Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: A randomized, placebo-controlled trial on temporomandibular side-effects.

Maria Nikolopoulou,Jan De Lange,Ghizlane Aarab,Jari Ahlberg,Hans L Hamburger,Frank Lobbezoo

doi:10.1002/cre2.288

Abstract

PurposeTo assess the differences in the frequency of clinical signs of temporomandibular disorder (TMD) pain and mandibular function impairment between mandibular advancement device (MAD) and nasal continuous positive airway pressure (nCPAP) therapies in obstructive sleep apnea (OSA) patients at baseline and after 6 month of treatment.MethodsThis study concerns a secondary analysis of a randomized placebo‐controlled trial in which different treatment effects of an objectively titrated MAD were compared with those of nCPAP and an intra‐oral placebo appliance in a parallel design. Sixty‐four mild to severe OSA patients (52.0 ± 9.6 years) were randomly assigned to these three groups. All patients underwent a shortened functional examination of their masticatory system at baseline and after 6 months to establish the presence of clinical signs of TMD pain. Mandibular function impairment was assessed with a questionnaire.ResultsClinical signs of TMD pain were only rarely present at baseline and therapy evaluation. No significant differences were found between the three groups in the (low) frequency of clinical signs of TMD pain at both time points (p = .401–.176). In addition, the (low) scores of mandibular function impairment did not differ between the three groups either, neither at baseline (p = .744) nor after 6 months (p = .359).ConclusionsA low frequency of clinical signs of TMD pain in mild to severe OSA patients was found after 6 months, regardless of treatment with MAD or nCPAP. In addition, no difference in mandibular function impairment was observed between the different treatment modalities.

Highlights

Obstructive sleep apnea (OSA) is characterized by recurrent obstructions of the upper airway, often resulting in oxygen desaturations and arousals from sleep (American Academy of Sleep Medicine, 1999)
No significant differences were found between the three treatment groups in the frequency of clinical signs of temporomandibular disorder (TMD) pain at baseline and at therapy evaluation after 6 months
Both studies supported a significant association between OSA symptoms and TMD, and they found evidence that OSA symptoms preceded firstonset TMD

Summary

Introduction

Obstructive sleep apnea (OSA) is characterized by recurrent obstructions of the upper airway, often resulting in oxygen desaturations and arousals from sleep (American Academy of Sleep Medicine, 1999). While (nasal) CPAP ([n]CPAP) was more or less the sole effective treatment for many years, mandibular advancement device (MAD) therapy is increasingly recognized as a viable treatment for OSA (Aarab, Lobbezoo, Hamburger, & Naeije, 2011; Ramar et al, 2015). During the monitoring phase of this treatment, the mandibular protrusion position of the MAD is often titrated by the dentist or patient to improve its efficacy and to reduce its side-effects (Aarab, Lobbezoo, Hamburger, & Naeije, 2010). Due to their design, MADs exert potentially detrimental forces on the teeth, oral soft tissues, and musculoskeletal structures of the masticatory system. MADs may result in excessive salivation, mouth dryness, and temporomandibular side-effects in the short-term (Doff et al, 2012; Hammond et al, 2007; Martinez-Gomis et al, 2010; Pantin, Hillman, & Tennant, 1999; Tegelberg et al, 1999)

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