Effects Of Mandibular Advancement Device Research Articles

Effect of mandibular advancement device treatment on HIF-1\u03b1, EPO and VEGF in the myocardium of obstructive sleep apnea\u2013hypopnea syndrome rabbits

The aim of this study was to investigate the effects of mandibular advancement device (MAD) therapy for obstructive sleep apnea–hypopnea syndrome (OSAHS) on hypoxia-inducible factor-1α (HIF-1α), erythropoietin (EPO) and vascular endothelial growth factor (VEGF) in myocardial tissue. New Zealand rabbits were used to develop OSAHS and MAD models. Cone beam computed tomography (CBCT) of the upper airway and polysomnography (PSG) recordings were performed with the animals in the supine position. All of the animals were induced to sleep in a supine position for 4–6 h each day and were observed continuously for 8 weeks. The myocardial tissue of the three groups was dissected to measure the expression of HIF-1α, EPO and VEGF. The results showed that there was higher expression of HIF-1α, EPO and VEGF in the OSAHS group than those in the MAD and control groups. MAD treatment significantly downregulated the expression of HIF-1α, EPO and VEGF in the OSAHS animals. We concluded that MAD treatment could significantly downregulate the increased expression of HIF-1α, EPO and VEGF in OSAHS rabbits, improving their myocardial function.

Mandibular advancement devices: a real alternative to CPAP therapy?

Background: Obstructive sleep apnea syndrome (OSAS) is characterized by interruption of breath during sleep. OSAS is related to hypertension, type II diabetes and obesity. This disease has various implications on patient’s quality of life. The gold standard for OSAS treatment is continuous positive airway pressure (CPAP). Due to the high level of patients that complain about CPAP therapy, mandibular advancement devices could play an important role in OSAS treatment. Objectives: The purpose of this review is to appraise scientific evidence concerning the effectiveness of Mandibular Advancement Devices (MADs) for OSAS treatment and look over MADs designs that are currently being used scanning for its efficacy. Data sources: Five databases will be accessed (SCOPUS, PubMed, Web of Science, Science Direct and Wiley Online Library) and 6 keywords will be combined. Study eligibility and criteria: This systematic review will only include study’s developed with humans diagnosed with OSAS and with more than eighteen years old. English is the only language accepted. Study appraisal and synthesis methods: Studies assessment will be made by two authors (HCS and FM) and organized in three different parts: screen all articles; screen all abstracts, screen all full texts. In all phases articles that don’t have interest for this systematic review will be excluded. Two review authors (HCS and FM) will also assess the risk of bias and the quality of evidence, taking as a reference the Cochrane Collaboration’s Tool.

Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS)

Although considerable research highlights the interactions between obstructive sleep apnea-hypopnea syndrome (OSAHS) and cardiovascular diseases, the effect of mandibular advancement device (MAD) treatment on cardiovascular complications in OSAHS patients remains unclear. We evaluated the effect of OSAHS treatment with MADs on the myocardium. All methods in this study were in accordance with relevant guidelines and regulations of the medical ethics committee in Hospital of Stomatology, Hebei Medical University approved the work. Thirty New Zealand rabbits were randomized into three groups: the control group, Group OSAHS, and Group MAD. Hydrophilic polyacrylamide gel was injected into the soft palate of the rabbits to induce OSAHS. In Group MAD, a MAD was positioned after OSAHS induction. All animals were induced to sleep in a supine position for 4–6 h/day for 8 weeks. Echocardiography was used to determine the structure and function of the heart. The histological changes were detected by optical microscopy and transmission electron microscopy (TEM). The levels of ET-1(endothelin-1) and Ang II (Angiotensin II) in the plasma were measured by an enzyme-linked immunosorbent assay (ELISA). The expression of ET-1 mRNA in heart tissue was detected by RT-PCR. Histological abnormalities, left ventricular hypertrophy, and left ventricular dysfunctions were demonstrated in Group OSAHS, and the abnormities were rescued with MAD treatment. Higher levels of plasma ET-1 and Ang II and elevated expression of ET-1 mRNA in cardiac tissue were detected in Group OSAHS compared with Group MAD and the control group. The blood oxygen saturation was negatively correlated with the levels of ET-1 and Ang II. OSAHS-induced elevated levels of ET-1 and Ang II may be attributed to myocardial structural abnormalities and dysfunction. Early treatment of MADs may play an important role in preventing myocardial damage in OSAHS rabbit model.

Long-Term Side Effects of Mandibular Advancement Devices in Patients with Obstructive Sleep Apnea

Long-Term Side Effects of Mandibular Advancement Devices in Patients with Obstructive Sleep Apnea

The Effect of the Modified Jaw-Thrust Maneuver on the Depth of Sedation During Drug-Induced Sleep Endoscopy.

The modified jaw-thrust maneuver (MJTM) during drug-induced sleep endoscopy (DISE) is known to predict the treatment effect of mandibular advancement devices. However, its effect on the depth of sedation and potential to provoke arousal by awakening patients during the maneuver has not been studied so far. This study investigated the effect of the MJTM on the depth of sedation during DISE. Forty patients on whom the MJTM was performed during DISE were included. The effect of the maneuver was evaluated at the levels of the velum, lateral wall of the oropharynx, base of the tongue, and epiglottis. Obstruction was defined as the collapse of the upper airway exceeding 75%, and improvement with the MJTM was defined as the widening of the upper airway by more than 50% during the maneuver. A bolus injection of midazolam was used to induce sedation and control the depth of sedation (bispectral index value of 60 to 80). Obstructions were present in the velum of all patients, lateral wall of the oropharynx of 13 patients, base of the tongue of 28 patients, and epiglottis of 6 patients. After the MJTM, improvement of the obstruction was observed in 57.5%, 61.5%, 82%, and 66.7% of patients with velum, lateral wall of the oropharynx, base of the tongue, and epiglottis obstructions, respectively. An increase in the bispectral index value of more than 20 was observed in 8 patients. Four patients awakened during the procedure. The MJTM significantly relieved obstruction during DISE, especially at the base of the tongue. However, this might have been caused by an increase in the degree of awakening during the maneuver. Therefore, MJTM's effect on the depth of sedation may help in improving the degree of airway obstruction.

Oral appliance therapy in obstructive sleep apnea and snoring - systematic review and new directions of development

ABSTRACT Objective: Oral appliance therapy is a non-invasive treatment that offers a wide variety of oral devices for the treatment of obstructive sleep apnea (OSA). The present review focuses on the effectiveness of mandibular advancement devices for the treatment of OSA. Methods: A systematic review based on the PRISMA checklist was carried out. A detailed electronic database search was conducted using “Obstructive sleep apnea” AND “Oral appliance” AND “Dentistry” as keywords. Results: The initial search in the electronic databases resulted in a total of 262 papers. After the title and abstract analysis and full-text review, the number of eligible papers was reduced to 15. Conclusion: The mandibular advancement device is an effective treatment, improving the Apnea Hypopnea Index and the symptoms of patients with OSA in 92% of the subjects from all the investigated studies. The future may include the integration of a biosensor for the diagnosis and follow-up. Abbreviations: OSA: Obstructive sleep apnea; MADs: Mandibular advancement devices; CPAP: Continuous positive airway pressure; OAT: Oral appliance therapy; MRD: Mandibular repositioning devices; MAS: Mandibular advancement splints; MAA: Mandibular advancement appliances; OA: Oral appliances; AASM: American Academy of Sleep Medicine; AHI: Apnea-hypopnea index; EEG: Sleep-related breathing disorder SRBD; Electroencephalogram; EOG: Electrooculogram; ECG: Electrocardiogram; QOL: Quality of life; TMJ: Temporomandibular joint.

The effectiveness of mandibular advancement devices in the treatment of obstructive sleep apnoea in adults: a methodological quality assessment of systematic reviews.

There is growing interest in the use of mandibular advancement devices (MADs) for the treatment of obstructive sleep apnoea (OSA). Many systematic reviews (SRs) have investigated their effectiveness, but the applicability of SR results is affected by their methodological quality. This study critically appraises the methodological quality of SRs on this topic using a more detailed and updated version of A MeaSurement Tool to Assess systematic Reviews (AMSTAR). The literature was searched for SRs on MAD effectiveness in adults (≥18 years of age) for OSA treatment as compared with other non-surgical or surgical interventions or no intervention. Any objective or subjective measures of treatment outcome were considered eligible. AMSTAR2 was used to assess methodological quality. The literature search yielded 64 potential reports; 10 met the eligibility criteria. All SRs had more than one critical flaw in AMSTAR2, so their methodological quality was rated as critically low. The most common issues included non-registration of study protocol, absence of list of excluded studies, no acknowledgment of fundings of included studies, no impact of risk of bias on SR results or interpretation and discussion of results, and data extraction not in duplicate. If a SR was not clearly identified by title or abstract as a SR or meta-analysis, it may have been missed during the screening process. The methodological quality of SRs was suboptimal and warrants further improvement in order to provide strong evidence of MAD effectiveness and increase applicability of SR results for clinical decision-making.

Long-term dental and skeletal effects of mandibular advancement devices in adults with obstructive sleep apnoea: A systematic review

This systematic review aimed to clarify whether there are any significant long-term sequelae to wearing mandibular advancement devices focusing on dental and skeletal effects in adults with OSA. Databases, including PubMed, Medline, Embase, Web of Science, Cochrane Central Register of Controlled Trials, and SAGE Journals. Hand searches and grey literature were also used. A piloted data collection form was used to extract the appropriate data. Twenty-three reports of 19 studies were included. Five had serious risk of bias while 18 had moderate risk of bias. Meta-analysis revealed a significant change in overbite and overjet. I-squared analysis showed a high level of statistical heterogeneity. A moderate correlation was found between wear time and amount of change. Mandibular advancement devices will cause a small but statistically significant change in the dentition of long-term wearers. Skeletal changes are generally secondary to dental changes.

Long-term effectiveness and side effects of mandibular advancement devices on dental and skeletal parameters

IntroductionContinuous positive airways pressure, generally used to treat obstructive sleep apnea-hypopnea syndrome (OSAHS), is not tolerated well by many patients. An alternative is to treat OSAHS with mandibular advancement devices (MAD). This research assesses the long term (> 2 years) effectiveness and the side effects on dental and skeletal parameters of these devices. Material and methodsWe selected 24 patients with moderate to severe OSAHS. All were treated with MADs for at least 2 years. We gathered cephalometric teleradiographs in centric relation and sleep recordings before and after the patients were treated. We evaluated the patients’ apnea-hypopnea indexes (AHI) as well as their Epworth sleepiness scale (ESS) scores. We measured the inclination of the central incisors and the positions of the upper and lower jaws. ResultsMandibular advancement devices were used for more than 2 years (3.9 ± 1.9 years). We observed a statistically significant decrease of the patients’ AHI and their ESS scores. We also observed a modification of the inclination of the lower central incisors (+0.521; P = 0.047) and of the position of the maxilla (−0.287; P = 0.039). DiscussionWe demonstrated the clinical effectiveness of mandibular advancement devices for treating OSAHS, with a very low rate of side effects on dental and skeletal positions.

Biomechanical effect of mandibular advancement device with different protrusion positions for treatment of obstructive sleep apnoea on tooth and facial bone: A finite element study.

The mandibular advancement device (MAD) is widely used for obstructive sleep apnoea (OSA) treatment, and several studies have demonstrated its effectiveness. However, no comprehensive studies have yet examined the biomechanical safety of the MAD. The objective of this study was to analyse the biomechanical effect of different protrusion positions of a MAD on the teeth and facial bones. The posterior restorative forces due to the stretched mandibular muscles were measured by pressure sensors attached to the experimental mandibular advancement device for mandibular protrusions of 10-70% of the maximum protrusion of the subject. A detailed three-dimensional biomechanical model of the study subject, constructed from computed tomography scans, was used in finite element analysis, with loading conditions calculated from the measured posterior restorative forces. The outcome measures were the principal stresses on the periodontal ligaments (PDL) and cancellous bone, and the pressure at the PDL surfaces. The measurements were used to analyse the risk of the tooth movement, tooth root resorption, and bone resorption. The lowest and highest restorative forces occurred at 40% and 70% of maximum protrusion, respectively. The highest risk of tooth movement occurred at the mandibular molar teeth. The mandibular second molar teeth had the highest risks of root and bone resorption. Mandibular advancement at 70% of maximum protrusion induces risks of tooth root resorption and bone resorption. The mandibular second molars were subjected to the highest stresses. Stress on the teeth and facial bones was the lowest at 40% of maximum mandibular advancement.

Effect of oral appliance on circulating leukocyte telomere length and SIRT1 in obstructive sleep apnea.

The increased cardiovascular risk seen in patients with obstructive sleep apnea (OSA) may be due to combination of oxidative stress, systemic inflammation and damage to leukocyte telomere length (LTL) seen with aging. Another molecule, Sirtuin 1 (SIRT1), a histone/protein deacetylase, regulates endothelial nitric oxide synthase and is involved in different aspects of cardiovascular disease, aging and stress resistance. The aim of this study was to evaluate the effects of mandibular advancement device (MAD) on the circulating LTL and SIRT1 protein level in peripheral blood mononuclear cells (PBMCs) in patients with OSA. Forty patients with moderately severe to severe OSA who desired MAD and 20 healthy controls were prospectively enrolled. The LTL was measured by quantitative polymerase chain reaction while SIRT1 protein levels in PBMC was assessed using a Sirtuin 1 ELISA Kit. All study subjects underwent baseline sleep study, with OSA patients having repeat testing at 3months after MAD. Compared to healthy subjects, patients with OSA at baseline had lower LTL and SIRT1 protein levels in PBMC. After 3months of MAD, 24 OSA patients, designated as MAD responders, median (range) LTL increased from (0.556 [0.393-0.748]) to (0.708 [0.533-0.893]) and SIRT1 protein levels in PBMC increased from 0.58 ± 0.23pg/μg of total protein to 0.95 ± 0.26pg/μg of total protein. For the 16 MAD unresponsive patients, LTL and SIRT1 protein levels remained low. Successful treatment of OSA with MAD can restore LTL and SIRT1 protein levels in PBMC. LTL and SIRT1 protein levels in PBMC can be improved following effective treatment of OSA using MAD.

Dental and skeletal long-term side effects of mandibular advancement devices in obstructive sleep apnea patients: a systematic review with meta-regression analysis.

Mandibular advancement devices (MAD) are effective in reducing apnea episodes and they are frequently used as first-line therapy in obstructive sleep apnea (OSA) patients. The MAD must be used every night for a lifetime and since it performs its function discharging the forces on dental elements the aim of this systematic review was to identify the dental and skeletal long-term side effects of MAD therapy and to evaluate the influence of time on them in OSA or snoring patients. An electronic search was performed in MEDLINE, Cochrane Database, Google Scholar Beta, Scopus, and LILACS. Studies until 4 April 2018 were analysed, without language restrictions. Randomized controlled trials and cohort studies investigating dental and/or skeletal side effects on adult patients wearing MAD for OSA or snoring treatment with at least 2 years follow-up were included and independently evaluated by two investigators. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by means of Cochrane's tools. For each study included and for each dental and/or skeletal parameter, the difference in means and 95% CI was calculated between baseline and follow-up. Twenty-one studies with follow-up between 2 and 11 years were included. The side effects reported were a reduction in overjet, overbite, and in the upper incisor inclination, and an increase in lower incisor inclination, A point-Nasion-B point, and anterior facial height. The meta-regression analysis showed that the side effects were influenced by the therapy duration for all parameters (P < 0.05). The quality of evidence was low/moderate. MAD therapy produces time-related dental and skeletal side effects. After a long period of treatment, the dental side effects are clinically relevant and therefore the clinician should inform the patients about this issue. Since the side effects are progressive, patients need to be continuously monitored over time. The study protocol was not registered.

The use of oral appliances in obstructive sleep apnea: a retrospective cohort study spanning 14years of private practice experience.

In 2005, the American Academy of Sleep Medicine stated, "Oral appliances are indicated for use in patients with mild to moderate obstructive sleep apnea (OSA) who prefer them to CPAP therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP." However, this recommendation is based upon variable results from only six studies with more than 100 participants. These studies have assessed the effectiveness of mandibular advancement devices (MADs) in specific groups (military populations, academic institutions, or hospital settings) with no large study conducted in a fee-for-service private practice where the majority of patients receive MADs for OSA. The purpose of this study is to report outcomes of a board-certified dental sleep practitioner managing mild, moderate, and severe OSA using customized titratable MADs. We hypothesize that patients will demonstrate a significant reduction in apnea-hypopnea index (AHI) scores after adjusting their customized titratable MADs. This is a 14-year retrospective study design with pre- and post-treatment sleep studies. An AHI score < 10 respiratory events per hour with therapy is defined as treatment success. This study was performed by a single private practitioner. Of 2419 patient records analyzed, 544 (22%) had pre- and post-treatment sleep studies (89% polysomnograms). Of 510 patients with complete data, 459 (90%) revealed a decrease in AHI score < 10 respiratory events per hour indicating treatment success. Only 51 of these patients (10%) had a final AHI ≥ 10 and were considered treatment failures. Among the patients who lacked post overnight polysomnogram, 66/1921 (3%) discontinued the MAD due to adverse effects. Considering these patients as treatment failures as well, and therefore adding their number to the patients with complete sleep study data, the total treatment failures were 117/576 or 20%. Of the treatment successes, OSA was categorized by AHI at baseline as mild in 170 (34%), moderate in 181 (36%), and severe in 138 (28%). In patients with evaluable data, there was an 80% success rate for treatment of OSA using a custom-fabricated adjustable MAD including substantial numbers of patients with moderate and severe disease.

Effect of mandibular advancement device upon nuclear factor κB and tumor necrosis factor α, interleukin 6 in genioglossus of rabbit with obstructive sleep apnea hypopnea syndrome

Objective: To investigate the effects of mandibular advancement device (MAD) upon nuclear factor κB (NF-κB), tumor necrosis factor α (TNF-α) and interleukin 6 (IL-6) in the genioglossus. Methods: Eighteen New Zealand white rabbits (male, six months old), in accordance with the random number table, were equally divided into three groups, the control group, obstructive sleep apnea hypopnea syndrome (OSAHS) group and MAD group. All animals were induced to sleep in supine position for 2 hours every morning in the next 8 weeks. The specimens of genioglossus were prepared. The relative expression of NF-κB p65 was measured with Western blotting and the mass concentration of TNF-α and IL-6 was determined with enzyme-linked immunosorbent assay. Results: The relative expressions of NF-κB p65 protein in genioglossus in the control group, OSAHS group and MAD group were 0.24±0.07, 0.44±0.08 and 0.30±0.09, respectively. The mass concentrations of TNF-α in genioglossus in the control group, OSAHS group and MAD group were (0.065±0.020), (0.097±0.018) and (0.071±0.020) μg/L, respectively. The mass concentrations of IL-6 in genioglossus in the control group, OSAHS group and MAD group were (0.063±0.013), (0.093±0.017), and (0.069±0.014) μg/L, respectively. For the above indicators, the data in OSAHS group were all significantly higher than that in MAD group and the control group (P<0.05). No significant difference was found between MAD group and the control group (P>0.05). Conclusions: Treatment of OSAHS with MAD decreased the mass concentration of TNF-α and IL-6 leading to fatigue of genioglossus, reduced the activation of NF-κB and played a significant role in protecting genioglossus.

Improvement of Cognitive and Psychomotor Performance in Patients with Mild to Moderate Obstructive Sleep Apnea Treated with Mandibular Advancement Device: A Prospective 1-Year Study.

This study aimed to provide the evidence on effect of mandibular advancement device (MAD) therapy on long-term cognitive and psychomotor performance, excessive daytime sleepiness, and quality of life in patients with mild to moderate obstructive sleep apnea (OSA). A total of 15 patients with mild to moderate OSA were treated with MAD therapy and they were followed up after 3 mo and 1 y of therapy. The patients were tested on three different tests of cognitive and psychomotor performance using the computer-based system Complex Reactionmeter Drenovac (CRD-series) at baseline and at the time of follow-up, and the 36-Item Short Form Health Survey (SF-36) questionnaire and Epworth Sleepiness Scale were used to assess their quality of life and excessive daytime sleepiness, respectively. The mean apnea-hypopnea index (AHI) decreased significantly from 22.9 ± 5.9 events/h at baseline, to 9.7 ± 4.5 events/h after 1 y of MAD therapy (p < 0.001). There was significant improvement on all three CRD-series tests used after 1 y of MAD therapy, considering total test solving time (TTST) and minimal single task solving time (MinT), whereas total number of errors committed during the tests (TE) remained unchanged. Self-reported measures, excessive daytime sleepiness, and three domains of quality of life, social functioning, general health perception, and health change following MAD therapy showed significant improvements after 1 y of MAD therapy. This study demonstrates significant improvements in cognitive and psychomotor performance, particularly in the domain of perceptive abilities, convergent thinking (constructing and solving simple mathematical tasks) and psychomotor reaction times, excessive daytime sleepiness, and quality of life in patients with mild to moderate OSA following MAD therapy.

Effects of mandibular advancement devices for the treatment of sleep apnea syndrome based on cardiopulmonary coupling analysis

Effects of mandibular advancement devices for the treatment of sleep apnea syndrome based on cardiopulmonary coupling analysis

The influence of a mandibular advancement plate on polysomnography in different grades of obstructive sleep apnea.

ABSTRACTObjectivesThe purpose of this study was to investigate the effect of a mandibular advancement device on different grades of obstructive sleep apnea using a relatively simple test for the apnea-hypopnea index to determine if a mandibular device will be effective.Material and MethodsA total of 68 patients with obstructive sleep apnea syndrome (OSAS) including, 31 with mild, 23 with moderate and 14 with severe OSAS were treated with a mandibular advancement device (MAD) and monitored with polysomnography.Results25 of the 31 mild, 15 of the 23 moderate and 2 of the 14 severe OSAS patients were cured of their OSAS if a post treatment apnea-hypopnea index of less than 5 is regarded as cured. The odds ratios for success with MAD therapy are 3 for women over men, 14.9 for mild obstructive sleep apnea, 5.42 for moderate obstructive sleep apnea if severe obstructive sleep apnea is assigned an odds ratio of 1.ConclusionsThe use of the apnea-hypopnea index alone is useful in mild and moderate disease to predict the effectiveness of mandibular advancement device. Treatment with a mandibular advancement device is very effective in treating mild and moderate obstructive sleep apnea. Conservative treatment with a mandibular advancement device can be successful in less severe grades of sleep apnea and may be an alternative for non-surgical patients with severe obstructive sleep apnea intolerant of Continuous Positive Airway Pressure management.

Effects of Mandibular Advancement Devices on Sleep, Blood Pressure and Jaw Functions in Patients with or without Diabetes

Severity of obstructive sleep apnea (OSA) has two main components: severity of daytime sleepiness and apnea hypopnea index (AHI) in addition to adjacent health complications. We investigated the effect of custom-made Mandibular Advancement Devices (MADs) on breathing pattern parameters (including apneahypopnea index), blood pressure, daytime sleepiness (Epworth score) and temporomandibular disorders (TMD) in a randomized crossover trial at the Department of Oral and Maxillofacial Surgery, Odense University Hospital, on consecutively treated patients diagnosed with snoring or sleep apnea. Continuous registrations of outcome variables were performed; patients underwent diagnostic cardio-respiratory monitoring before and after 3 months’ MAD therapy, and results obtained in patients before MAD therapy were compared with those obtained after MAD therapy. Measurements with and without MAD were compared using Student’s t-test or Wilcoxon signed rank test, and mixed-model analyses was performed to analyze repeated measurements and adjusting for sleep apnea severity, type 2 diabetes, body-mass-index, sex and age. A total of 44 patients (31 men; 13 women, aged 50 ± 13 years, BMI 31 ± 5.6, diabetic n=18; non-diabetic n=26) completed the trial. The apnea-hypopnea index (AHI) reduced from 15.8 ± 17.4 without MAD to 6.2 ± 9.8 events/h with MAD (P<0.001). After 6 months without therapy compared with 6 months’ MAD therapy, mean systolic blood pressure decreased from 135 ± 15 to 132 ± 15 mm/Hg (P=0.02) and Epworth score decreased from 10 ± 5 to 6 ± 3 (P<0.001). The occurrence of TMD diagnoses did not increase, no patients discontinued therapy due to TMD, and there were no interactions between diabetes status or obstructive sleep apnea severity evident for any outcome parameter. Conclusions: The present study confirmed MAD therapy to be a relevant treatment option without significant side effects on jaw function in patients with high as well as low AHI, and in diabetic as well as non-diabetic patients.

Effect of oral appliance on endothelial function in sleep apnea

This study evaluated the effects of mandibular advancement device (MAD) on serum levels of nitric oxide derivatives and endothelial function by endothelium-dependent flow-mediated dilation (FMD) in obstructive sleep apnea syndrome (OSAS). Thirty patients with moderately severe-to-severe OSAS who desired MAD and 15 healthy controls were prospectively enrolled. FMD was measured by high-resolution B-mode ultrasonography, while serum NO x level from peripheral blood samples was measured by ELISA. All subjects participated in the sleep studies, which were repeated 2months after MAD in OSAS patients. Serum NO x level and FMD were lower in patients with OSAS than in controls prior to MAD. Serum NO x levels in 19 of 30 patients with OSAS, the designated MAD responders, increased from 11.8 ± 5.8μM pre-MAD to 22.7 ± 4.9μM post-MAD. The FMD increased from 5.9 ± 4.6 pre-MAD to 10.5 ± 4.8 post-MAD. For the 11 unresponsive patients, serum NO x and FMD remained impaired after MAD. Successful treatment of OSAS with MAD can restore serum levels of NO x and FMD. Endothelial function can be improved following effective treatment of OSAS using MAD.

Influencing factors on the effect of mandibular advancement device in obstructive sleep apnea patients: analysis on cephalometric and polysomnographic parameters

The purposes of this study were to evaluate clinical outcome of mandibular advancement device (MAD) for obstructive sleep apnea (OSA) patients and to estimate influencing factors on MAD effect. From the patients who were diagnosed as OSA by polysomnography at Seoul National University Bundang Hospital from January 2007 to February 2009, the patients who chose MAD as initial treatment option were included. All the patients' data were collected by reviewing and analyzing medical record and radiograph retrospectively. Eighty-six patients (76 males and 10 females; mean age of 51.5 ± 9.8 years) with OSA were included in this study. Total success rate of MAD treatment was 47.7% (41/86 patients). Among cephalometric parameters, lower facial height (35.61 ± 4.26 vs. 38.19 ± 4.89) showed significant difference between success group and non-success group. From the polysomnographic parameters, apnea index (19.79 ± 17.32 vs. 30.08 ± 23.28), average oxygen saturation (95.03 ± 1.42 vs. 94.32 ± 1.56), lowest oxygen saturation (81.44 ± 6.64 vs. 76.87 ± 7.98), oxygen saturation under 90% (4.47 ± 5.90 vs. 9.01 ± 9.29), and oxygen desaturation index (23.58 ± 17.46 vs. 37.16 ± 22.35) showed significant difference between groups. From the results, it was proved that MAD was an effective treatment option for the OSA patients. Some cephalometric and polysomnographic parameters including posterior lower facial height, apnea index, average oxygen saturation, lowest oxygen saturation, oxygen saturation under 90 %, and oxygen desaturation index could be influencing factors on MAD effect.