Abstract
Objectives
The purpose of this study is to evaluate the efficacy of oral appliance (OA) treatment for subjects with severe obstructive sleep apnea (OSA) and to determine the dental parameters associated with treatment outcomes.
Study design
This study uses a prospective longitudinal design.
Methods
Consecutive Chinese subjects with severe OSA who refused continuous positive airway pressure treatment were recruited. Their dental measurements were taken from lateral cephalometric radiographs. Polysomnograms with OA were repeated at 3 months and 1 year. Blood pressure was taken in the morning after sleep studies.
Results
Thirty-four subjects were evaluated at 3 months and 1 year according to the principle of intention-to-treat analysis. OA reduced AHI significantly in subjects with favorable responses, from 49.3 (37.4–67) to 12.5 (6.1–15.7), p < 0.001 at 3 months and from 47.5 (41.1–72.9) to 13.1 (6.0–14.0), p < 0.001 at 1 year. These OSA subjects had an increased overjet at baseline compared to those with unfavorable responses (p ≤ 0.05). Systolic blood pressure was significantly reduced in those hypertensive OSA subjects after 3 months and 1 year of treatment.
Conclusions
OA reduces the severity of sleep apnea, and the effect is maintained at 1 year in subjects with retrognathism. OA appears to reduce systolic blood pressure in hypertensive OSA subjects at 3 months and 1 year.
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References
Young T, Peppard PE, Gottlieb DJ (2002) Epidemiology of obstructive sleep apnea: a population health perspective. Am J Respir Crit Care Med 165:1217–1239
Engleman H, Martin SE, Douglas NJ (2000) Cognitive function in the sleep apnea/hypopnea syndrome. Sleep 23:S102–S107
McNicholas WT, Bonsignore MR, the Management Committee of EU COS ACTION B26 (2007) Sleep apnoea as an independent risk factor for cardiovascular disease: current evidence, basic mechanisms and research priorities. Review. Eur Respir J 29:156–178
Giles TL, Lasserson TJ, Smith BH, White J, Wright J, Cates CJ (2006) Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 1:CD001106
Montserrat JM, Ferrer M, Hernandez L, Farré R, Vilagut G, Navajas D, Badia JR, Carrasco E, De Pablo J, Ballester E (2001) Effectiveness of CPAP treatment in daytime function in sleep apnea syndrome. Am J Respir Crit Care Med 164:608–613
Bazzano LA, Khan Z, Reynolds K, He J (2007) Effect of nocturnal nasal continuous positive airway pressure on blood pressure in obstructive sleep apnea. Hypertension 50:417–423
Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ (2004) Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 170:656–664
McArdle N, Devereux G, Heidarnejad H, Engleman HM, Mackay TW, Douglas NJ (1999) Long-term use of CPAP therapy for sleep apnea/hypopnea syndrome. Am J Respir Crit Care Med 159:1108–1114
Kushida CA, Morgenthaler TI, Littner MR, Alessi CA, Bailey D, Coleman J Jr, Friedman L, Hirshkowitz M, Kapen S, Kramer M, Lee-Chiong T, Owens J, Pancer JP, American Academy of Sleep (2006) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: an update for 2005. Sleep 29:240–243
Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth Sleepiness Scale. Sleep 14:540–545
Sam K, Lam B, Ooi CG, Cooke M, Ip MS (2006) Effect of a non-adjustable oral appliance on upper airway morphology in obstructive sleep apnoea. Respir Med 100:897–902
Rechtschaffen A, Kales AA (eds) (1968) A manual of standardized terminology, techniques and scoring system for sleep stages of human subjects. Government Printing Office, Washington, D.C, NIH publication no. 204
American Sleep Disorders Association (1992) EEG arousals: scoring rules and examples [ASDA Report]. Sleep 15:173–184
Meoli AL, Casey KR, Clark RW, Coleman JA Jr, Fayle RW, Troell RJ, Iber C, Committee Clinical Practice Review (2001) Clinical practice review committee. Hypopnea in sleep-disordered breathing in adults. Sleep 24:469–470
Lim J, Lasserson TJ, Fleetham J, Wright J (2006) Oral appliances for obstructive sleep apnea. Cochrane Database Syst Rev (1):CD004435.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, Roccella EJ, National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, National High Blood Pressure Education Program Coordinating Committee (2003) The seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. Hypertension 42:1206–1252
International Diabetes Institute Steering Committee (2000) The Asia-Pacific perspective: redefining obesity and its treatment. Melbourne, Australia. Retrieved from http://www.diabetes.com.au/pdf/obesity_report.pdf
Engleman HM, Wild MR (2003) Improving CPAP use by patients with the sleep apnea/hypopnea syndrome. Sleep Med Rev 7:81–99
Loube DI, Gay PC, Strohl KP, Pack AI, White DP, Collop NA (1999) Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest 115:863–866
Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262
Cohen R (1988) Obstructive sleep apnea: oral appliance therapy and severity of condition. Oral Surg Oral Med Oral Pathol 85:388–392
Rose ESR, Schulte-Monting J, Jonas IE (2002) Treatment of obstructive sleep apnea with the Karwestzky oral appliance. Eur J Oral Sci 110:99–105
Barthlen GM, Brown LK, Wiland MR, Sadeh JS, Patwari J, Zimmerman M (2000) Comparison of three oral appliances for treatment of severe obstructive sleep apnea syndrome. Sleep Med 1:299–305
Fleury B, Rakotonanahary D, Petelle B, Vincent G, Pelletier Fleury N, Meyer B, Lebeau B (2004) Mandibular advancement titration for obstructive sleep apnea: optimization of the procedure by combining clinical and oximetric parameters. Chest 125:1761–1767
Ferguson KA, Ono T, Lowe AA, Ryan CF, Fleetham JA (1995) Relationship between obesity and craniofacial structure in obstructive sleep apnea. Chest 108:375–381
Hoekema A, Doff MH, de Bont LG, van der Hoeven JH, Wijkstra PJ, Pasma HR, Stegenga B (2007) Predictors of obstructive sleep apnea–hypopnea treatment outcome. J Dent Res 86:1181–1186
Andren A, Sjoquist M, Tegelberg A (2009) Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance—a three-year follow-up. J Oral Rehabil 36:719–725
Itzhaki S, Dorchin H, Clark G, Lavie L, Lavie P, Pillar G (2007) The effects of 1-year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function. Chest 131:740–749
Montserrat JM, Garcia-Rio F, Barbe F (2007) Diagnostic and therapeutic approach to non-sleepy apnea—pulmonary perspectives. Am J Respir Crit Care Med 176:6–9
Yoshida K (2006) Effect on blood pressure of oral appliance therapy for sleep apnea syndrome. Int J Prosthodont 19:61–66
Gotsopoulos H, Kelly JJ, Cistulli PA (2004) Oral appliance therapy reduces blood pressure in obstructive sleep apnea: a randomized, controlled trial. Sleep 27:934–941
Lavie-Nevo K, Pillar G (2006) Evening–morning differences in blood pressure in sleep apnea syndrome: effect of gender. Am J Hypertens 19:1064–1069
Tsai WH, Vazquez JC, Oshima T, Dort L, Roycroft B, Lowe AA, Hajduk E, Remmers JE (2004) Remotely controlled mandibular positioner predicts efficacy of oral appliances in sleep apnea. Am J Respir Crit Care Med 170:366–370
Tsuiki S, Hiyama S, Ono T, Imamura N, Ishiwata Y, Kuroda T, Lowe AA (2001) Effects of a titratable oral appliance on supine airway size in awake non-apneic individuals. Sleep 24:554–560
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Lam, B., Sam, K., Lam, J.C.M. et al. The efficacy of oral appliances in the treatment of severe obstructive sleep apnea. Sleep Breath 15, 195–201 (2011). https://doi.org/10.1007/s11325-011-0496-y
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DOI: https://doi.org/10.1007/s11325-011-0496-y