Drug-induced Sleep Endoscopy: Are there Predictors for Failure of Oral Appliance Treatment?

Abstract Introduction In the literature, evidence is lacking on the predictive value of druginduced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] >10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or >50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI <30events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI <30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p< 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

Aparelhos de registro tipo "George Gauge" para posição mandibular terapêutica em aparelhos intra-orais para ronco primeiro e síndrome obstrutiva da apneia e hiponeia / Obstrutiva do sono (SHAOS) type recording devices "George Gauge" recording devices for therapeutic mandibular position in intraoralappliances for snoring first and obstructive sleepapnea hyponea syndrome (SHAOS)

As multifatoriedades do aumento da SHAOS têm diversas causas, desdês de obesidades até sedendarismo de grande proporção. No entanto a ciência tem feito grandes esforços para isso se altere. Mesmo assim muito tem que se pesquisar para um tratamento efetivo que seja capaz de ajudar o paciente a ter um sono reparador e uma qualidade de vida mais satisfatória. A sofisticação dos CPAP, melhores alternativas para o tratamento se sofisticaram de tal em volume, barulho e tamanho que estão aumentanto em muito sua utilização. Os mini-cpaps são uma prova disso. No entanto ainda nos confrontamos com a baixa adesão do tratamento frente ao desconforto causado. Ao aparelhos intra-orais são uma alternativa viáveis para os casos de IAH (índice de apneia e hipopneia) leve, moderada e ronco primário. Importante frisar que sem um exame de polissografia e teleradiografias laterais o Cirurgião Dentista não pode fazer nada(AU)

The multifactorial causes of the increase in SHAOS have several causes, from obesity to a large sedentary lifestyle. However science has made great efforts to change this. Even so, much remains to be researched for an effective treatment that is capable of helping the patient to have a restful sleep and a more satisfactory quality of life. The sophistication of CPAP, the best alternatives for treatment, has become so sophisticated in volume, noise and size that its use is greatly increasing. The mini-cpaps are proof of that. However, we are still faced with the low adherence to the treatment due to the discomfort caused. Intraoral appliances are a viable alternative for cases of mild, moderate AHI (apnea and hypopnea index) and primary snoring. It is important to emphasize that without a polysomnography exam and lateral teleradiographies, the Dental Surgeon cannot do anything(AU)

A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients

ABSTRACT Introduction: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper's plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. Objective: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. Methods: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. Results: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. Conclusion: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.

RESUMO Introdução: A opção mais indicada para tratamento da apneia obstrutiva do sono (AOS) é o CPAP; contudo, a aderência é limitada. A Terapia com Aparelho Oral (TAO) é, frequentemente, uma opção, ou mesmo um adjuvante. A prescrição mais utilizada é o Aparelho Oral de avanço mandibular (AOm). O AOm modifica a via aérea superior, melhorando a patência do espaço aéreo. A construção do AOm se baseia no plano de oclusão para desoclusão. No presente estudo, usamos o DIORS®, um AOm diferente, baseado nos conceitos da Reabilitação Neuro-Oclusal (RNO), que utiliza o Plano de Camper como referência da desoclusão para alcançar o equilíbrio neuromuscular e estabilidade funcional. Objetivo: O presente estudo teve como objetivo principal abordar a eficácia do DIORS®, considerando-se os resultados clínicos e polissonográficos. Adicionalmente, foi avaliado, também, se o uso desse AOm é tão eficaz quanto a titulação do CPAP para tratar pacientes com AOS não aderentes ao CPAP. Métodos: Vinte pacientes foram incluídos neste estudo. Dados clínicos objetivos e subjetivos foram avaliados em um laboratório de sono usando polissonografia de noite inteira e a Escala de Sonolência de Epworth (ESE) observando-se três momentos: inicial, titulação do CPAP e usando o DIORS®. Os critérios de sucesso da TAO foram assumidos pela análise dos parâmetros respiratórios como Índice de Apneia e Hipopneia (IAH) e níveis de saturação de oxi-hemoglobina, o índice de despertar e a sonolência diurna. Resultados: Em ambas as terapias, os parâmetros respiratórios e de despertares melhoraram. Adicionalmente, uma melhora na ESE foi alcançada com o DIORS®. Conclusão: Os resultados do presente trabalho apoiam que o DIORS® é uma terapia adjuvante viável e bastante eficaz para pacientes com AOS moderada a grave não aderentes ao CPAP.

Morphological change analysis based on cone beam CT of the upper airway for obstructive sleep apnea syndrome patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical patterns / 华西口腔医学杂志

OBJECTIVE@#To analyze the morphological changes in the upper airway of obstructive sleep apnea syndrome (OSAS) patients treated with oral appliance in skeletal class Ⅱ malocclusion with different vertical features by using cone beam CT (CBCT).@*METHODS@#Thirty-six patients diagnosed with OSAS by polysomnography and daytime sleepiness scale and skeletal class Ⅱ malocclusion were treated with oral appliance for 4 months. The changes based on CBCT in the morphology of glossopharyngeal and palatopharyngeal before and after treatment in OSAS patients with different vertical features were compared.@*RESULTS@#After treatment with oral appliance, the glossopharyngeal and palatopharyngeal morphologies of patients with mild OSAS showed significant changes. After treatment with oral appliance, the glossopharyngeal morphology of all patients showed significant changes (P<0.05). The palatopharyngeal morphology of patients in the lower and average groups also exhibited significant changes (P<0.05). Sagittal changes in the glossopharyngeal measurements of high-angle patients demonstrated significant difference, whereas the other measured values showed no significant difference.@*CONCLUSIONS@#The morphological changes in the upper airway were significant in OSAS patients with lower and average vertical patterns when treated with oral appliance, but the changes in high vertical patterns were not significant.

Effect of oral appliance treatment on age-related changes of sleep respiratory function in patients with obstructive sleep apnea hypopnea syndrome / 中华耳鼻咽喉头颈外科杂志

Objective@#The severity of obstructive sleep apnea hypopnea syndrome (OSAHS) has a tendency to increase with age. The purpose of this study was to explore whether oral appliance (OA) treatment can block this age-related change.@*Methods@#This study was a retrospective study. Fifteen patients (12 males,3 females) of OSAHS treated with OA were selected as treatment group,with an average age of (47.44±10.00) years and initial body mass index (BMI) of (26.31±3.33) kg/m2. The follow-up length was 54 [22, 100] months. Nineteen patients (13 males,6 females) with untreated OSAHS served as controls, with an average age of (45.00±9.26) years and initial BMI of (25.53±2.58) kg/m2,and the follow-up length was 35 [26,63] months. There were no significant differences in terms of gender,age,initial BMI, apnea hypopnea index(AHI), and follow-up length between the two groups. Polysomnography(PSG) data for the two groups were compared to observe the sleep respiratory function changes as aging by Wilcoxon test.@*Results@#There was no significant difference in BMI of the treatment group and the control group at the time of follow-up, with BMI of treatment group from (26.31±3.33) kg/m2 to (25.67±3.65) kg/m2,Z=-1.223,P=0.221; and BMI of control group from (25.53±2.58) kg/m2 to (25.12±2.72) kg/m2,Z=-1.193,P=0.233. There was no significant difference in the change of AHI within the treatment group, from 26.20 [11.50, 52.98]/h to 23.10 [16.00, 45.00]/h, Z=-0.284, P=0.776; AHI in the control group was higher than that at the first visit, and the AHI increased from 15.00 [10.72, 28.90]/h to 31.10 [13.00, 41.80]/h, Z=-3.481, P<0.001. The longest apnea duration was not statistically different in the treatment group, from 60.00 [56.40, 74.00] s to 63.00 [52.00, 77.00] s, Z=-0.345, P=0.730; the longest apnea duration in the control group increased from 42.00 [34.00, 56.70] s to 46.00 [37.00,62.00] s,Z=-2.274,P=0.023. There was no significant difference in the lowest blood oxygen saturation of the treatment group and the control group, with the treatment group from 72.47%±12.69% to 72.73%±17.59%, Z=-0.597, P=0.550; and the control group from 78.21%±9.30% to 76.42%±12.17%, Z=-0.153, P=0.879.@*Conclusion@#Symptoms of sleep apnea in OSAHS patients tend to increase with age,and oral appliance treatment may have the effect of slowing down this age-related worsening effect.

Effect of Drug-Induced Sedation Endoscopy on the Decision of Treatment Plan in Patients with Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Drug-induced sedation endoscopy (DISE) has recently gained popularity among otolaryngologists because it can provide direct information of upper airway obstruction in patients with obstructive sleep apnea (OSA). In that regard, we examined how DISE examination affected the decision of clinician's treatment plan and the consequent patient's compliance in OSA patients. SUBJECTS AND METHOD: All enrolled patients were classified into two groups according to the method of upper airway evaluation employed: a physical examination only group and a physical examination combined with DISE group. The clinician's treatment plan was categorized into the following four groups: sleep surgery, positive airway pressure, oral appliance, and sleep surgery combined with oral appliance. The change of patient's compliance was also evaluated. RESULTS: There were several differences in how DISE evaluation affected the decision of clinician's treatment plan and patient's compliance between the two groups. The rate for sleep surgery fell from 69.6% to 15.9%; on the other hand, the rate for positive airway pressure, oral appliance and sleep surgery combined with oral appliance all increased from 13.0% to 36.2%, 14.5% to 26.6%, and 2.9% to 21.3%, respectively. The patient's compliance also changed after DISE evaluation: sleep surgery, positive airway pressure, oral appliance and sleep surgery combined with oral appliance all increased from 78.1% to 87.9%, 16.7% to 76.0%, 25.0% to 87.3%, and 50.0% to 91.03%, respectively. CONCLUSION: We found that DISE examination influences the decision of clinician's treatment plan and patient's compliance. We suggest additional cohort studies to confirm these findings.

Influência do aparelho intra-oral em pacientes com apneia obstrutiva do sono por meio de avaliação polissonográfica pré e pós instalação do dispositivo oral / Influence of the intra-oral device in patients with obstructive sleep apnea by polyssonographic evaluation before and after installation of oral device

Introdução: Estima-se que a Síndrome da Apneia Obstrutiva do Sono (SAOS) afete 2% a 4% da população adulta de meia idade, no mundo. Contudo, estudo epidemiológico recente demonstrou que a prevalência da SAOS na população de São Paulo é de 32,8%. Apesar do tratamento padrão ouro ser com Pressão Positiva Contínua na Via Aérea (CPAP), os aparelhos intra-orais (AIOs) constituem uma alternativa de tratamento clínico com resultados favoráveis quando bem indicados. Objetivos: avaliar a influência do AIO em pacientes com SAOS, por meio de análise polissonográfica pré e pós instalação do dispositivo oral. Metodologia: Estudo observacional transversal, de abordagem quantitativa com coleta de dados secundários. A amostra deste estudo foi composta por prontuários e laudos de 26 pacientes com diagnóstico polissonográfico de SAOS e indicação de tratamento com AIO. Resultados: A idade média observada foi de 55,38 (±14,72) anos, índice de massa corporal (IMC) médio de 26,76(±3,92) Kg/m2 e perímetro cervical médio de 37,15 (±2,98) cm. No índice de apneia e hipoapneia (IAH) houve redução na média do número de eventos por hora de 12,98 (±5,75) pré-AIO para 6,91 (±7,23) pós-AIO, sendo estatisticamente significativo com p<0,001. Houve melhora significativa no índice de microdespertar, porcentagem de ronco no tempo total de sono, no IAH-NREM (non rapideyemovement), número de apneias mistas, hipopneias e número total de eventos respiratórios. Conclusão: Houve umaredução significativa doIAH em relação a polissonografia basal e pós instalação do AIO em pacientes com SAOS.

Background: It is estimated that the obstructive sleep apnea syndrome (OSAS) affects 2% to 4% of the adult population middle-aged, in the world. Recent epidemiological study showed that the prevalence of OSAS in the population of São Paulo is 32.8 %. Despite the best treatment to OSAS is Continuous Positive-Pressure Airway (CPAP), the oral devices may be an alternative clinical treatment with favorable results when well indicated. Objective: Evaluate the influence of oral device in patients with OSAS, through polysomnography pre and post installation of the oral appliance. Methods: A cross-sectional observational study was made, with quantitative approach and secondary data collection. The sample was composed of records and reports of 26 patients with polysomnographic diagnosis of OSAS and indication for treatment with oral devices. Results: The mean age was of 55.38 (± 14.72) years, body mass index (BMI) of 26.76 (± 3.92) kg / m2 and average cervical circumference of 37.15 (± 2.98) cm. The apnea-hypopnea index (AHI) decreased from 12.98 (± 5.75) events per hour before oral device to 6.91 (± 7.23) events per hour after oral device, being statistically significant (p<0.001). There was significant improvement in arousal index, percentage of snoring in total sleep time, AHI in non rapid eye movement, number of mixed apneas, hypopneas and total number of respiratory events. Conclusion: There was a significant reduction in AHI compared to baseline polysomnography and after installation of the oral appliance in OSAS patients.

Treatment outcome evaluation of different mandibular advancements using oral appliance to treat obstructive sleep apnea and hyponea syndrome:a systematic review / 北京大学学报(医学版)

Objective: To evaluate the polysomnology results along with mandibular titrated advancement using oral appliance to treat obstructive sleep apnea and hyponea syndrome(OSAHS).Methods: Several electronic databases (PubMed, Embase, Cochrane Library, CNKI, VIP, and Wanfang) were systematically searched up to September 2015.There was no restriction of language or source of information.All randomized clinical trials (RCT) and before-after trials (BAT) comparing at least two different mandibular advancements were included.Two independent reviewers selected the studies, extracted data and evaluated risk of bias by quality assessment.Data were pooled using a fixed-effects model, and the summary effect measure was calculated by risk ratio (RR) and 95%CI.Meta-analysis was performed using RevMan 5.3 software.Results: Two RCTs and five BATs were included in the review.Among the five BATs, two of them were randomized, while the other three were not.Outcomes including apnea hypopnea index (AHI), oxygen desaturation index (ODI), success rate (reduction of AHI or ODI >50%), normalization rate (AHI or ODI<10/h) were assessed in this review.Based on the trial design and quality assessment, four studies were included for meta-analysis.No significant difference in the success rate was found between the group with 50% of the maximal mandibular advancement (MMA) and the group with 75% of MMA [I2=0%, RR=0.93, with 95%CI (0.80, 1.09)].No significant dif-ference in the normalization rate was found between the 50% of MMA and 75% of MMA groups [I2=45%, RR=0.85, with 95%CI (0.68, 1.06)].Subgroup analysis displayed that the severity of OSAHS before treatment was a potential factor affecting the normalization rate.Conclusion: Based on current available evidence, the success rate and normalization rate for treating OSAHS in the patients with 75% MMA were not found to be significantly higher than those with 50% MMA.Due to small simple size in this meta-analysis, the results of the present study should be interpreted with caution.Further prospective studies are needed to strengthen the evidence.

Efficacy of oral appliance therapy of obstructive sleep apnea and hypopnea syndrome in different periods of treatment / 北京大学学报(医学版)

Objective:To investigate the long-term efficacy of oral appliance treating of obstructive sleep apnea and hypopnea syndrome (OSAHS) in different periods of treatment.Methods:A total of 55 patients were included in the study.Patients were all diagnosed with OSAHS by overnight polysomnography and all received oral appliance (OA) as the therapy.The OA positioned the mandible at 60％-70％ of the maximal mandible advancement position and created a 4-5 mm incisor separation.The patients were instructed to wear the appliance during sleep,6-8 hours per day,for 5-7 days per week.They were divided into four groups by the period of treatment,including less than 1 year group;1-2 years group;2-6 years group and 6-9 years group.The polysomnographic study was used to investigate the efficacy of the four groups.The outcome measures included the score on the apnea-hypopnea index (AHI),the longest apnea time and the lowest oxygen saturation (LSaO2) levels during an overnight sleep.Results:The AHI decreased significantly in all the four groups.The less than 1 year group decreased from 24.50 (14.65,54.05) to 7.40 (2.12,10.00) events/h (P ＜ 0.001);The 1-2 years group decreased from 19.50 (12.15,39.23) to 1.80 (0.70,6.58) events/h (P =0.001);The 2-6 years group decreased from 25.00 (11.41,42.60) to 4.50 (1.35,7.90) events/h (P =0.001);The 6-9 years group decreased from 26.2 (16.95,47.45) to 4.00 (1.90,26.70) events/h (P =0.043).The longest apnea decreased significantly in less than 1 year group,1-2 years group and 2-6 years group.The longest apnea decreased from 57.00 (37.70,61.50) to 25.00 (15.90,33.50)seconds (P＜0.001) in the less than 1 year group,from 41.00 (25.50,62.26) to 13.10 (0.00,22.10) seconds (P =0.001) in the 1-2 year group and from 42.50 (30.35,58.15) to 15.60 (0.00,28.10) seconds (P =0.003) in the 2-6 year group.The LSaO2 levels increased significantly in the less than 1 year group and 2-6 years group.The LSaO2 levels rose significantly in the less than 1 year group,from 74.18％ ±7.96％ to 84.06％ ±7.67％ (P =0.001),and in the 2-6 years group,from 76.71％ ± 10.98％ to 84.06％ ±4.64％ (P =0.006),The LSaO2 levels did not increase significantly in the 1-2 years and 6-9 years groups.Kruskal-Wallis test showed that there were no statistically significant differences in the AHI,longest apnea time and LSaO2 in 4 the groups.Conclusion:The oral appliance is an effective therapy for patients with OSAHS in the long-term treatment.However,it's recommended to make appointments with patients as a follow-up supervision whether there is any efficacy decrease.And the oral appliance should be replaced if necessary.

Analysis of Long-Term Complication on Patients with Obstructive Sleep Apnea Who Treated Mandibular Advancement Device / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Recently, mandibular advancement device (MAD) has been used widely used for the treatment of obstructive sleep apnea (OSA) because it can effectively reduce the collapsibility of upper airway during sleep. Although MAD is widely prescribed by otorhinolaryngologists, several studies described its complications arising from the anterior placement of the mandible with long-term use. However, there is still a lack of studies on long-term complications in Korean patients. SUBJECTS AND METHOD: Retrospectively, we included a total of 57 OSA patients in the study. In this study, all enrolled OSA patients had used MAD over two years with more than 4 hours/day. Dental consulting and cephalometric analysis were conducted to identify the change of dental and skeletal findings at two different times (baseline and after 2 year). RESULTS: The dental findings showed that the overbite and overjet were significantly decreased. Additionally, the proclination of the lower incisors were increased significantly, whereas there was no significant change on the retroclination of the upper incisors. Three patients showed a change of malocclusion type. On the analysis of skeletal findings, we found a significant increase in the sella turcica central point-nasion-supramental point angle and a decrease in the subspinal point-nasion-supramental point angle. Moreover, the anterior lower facial height and anterior facial height were significant increased. CONCLUSION: Consistent with Western studies, our findings suggest that the long-term use of MAD could induce changes in dental and skeletal morphologies in Korean OSA patients. Therefore, clinicians should thoroughly evaluate potential changes in dental and skeletal morphologies when they prescribe MAD to patients with OSA.

Overview of Treatment for Obstructive Sleep Apnea in Adults

Obstructive sleep apnea (OSA) is a common disorder characterized by obstructive apneas, hypopneas, and respiratory effort related arousals during sleep. Treatment of OSA is important because untreated patients have potential adverse clinical outcomes, such as excessive daytime sleepiness, metabolic dysfunction, cardiovascular disease, and mortality. Therefore, OSA should be considered as a chronic disease that requires long-term and multidisciplinary care. Positive airway pressure (PAP) therapy is the mainstay of treatment for OSA in adults. Alternative therapies include oral appliance, behavioral modification, and upper airway surgery. The treatment of OSA in adults is reviewed here with focus on PAP therapy.

Safety and Efficacy of the Mandibular Advancement Device 'Bioguard' for the Treatment of Obstructive Sleep Apnea: A Prospective, Multi-Center, Single Group, and Non-Inferiority Trial / 수면정신생리

OBJECTIVES: The purpose of this study was to estimate the safety and efficacy of a mandibular advancement device (MAD), 'Bioguard,' for the treatment of obstructive sleep apnea (OSA). METHODS: In this 5-week prospective, multi-center, single group, and non-inferiority trial, patients who chose 'Bioguard' as their treatment option were evaluated using both questionnaires (Pittsburgh Sleep Quality Index (PSQI), Epworth sleepiness scale (ESS)) and polysomonography (PSG) (apnea hypopnea index (AHI), oxygen saturation). All patient data, including clinical records, PSG studies (both pre- and post-treatment), and adverse events (AEs), were reviewed and analyzed. RESULTS: Results were obtained for 59 of 62 patients (95.16%). No significant difference in success rate was found between the MAD treatment and surgical treatment (95% CI). AHI, PSQI, ESS and oxygen saturation demonstrated significant improvement (p < 0.001) after MAD treatment, and 39 of 62 patients (62.9%) reported 85 AEs. 79 of the 85 AEs (91.8%) were mild cases, and there were no severe AEs related to the MAD treatment. CONCLUSION: The MAD 'Bioguard' should be considered as an alternative treatment option for OSA patients.

Oral-appliance combined with tadalafil for erectile dysfunction induced by severe obstructive sleep apneahypopnea syndrome / 中华男科学杂志

<p><b>Objective</b>To evaluate the effect of the oral-appliance combined with tadalafil in the treatment of erectile dysfunction (ED) induced by severe obstructive sleep apnea-hypopnea syndrome (OSAHS).</p><p><b>METHODS</b>We equally randomized 90 patients with severe OSAHS-induced ED to groups A, B, and C to be treated with the oral-appliance, tadalafil (10 mg daily qd), and oral-appliance plus tadalafil, respectively, all for 3 months. Then we compared the therapeutic effects among the three groups of patients using the IIEF-5 questionnaire, Sexual Encounter Profile (SEP) diaries, and the intercourse satisfaction rate of the patients' partners.</p><p><b>RESULTS</b>Totally 87 of the patients accomplished the treatment, 29 in group A, 30 in B, and 28 in C. After treatment, group C, as compared with A and B, showed significant increases in the IIEF-5 score (4.18±1.19 vs 2.66±1.63 and 2.77±1.74, P=0.009 and P=0.026), the success rate of penile intromission (SEP2) (85.7% vs 58.6% and 53.3%, P=0.023 and P=0.008), and the success rate of intercourse (SEP3) (64.3%% vs 37.9% and 33.3%, P=0.047 and P=0.018). The overall satisfaction of the female partners was remarkably higher in groups A and C than in B (P=0.027 and P=0.007).</p><p><b>CONCLUSIONS</b>Oral-appliance combined with tadalafil can improve erectile function in patients with severe OSAHS-induced ED, with a better efficacy than either of them used alone.</p>

The systematic review of the effect between adjustable and fixed oral appliance on ventilation of obstructive sleep apnea hypopnea syndrome / 中国实用护理杂志

Objective To evaluate the efficacy of adjustable oral appliance (OA) on ventilation of patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods Databases were searched from Junuary 1990 to July 2014 for randomized controlled trials on the use of adjustable OA for the promotion of ventilation in OSAHS.Meta analysis was performed with RevMan5.2 software,and descriptive analysis of the data that could not be converted and merged was performed.Results Totally 6 RCTs involved,including 1 109 patients,which involved 4 random parallel controlled trials and 2 random crossover controlled trials.Meta-analysis showed that adjustable OA were associated with a decreased apnea-hypopnea index(AHI) [fixed effect model,WMD=-2.38,95％CI (-3.59--1.17),P＜0.01] and an improvement in minimum arterial oxygen saturation (SaO2)[randomized effect model,WMD=3.09,95％CI(1.16-5.02),P＜0.01] of OSAHS patients.The descriptive analysis showed that the difference in the sleep score was not statistically significant because the data could not be converted.Conclusions Compared to fixed oral appliance,adjustable oral appliance produced greater effect in reduction of AHI and the improvement in minimum SaO2,but the sleep score is not improved significantly,the large sample and multi-center randomized controlled test needs to be designed for the verification of comprehensive effect of adjustable oral appliance.

The change of morphology and airflow dynamics in upper airway by the use of oral appliance in OSAHS patients / 实用口腔医学杂志

Objective:To analyse the change of morphology and internal air flow in upper airway by the use of oral appliance(OA)in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods:A 46-year-old male patient with OSAHS accepted CT scan before and three months after use of OA.Computational fluid dynamics(CFD)model was built on the base of CT scans by Mimics 10.01 and ANSYS ICEMCFD14.0.The internal flow of upper respiratory tract was simulated by ANSYS-FLUENT 14.0 and the re-sults was analyzed by ANSYS-CFD-Post14.0.Results:The most narrow area of upper airway was located in the lower bound of pha-ryngopalatiae,and it augmented from 0.119 4 cm2 to 0.409 9 cm2 after wearing OA;the maximum air velocity was decreased from 11 . 087 m/s to 8.204 m/s,the minimum negative pressure was decreased from -83 Pa to -59 Pa,the resistance of cavum pharyngis de-creased from 250 Pas/L to 145 Pas/L.Conclusion:Application of OA may expanse the upper respiratory tract,decrease the negative pressure and resistance of the upper respiratory tract in narrow area,reduce the collapsibility of the upper airway and maintain the pa-tency of the airflow.

Treatment of Obstructive Sleep Apnea with Oral Appliance / 이화의대지

Oral appliances have been considered as effective treatment modality for obstructive sleep apnea (OSA). Especially mandibular advanced device (MAD) showed more effective treatment results compared to other oral appliances. With the accurate diagnosis through polysomnography, clinical examination and radiographic examination, the appropriate application of oral appliances would show promising results for OSA and snoring. However oral appliances can raise the complications such as untoward movement of teeth and development of temporomandibular joint disorders, thus it is highly recommended that the treatment Should be undertaken by skilled dental specialists. Moreover, periodic check-up and adjustment of appliances, if needed, should be performed. Although the assertion that continuous positive airway pressure is superior to MAD physiologically, consensus is not available until now. For optimum treatment for OSA, further researches are necessary for investigation of long-term efficiency, performance, cardiovascular status and objective adaptation.

Assessment of Treatment Outcome after Using Temporary Mandibular Advancement Devices in Obstructive Sleep Apnea Patients

50% Apnea-Hypopnea Index (AHI) reduction plus post-MAD AHI <10, and the non-response group was defined as <50% AHI reduction. The lateral cephalogram was analysed including SNA, SNB, UL, MPH, PAS, PASU, and PAST using V-ceph(TM) (Cybermed, USA).RESULTS: The responsers were 23 patients, and non-responsers were 5 patients. The AHI was significantly reduced with temporary MAD (8.08+/-7.93) compared with baseline (28.51+/-20.56) in the response group (n=23). No significant difference was observed between pre MAD and post MAD except SNB on cephalometric analysis. Among 11 patients successfully treated with the temporary device, 9 patients said that using permanent device brings better effect too.CONCLUSION: These results indicate that the Temporary MAD could not be the only effective tools on OSA but also be used to predict patient's reactivity about permanent appliance treatment. Further studies are warranted to evaluate the relations between temporary MAD and permanent MAD.

Role of oral appliance in clinical management of obstructive sleep apnea in children.

Obstructive sleep apnea (OSA) as repetitive episodes of upper airway obstruction that occur during sleep, usually associated with a reduction in blood oxygen saturation. OSA syndrome is thought to affect 1 – 3% of children. OSA can be treated with continuous positive air pressure (CPAP), oral appliance (OAs) and surgical intervention depending on the condition. In this article role of oral appliance, types and guidelines of using OAs in clinical management of OSA in children will be discussed

Comparativo entre aparelho intraoral e CPAP no tratamento do ronco e apneia do sono: relato de um caso clínico / Comparative study between intra oral appliance and CPAP in snoring and sleep apnea treatment: case report

A síndrome da apneia obstrutiva do sono (SAOS) é um distúrbio respiratório do sono caracterizado por episódios recorrentes de obstrução da via aérea superior durante o sono, pelo colapso da Faringe. O ronco, sonolência excessiva diurna e a presença de pausas respiratórias durante o sono são os sinais e sintomas mais comumente relatados. A classificação da gravidade da SAOS depende do grau de sonolência diurna e do índice de apneia e hipoapneia (IAH). Aparelhos de pressão positiva (CPAP) e aparelhos intraorais (AIO) tem apresentado resultados satisfatórios no controle da SAOS. O Cpap é atualmente o tratamento de escolha para os pacientes com SAOS moderada e grave. Os AIO laboratoriais são os que apresentam os melhores resultados promovendo avanço mandibular afastando os tecidos da garganta, aumentando a tonicidade da musculatura e estabilizando a mandíbula, são indicados para tratamento de ronco primário e apneia leve ou moderada, podendo ser utilizados em pacientes com apneia grave que não se adaptem ao Cpap e não tenham indicação cirúrgica. O caso descrito neste artigo compara a eficácia do AIO com o Cpap em um paciente com SAOS moderada (IAH basal de 20,93), utilizando um avanço mandibular de 07mm. Através de uma polissonografia dividida em duas partes, na primeira metade da noite com o AIO e na segunda com o Cpap, foi possível comparar os resultados dos dois tipos de terapia para SAHOS, obtendo resultados semelhantes nos dois casos, com resolução completa do caso (IAH final < 5) tanto no AIO como no Cpap).

The obstructive sleep apnea syndrome (OSAS) is a sleep breathing disorder characterized by recurrent episodes of upper airway obstruction during sleep, caused for the the pharynx collapse. Snoring, excessive daytime sleepiness and the presence of pauses in breathing during sleep are the signs and symptoms most commonly reported. The severity of OSAS depends on the degree of daytime sleepiness and apnea-hipopneia index (IHA). Positive airway pressure devices (CPAP) and the intra-oral appliance(IOA) has shown satisfactory results controlling OSAS. The CPAP is currently the gold standard for patients with moderate and severe OSAS. The laboratory made IOA are those with the best results, promoting mandibular advancement, improving the collapse of the tissues of the throat, increasing muscle tone and stabilizing the mandible. It are indicated for the treatment of primary snoring and mild or moderate apnea and may be used in patients with severe apnea that are not comppliant with Cpap therapy and have not referred to surgery. The case described in this article compares the effectiveness of IOA and CPAP in a patient with moderate OSA (baseline IHA 20.93), using a mandibular advancement of 07mm. Through a split-night polysomnography where the first half with the AIO and the second with the CPAP, it was possible to compare the results of these two types of therapy for OSAS, obtaining similar results in both cases, with complete resolution of the case ( final IHA <5) in both treatments (IAO X CPAP).

Comparison of two kinds of oral appliance in the treatment of mild or moderate obstructive sleep apnea-hypopnea syndrome / 中国医师进修杂志

Objective To compare the mandibular advancement appliance(MAA) with mandibular advancement and left-leaning appliance (MALA) in the treatment of mild or moderate obstructive sleep ap-nea-hypopnea syndrome (OSAHS). Methods Twenty-two cases of mild or moderate OSAHS were treated with MAA, and 19 cases with MALA. After 1-3 months, they were examined again with Epworth score and polysonmography (PSG). Results After 1-3 months of the MAA or MALA treatment, the Epworth score was improved evidently. The apnea -hypopnea index, max apnea time, mean apnea time, oxygen desaturatian index, and the longest time of oxygen desaturation were all lowered after the treatment, and the lowest SaO2 and the mean SaO2 were higher after the treatment. The differences were all distinctive (P<0.05 or<0.01). When patients treated with MAA were compared with those treated with MALA,only the max apnea time [(35.5±6.9),(31.3±6.0) s, respectively] and the longest time of oxygen desaturation [ (41.0±18.9), (29.9±9.3) s, respectively] had significant difference. Conclusion MALA may be helpful for shortening max apnea time and the longest time of oxygen desaturation, thus MAA is an effective alternative to patients of OSAHS. Further research should be done.