Abstract
Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).
Highlights
IntroductionSleep disordered breathing (SDB) comprises a series of clinical conditions including simple snoring and obstructive sleep apnea hypopnea syndrome (OSA)
Regarding the most recent definition of obstructive sleep apnea hypopnea syndrome (OSA), it is considered when there is either the presence of an apneahypopnea index (AHI) ≥15/h, which is predominantly obstructive, or when there is the presence of an AHI ≥5/h accompanied by one or more of the following factors: excessive sleepiness during the day, non-restorative sleep, excessive tiredness and/or deterioration of the quality of life related to sleep, not justifiable for other reasons [1]
The mandibular advancement device used in the present study has been shown to be effective in patients with OSA and simple snoring, reducing AHI in the cases of OSA and improving the patient symptoms
Summary
Sleep disordered breathing (SDB) comprises a series of clinical conditions including simple snoring and obstructive sleep apnea hypopnea syndrome (OSA). Simple snoring is defined as hoarse breathing sounds produced in the upper airway (UA) during sleep, without the presence of airway obstruction. The diagnosis of OSA requires an exhaustive exploration of a physician specialized in sleep breathing disorders, which includes certain screening tests such as the Mallampati score [3]. The AHI, corresponding to the number of apnea hypopnea events per hour of sleep, has been regarded as the main parameter for determining the severity of OSA, with the definition of three categories: mild (5 ≤ AHI < 15), moderate (15 ≤ AHI < 30)
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