Sydney Medical School, University of Sydney, Sydney, Australia

      Kate Sutherland

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    1. Toru Ogawa
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    2. Jianlan Long
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    3. Kate Sutherland
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    4. Andrew S. L. Chan
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    6. Peter A. Cistulli
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    Correspondence to Jianlan Long.

    Additional information

    Toru Ogawa and Jianlan Long contributed equally to this work

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    Ogawa, T., Long, J., Sutherland, K. et al. Effect of mandibular advancement splint treatment on tongue shape in obstructive sleep apnea. Sleep Breath 19, 857–863 (2015). https://doi.org/10.1007/s11325-014-1101-y

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    • DOI: https://doi.org/10.1007/s11325-014-1101-y

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