The effects of 1-year treatment with a herbst mandibular advancement splint on obstructive sleep apnea, oxidative stress, and endothelial function
ABSTRACT Obstructive sleep apnea (OSA) is associated with endothelial dysfunction. In the current study, we assessed the effect of long-term modified Herbst mandibular advancement splint (MAS) treatment on OSA, oxidative stress markers, and on endothelial function (EF).
A total of 16 subjects participated (11 men and 5 women; mean [+/- SD] age, 54.0 +/- 8.3 years; mean body mass index, 28.0 +/- 3.1 kg/m(2)), 12 of whom completed the 1-year evaluation. Apnea severity, levels of oxidative stress markers, and EF were assessed after 3 months and 1 year of receiving treatment. For comparison, 6 untreated patients underwent two evaluations 9 months apart, and 10 non-OSA individuals were assessed once as a reference group. The results are presented as the mean +/- SD.
The mean apnea-hypopnea index (AHI) decreased significantly from 29.7 +/- 18.5 events/h before treatment to 17.7 +/- 11.1 events/h after 3 months of treatment and 19.6 +/- 11.5 events/h after 1 year of treatment (p < 0.005 for both). The mean Epworth sleepiness scale score decreased significantly from 12.4 +/- 6.0 before treatment to 10.2 +/- 6.6 after 3 months of treatment and 7.8 +/- 3.8 after 1 year of treatment (p < 0.001 for both). The mean EF improved significantly from 1.77 +/- 0.4 before treatment to 2.1 +/- 0.4 after 3 months of treatment (p < 0.05) and 2.0 +/- 0.3 after 1 year of treatment (p = 0.055), which were similar to the values of the reference group. Thiobarbituric acid-reactive substance (TBARS) levels decreased from 18.8 +/- 6.2 nmol malondialdehyde (MDA)/mL before treatment to 15.8 +/- 3.9 MDA/mL after 3 months of treatment (p = 0.09) and 15.5 +/- 3.2 nmol MDA/mL after 1 year of treatment (p < 0.05). There was a correlation between the improvement in AHI and in EF or TBARS levels (r = 0.55; p = 0.05). The untreated control group remained unchanged.
The Herbst MAS may be a moderately effective long-term treatment for patients with OSA. EF improved to levels that were not significantly different than reference levels, even though apneic events were not completely eliminated. We think that these data are encouraging and that they justify the performance of larger randomized controlled studies.
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ABSTRACT: Pharyngeal airway size is increasingly recognized as an important factor in obstructive sleep apnea. However, few studies have examined the changes of pharyngeal airway form after dental procedures for treating obstructive sleep apnea during growth. The purpose of this study was to evaluate the effect of the Herbst appliance on the 3-dimensional form of the pharyngeal airway using cone-beam computed tomography. Twenty-four Class II subjects (ANB, ≥5°; 11 boys; mean age, 11.6 years) who required Herbst therapy with edgewise treatment had cone-beam computed tomography images taken before and after Herbst treatment. Twenty Class I control subjects (9 boys; mean age, 11.5 years) received edgewise treatment only. The volume, depth, and width of the pharyngeal airway were compared between the groups using measurements from 3-dimensional cone-beam computed tomography images of the entire pharyngeal airway. The increase of the oropharyngeal airway volume in the Herbst group (5000.2 mm(3)) was significantly greater than that of the control group (2451.6 mm(3)). Similarly, the increase of the laryngopharyngeal airway volume in the Herbst group (1941.8 mm(3)) was significantly greater than that of the control group (1060.1 mm(3)). The Herbst appliance enlarges the oropharyngeal and laryngopharyngeal airways. These results may provide a useful assessment of obstructive sleep apnea treatment during growth. Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.American Journal of Orthodontics and Dentofacial Orthopedics 12/2014; 146(6):776-85. DOI:10.1016/j.ajodo.2014.08.017 · 1.44 Impact Factor
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ABSTRACT: Obstructive sleep apnoea (OSA) is a leading yet often undiagnosed cause of daytime sleepiness. It affects between 3 and 7% of the adult population, and the prevalence is expected to increase due to the obesity epidemic and ageing population. OSA is a sleep-related breathing disorder in which the airway completely (apnoea) or partly closes (hypopnea) during sleep at the end of expiration. This can lead to decreases in blood oxygen saturation and sleep fragmentation. Those who suffer with OSA are often unaware of their symptoms. Severe, untreated OSA can have serious implications such as an increased risk of cardio-vascular disease, motor vehicle accidents, poor neurocognitive performance and increased mortality. Many patients are pre-scribed continuous positive airway pressure (CPAP) as a treatment, but compliance with CPAP is often low. We briefly review the diagnosis and prognosis for obstructive sleep apnoea. But the main focus of our review is the critical evaluation of the numerous treatment strategies available for sleep apnoea as a multi-comorbid and multi-factorial condition. We also high-light areas that need further research.Bioscience Horizons 01/2014; 7. DOI:10.1093/biohorizons/hzu011
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ABSTRACT: Study Objectives: To perform a systematic review of the current evidence regarding the cardiovascular benefits of oral appliance (OA) therapy in obstructive sleep apnea (OSA) patients. Methods: A systematic review of relevant articles retrieved from online databases (PubMed, Web of Science, Medline, OvidSP) was conducted. All relevant studies published prior to January 20, 2013 that examined the effects of OA on any of the cardiovascular parameters were included. Results: OA therapy could have a beneficial effect on blood pressure (BP), endothelial function (EF), and left ventricular (LV) function of the heart. Eleven articles were included in this systematic review; 7 of 8 studies showed a significant reduction in BP with a mean BP decrease of 4.2 mm Hg, 2 studies showed significant improvement in EF, and 1 study showed significant improvement in LV heart function. Conclusion: OA therapy showed beneficial effects on the cardiovascular comorbidity in OSA patients. In studies comparing OA to CPAP therapy, effects of OA therapy were in the same order of magnitude as the effect of CPAP therapy. benefits of oral appliance therapy in obstructive sleep apnea: a systematic review. Journal of Dental Sleep Medicine 2015;2(1):9–14. O bstructive sleep apnea (OSA) is characterized by repeti-tive episodes of partial or total upper airway obstruction during sleep, resulting in a decrease of oronasal airflow. 1 OSA is acknowledged as a serious health problem, 2,3 and it is the most common sleep-related breathing disorder. The current prevalence estimates of moderate to severe sleep disordered breathing (apnea-hypopnea index [AHI], measured as events/ hour, ≥ 15) are 10% among 30-to 49-year-old men, 17% among 50-to 70-year-old men, 3% among 30-to 49-year-old women, and 9% among 50-to 70-year-old women. 401/2015; 2(1):9-14. DOI:10.15331/jdsm.4430