Titrated mandibular advancement versus positive pressure for sleep apnoea
ABSTRACT The aim of this study was to compare mandibular advancement device (MAd) therapy and continuous positive airway pressure (CPAP) for obstructive sleep apnoea/hypopnoea syndrome (OSAHS) after one-night polysomnographic (PSG) titration of both treatments. 59 OSAHS patients (apnoea/hypopnoea index (AHI): 34+/-13 events x h(-1); Epworth scale: 10.6+/-4.5) were included in a crossover trial of 8 weeks of MAd and 8 weeks of CPAP after effective titration. Outcome measurements included home sleep study, sleepiness, health-related quality of life (HRQoL), cognitive tests, side-effects, compliance and preference. The median (interquartile range) AHI was 2 (1-8) events x h(-1) with CPAP and 6 (3-14) events x h(-1) with MAd (p<0.001). Positive and negative predictive values of MAd titration PSG for treatment success were 85% and 45%, respectively. Both treatments significantly improved subjective and objective sleepiness, cognitive tests and HRQoL. The reported compliance was higher for MAd (p<0.001) with >70% of patients preferring this treatment. These results support titrated MAd as an effective therapy in moderately sleepy and overweight OSAHS patients. Although less effective than CPAP, successfully titrated MAd was very effective at reducing the AHI and was associated with a higher reported compliance. Both treatments improved functional outcomes to a similar degree. One-night titration of MAd had a low negative predictive value for treatment success.
- SourceAvailable from: Joseph I Helman
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- "Although CPAP shows greater efficacy, mandibular advancement devices can lead to higher compliance with therapy (Phillips et al, 2013). In one study, both treatments improved subjective and objective EDS, cognitive performance, and quality of life (Gagnadoux et al, 2009). However, more than 70% of patients reported that they preferred the oral appliance. "
ABSTRACT: Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice.Oral Diseases 06/2013; 20. DOI:10.1111/odi.12152 · 2.40 Impact Factor
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- "Mandibular advancement devices (MADs) are currently the most common class of oral appliances used to treat OSA and custommade MADs are to be preferred and recommended over prefabricated devices (Vanderveken et al., 2008). MADs are worn intra-orally during the night and mechanically protrude the mandible, commonly with a design to gradually protrude the mandible applying a mechanical advancing mechanism (Dieltjens et al., 2012b; Gagnadoux et al., 2009). The aim is to prevent UA collapse and increase the cross-sectional airway dimensions, and thereby reduce snoring and obstructive sleep apneas (Tsuiki et al., 2004). "
ABSTRACT: The aim of this study was to assess the value of drug-induced sleep endoscopy (DISE) using a custom-made simulation bite in maximal comfortable protrusion (MCP) of the mandible, in the prediction of treatment outcome for obstructive sleep apnoea (OSA) with a mandibular advancement device (MAD). Two hundred patients (74% male; age 46 ± 9 years; apnoea-hypopnoea index [AHI] 19 ± 13 h(-1) sleep; body mass index [BMI] 27 ± 4 kg m(-2) ) with sleep-disordered breathing underwent DISE with a simulation bite in MCP. One hundred and thirty-five patients with an established diagnosis of OSA commenced MAD treatment. The associations between the findings during DISE with simulation bite and treatment outcome were evaluated. Treatment response was defined as a reduction in AHI following MAD treatment of ≥ 50% compared to baseline. Overall MAD treatment response in the studied population was 69%. The results of this study demonstrated a statistically significant association between a positive effect of the simulation bite on the upper airway patency during DISE and treatment response with MAD (P < 0.01). The results of this study suggest that the use of a simulation bite in maximal comfortable protrusion (MCP) of the mandible, as used during DISE in patients with OSA, tends to be effective in predicting treatment response of MAD treatment.Journal of Sleep Research 12/2012; DOI:10.1111/jsr.12008 · 2.95 Impact Factor
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- "However, OA is less systematically effective than CPAP at improving polysomnographic data; approximately 50% of patients with OA have an AHI <5, and 70% reduce their AHI by >50% (Fleury et al., 2004; Lim et al., 2009). Even so, OA is often preferred by patients (Gagnadoux et al., 2009). The use of OA may provide better compliance during sleep and, in a number of cases, control of OSAS is at least as effective as it is with Table 3 Validity of the decision board tested in healthy volunteers: changes in the number of participants who would still choose oral appliance (OA) according to changes in its rates of effectiveness and modification of occlusal contacts (n = 20) "
ABSTRACT: The objective of this study was to develop a tool to help clinicians inform patients about mechanical treatment options, continuous positive airway pressure and oral appliances for obstructive sleep apnoea syndrome, and to assess its validity, reliability and acceptability. Continuous positive airway pressure is always indicated as a first-line treatment in patients with severe obstructive sleep apnoea syndrome. However, oral appliances might be an effective treatment option in patients who fail treatment attempts, and also as a first-line treatment for patients with mild to moderate obstructive sleep apnoea. To help patients choose their initial treatment, we developed an electronic decision board to present information regarding the potential benefits and side effects of the two treatment options, using the best available evidence. In 34 healthy volunteers, to test validity we evaluated the extent to which the respondents' preferences for a treatment changed predictably when the rate of effectiveness and side effects were modified. Reliability was tested by readministering the decision board 2 weeks afterwards (kappa test). The decision-board acceptability was evaluated in 99 consecutive patients newly diagnosed with obstructive sleep apnoea syndrome. We found that the decision board was valid. Reliability was excellent (κ = 0.94). Concerning acceptability, 72% of the patients were satisfied with the information provided in the decision board and 71% indicated that it helped them to make a decision. The average score of true/false test of knowledge was 7.9 of 10 (range 3-10). The decision board we developed is a valid, reliable and acceptable tool to assess patients' preferences.Journal of Sleep Research 03/2012; 21(5):577-83. DOI:10.1111/j.1365-2869.2012.01015.x · 2.95 Impact Factor