Abstract
Objectives Obstructive sleep apnea is an inflammatory, chronic, and evolutive disease often needing adequate treatment and follow-up. The oral appliance (OA) is an accepted alternative therapy for obstructive sleep apnea (OSA) control. Due to greater adherence, OA with mandibular advancement (OA m ) is being recommended treatment for patients who refuse or do not tolerate continuous positive airway pressure. The mode of action of OA m is to promote the advancement of the mandible or tongue with a subsequent increase in the tone of the pharyngeal muscles and the permeability of the upper airway, but most OA m use conventional models as reference, analogic, or digital, dissociating dental arches of the skull structures. Materials and Methods A retrospective longitudinal study of 33 OSA patient treated with a different OA m , that use Camper plane as reference with skull structures for dental arches disocclusion, where polysomnographic, cephalometric measures, and subjective data from questionnaires pre- and post-treatment were assessed and correlated. Descriptive analysis, correlated Chi-square tests, and basic statistics were used. Generalized linear mixed model for repeated measure and post hoc Tukey–Kramer test compares the variables pre- and post-treatment. Shapiro–Wilk test and Pearson's correlation coefficients were used. All statistical tests were set in 5% level of significance. Results Regarding polysomnography data, there was a significant association between apnea hypopnea index (AHI) with oxygen saturation, arousal index (AI) and the maximum heartbeats, and sleep improvement and health risk reduction. Additionally, from cephalometric data, it was found a significant association between the tongue posture with the soft palate, hioyd-C3 and, lower and posterior airway. When both parameters are correlated, there are a significant dependent association with hyoid bone position with AHI and AI. The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters. Conclusion In this pilot study, DIORS OA m as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA.
Highlights
Obstructive sleep apnea (OSA) is a chronic, inflammatory, and progressive disease.[1,2] Its prevalence in the general population is between 9 and 38%, and varies according to age and gender.[3]
The limitation of this study was the two-dimensional image used without provide volumetric measurements, but this limitation was reduced with the follow-up polysomnography parameters. In this pilot study, DIORS oral appliance (OA) with mandibular advancement (OAm) as an uniquely designed device using Camper plane as a reference for disocclusion was effective in the control of OSA
Success Criteria We evaluated the successful criteria of therapies with arousal index in addition to respiratory parameters, as apnea hypopnea index (AHI) and oxygen saturation (SaO2), Fig. 2 The mode of action of oral appliance with mandibular advancement used are mapped in (A) and (B) in of airway space to identify tongue, soft palate, and pharyngeal airway
Summary
Obstructive sleep apnea (OSA) is a chronic, inflammatory, and progressive disease.[1,2] Its prevalence in the general population is between 9 and 38%, and varies according to age and gender.[3] The diagnosis[4] requires either signs/symptoms (e.g., associated sleepiness, fatigue, insomnia, snoring, subjective nocturnal respiratory disturbance, or observed apnea) or associated medical or psychiatric disorder (i.e., hypertension, coronary artery disease, atrial fibrillation, congestive heart failure, stroke, diabetes, cognitive dysfunction, or mood disorder) coupled with five or more predominantly obstructive respiratory events (obstructive and mixed apneas, hypopneas, or respiratory effort-related arousals, as defined by the American Academy of Sleep Medicine scoring manual) per hour of sleep during polysomnography (PSG). A frequency of obstructive respiratory events 15/hour satisfies the criteria, even in the absence of associated symptoms or disorders. Clinical symptoms vary depending on the type, frequency, and intensity of the respiratory abnormality.[5,6] Normal rates of apnea should be treated when associated with snoring, some controversial issues persist regarding the therapeutic criteria for snoring itself.[7]
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