Title: Obstructive Sleep Apnea and Oral Appliances- Review

Authors: Dr Shivasankar.V.MDS, Dr Geetha.C .MBBS

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i7.76

Abstract

Obstructive sleep apnea is a chronic, progressive and disabling sleep related breathing disorder. It requires long term, multidisciplinary management .Various treatment modalities such as behavioural, medical, surgical options are available. Contribution from various health care specialties could lead to effective treatment benefits when considering treatment for OSA. The most common clinical procedure involves continuous positive airway pressure (CPAP). Orthodontics is not just limited with mere alignment of the teeth and smile esthetics but it has an expanded health care role that has established a new standard of health care for OSA patients. Oral appliances are simple, noninvasive, cost effective and reliable treatment method compare to all other airway pressure therapy and surgical approach in mild and moderate OSA patient.

Key word: Apnea, CPAP, Obstructive Sleep Apnea, Oral appliance, Polysomnagraphy.

References

 

1.      Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. Sleep 1999;22:667-89.

2.      Peker Y, Hedner J, Norum J, Kraiczi H, Carlson J. Increased incidence of cardiovascular disease in middle-aged men with obstructive sleep apnea: a 7-year follow-up. Am J Respir Crit Care Med 2002;166:159-65.

3.      Yaggi HK, Concato J, Kernan WN,Lichtman JH, Brass LM, Mohsenin V.Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034-41.

4.      Peppard PE, Young T, Palta M, Skatrud J. Prospective study of the association between sleep-disordered breathing and hypertension. N  Engl J Med 2000;342:1378-84.

5.      Reichmuth KJ, Austin D, Skatrud JB, Young T. Association of sleep apnea and type II diabetes: a population based study. Am J Respir Crit Care Med 2005;172:1590-5.

6.      Loube DI, Gay PC, Strohl KP, Pack AJ, White DP, Collop NA.Indications for positive airway pressure treatment of adult obstructive sleep apnea patients: a consensus statement. Chest1999;115:863-6

7.      Wang Y, Beydoun MA. The obesity epidemic in the United States - gender, age, socioeconomic, racial/ethnic, and geographic characteristics: a systematic review and metaregression analysis. Epidemiol Rev 2007; 29 : 6-28.

8.      Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middle-aged adults. N Engl J Med 1993;328:1230–5.

9.      Marcus CL. Sleep-disordered breathing in children. Am J Respir Crit Care Med 2001;164:16–30

10.  Young T, Palta M, Dempsey J, Skatrud J, Weber S, Badr S. The occurrence of sleep-disordered breathing among middleaged adults. N Engl J Med 1993;328:1230-5

11.  Roehrs T, Zorick F, Sicklesteel J, Wittig R, Roth T. Agerelated sleep-wake disorder at a sleep disorders center. J Am Geriatr Soc 1983;31:364-70

12.  Jamie C.M. Lam, S.K. Sharma & Bing Lam Obstructive sleep apnoea: Definitions, epidemiology & natural history Indian J Med Res 131, February 2010, pp 165-170

13.  Williams AJ, Yu G, Santiago S, Stein M Screening for sleep apnea using pulse oximetry and a clinical score. Chest. 1991 Sep;100(3):631-5.

14.  Michael R. Littner ; Clete Kushida ; Merrill Wise ; David G. Davila, ; Timothy Morgenthaler ; Teofilo Lee-Chiong ; Max Hirshkowitz  Practice Parameters for Clinical Use of the Multiple Sleep Latency Test and the Maintenance of Wakefulness Test SLEEP, Vol. 28, No. 1, 2005

15.  Alan.A.Lowe. Cephalometric and demographic characteristics of obstructive sleep apnea: an evaluation with partial least squares analysis. The Angle orthodontist vol 67 no 2 1997

16.  Bernard Deberry-Borowiecki Cephalome-tric analysis for diagnosis and treatment of obstructive sleep apnea, The Laryngoscope  vol 98,issue 2, pages 226–234, February 1988

17.  Haponick EF, Smith PL, Bohlman ME, Allen RP, Goldman SM, Bleecker ER. Computerized tomography in obstructive sleep apnea. Correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis 1983, 127 : 221-6.

18.  Epstein LJ, Kristo D, Strollo PJ, Friedman N, Malhotra A, Patil SP, Ramar K, Rogers R, Schwab RJ, Weaver EM, Weinstein MD. Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. Adult obstructive sleep apnea task force of the American Academy of Sleep Medicine. J Clin Sleep Med. 2009; 5:263-76.

19.  Conley R. S. Management of sleep apnea: a critical look at intra-oral appliances. Orthod Craniofac Res 2015; 18(Suppl.1): 83–90

20.  DSC Hui, DKL Choy, FWS Ko, TST Li, CKW Lai  Obstructive sleep apnoea syndrome: treatment update HKMJ  june 2000 vol ;6 no:210

21.  Warunek SP. Oral appliance therapy in sleep apnea syndromes: a review. Semin Orthod. 2004; 10:73-89.

22.  Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RWW, Darendeliler MA, Cistulli PA. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax. 2010; 65:726-32.

23.  Lee CH, Kim JW, Lee HJ, Seo BS, Yun PY, Kim DY, Yoon IY, Rhee CS, Park JW, Mo JH. Determinants of treatment outcome after use of the mandibular advancement device in patients with obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2010; 136:677-81

24.  KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs. nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest. 1996; 109:1269-75.

25.  Almeida FR, Parker JA, Hodges JS, Lowe AA, Ferguson KA.Effect of a titration polysomnogram on treatment success with a mandibular repositioning appliance. J Clin Sleep Med. 2009; 5:198-204.

26.  Ferguson KA, Ono T, Lowe AA, al-Majed S, Love LL, Fleetham JA. A short term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax. 1997; 52:362-8.

27.  Ferguson, K.A., et al., A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea. Thorax, 1997. 52(4): p. 362-8.

28.  Engleman, H.M., et al., Randomized crossover trial of two treatments for sleep apnea/hypopnea syndrome: continuous positive airway pressure and mandibular repositioning splint. Am J Respir Crit Care Med, 2002. 166(6): p. 855-9.

29.  Bloch, K.E., et al., A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med, 2000. 162(1): p. 246-51.

30.  Clark, G.T., et al., A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea. Chest, 1996. 109(6): p. 1477-83.

31.  Hoekema A, Van der Hoeven JH, Wijkstra P J: Predictors of obstructive sleep Apnea-Hypopnea Treatment Outcome. JDent Res2007 86(21):1181-1186,

32.  Krishnan V, Nancy A., Steven C: An Evaluation of a Titration Strategy for prescription of oral appliances for obstructive sleep apnea; Chest 2008; 133;1135-1141.

33.  Chan, Andrew S.L, Cistulli, Peter A. Oral appliance Treatment of obstructive sleep apnea: an update. Current opinion in pulmonary Medicine. 2009; 15 (6): 591 – 596. 40.

34.  Chhajed PN, Chhajed T.P. Tamm M, Strobel W. Obstructive sleep apnea: therapies other then CPAP. JAPI,2004; 52: 143-151

35.  Lim J, Lasserson TJ, Fleetham JA, Wright J. Oral appliances for obstructive sleep apnoea. [Cochran Database]. Cochran Database Syst. Rev.; 2006; (1): CD004435.

36.  Petit FX; Pepin JL, Bettega G et al. Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. AM J Respir Crit Care Med 2002; 166: 274-78

37.  Scherr SC, D.L., Almeida FR, Bennett KM, Blumenstock NT, Demko BG, Essick GK, Katz SG, McLornan PM, Phillips and P.R. KS, Rogers RR, Schell TG, Sheats RD, Sreshta FP., Definition of an effective oral appliance for the treatment of obstructive sleep apnea and snoring: a report of the American Academy of Dental Sleep Medicine. Journal of Dental Sleep Medicine, 2014. 1(1): p. 39-50.

38.  Deane SA, Cistulli PA, Ng AT, Zeng B, Petocz P, Darendeliler MA. Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial. Sleep 2009;32:648–53.

39.  Lekerud AK, Sand L, Englund AK, Hirsch JM. Treatment of sleep apnoea using a mandibular advancement splint–an open prospective study. In Vivo 2012;26:841–5.

40.  Okuno K, Sato K, Arisaka T, Hosohama K, Gotoh M, Taga H, et al. The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: a systematic review and meta-analysis of randomised controlled trials. J Oral Rehabil 2014;41:542–54.

41.  Hoekema A, Stegenga B, Wijkstra PJ, van der Hoeven JH, Meinesz AF, de Bont LG. Obstructive sleep apnea therapy. J Dent Res 2008;87:882–7.

42.  Lam B, Sam K, Mok WY, Cheung MT, Fong DY, Lam JC, et al. Randomised study of three non-surgical treatments in mild to moderate obstructive sleep apnoea. Thorax 2007;62:354–9.

43.  Phillips CL, Grunstein RR, Darendeliler MA, Mihailidou AS, Srinivasan VK, Yee BJ, et al. Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea: a randomized controlled trial. Am J RespirCrit Care Med 2013;187:879–87.

44.  Nelly Huynh, Eve Desplats, Fernanda, Almeida Orthodontics Treatments for Managing Obstructive Sleep Apnea Syndrome in Children: A Systematic Review and Meta-analysis sleep medicine reviews feb 2015

45.  Holley, A.B., C.J. Lettieri, and A.A. Shah, Efficacy of an adjustable oral appliance and comparison with continuous positive airway pressure for the treatment of obstructive sleep apnea syndrome. Chest, 2011. 140(6): p. 1511

46.  Randerath, W.J., et al., An individually adjustable oral appliance vs continuous positive airway pressure in mild-to-moderate obstructive sleep apnea syndrome. Chest, 2002. 122(2): p. 569-75.

47.  Qaseem, A., et al., Management of Obstructive Sleep Apnea in Adults: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2013.

48.  Epstein, L.J., et al., Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med, 2009. 5(3): p. 263-76

49.  Robertson, S., et al., A randomized crossover trial of conservative snoring treatments: mandibular repositioning splint and nasal CPAP. Otolaryngol Head Neck Surg, 2008. 138(3): p. 283-288.

50.  Ghazal, A., et al., A randomized prospective long-term study of two oral appliances for sleep apnoea treatment. J Sleep Res, 2009. 18(3): p. 321-8.

51.  Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnoea-hypopnoea with or without treatment with continuous positive airway pressure: an observational study. Lancet 2005;365:1046–53.

52.  Yaggi HK, Concato J, Kernan WN, Lichtman JH, Brass LM, Mohsenin V. Obstructive sleep apnea as a risk factor for stroke and death. N Engl J Med 2005;353:2034–41.

53.  Ahrens A, McGrath C, Hagg U. A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea. Eur J Orthod 2011;33:318–24

54.  Iftikhar IH, Hays ER, Iverson MA, Magalang UJ, Maas AK. Effect of oral appliances on blood pressure in obstructive sleep apnea: a systematic review and meta-analysis. J Clin Sleep Med 2013;9:165–74.

Corresponding Author

Dr Shiva Sankar.V. MDS

Reader, Department of Orthodontics,

Rajas Dental College &Hospital, Kavalkinaru, Tirunelveli, Tamilnadu

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.