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1.
J Oral Rehabil ; 47(9): 1178-1183, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32632924

ABSTRACT

BACKGROUND: The efficacy of oral appliance (OA) varies greatly in patients with obstructive sleep apnoea (OSA). OBJECTIVE(S): The purpose of this cross-sectional study was to investigate the success rate of OA for OSA patients. METHODS: This study was based on a cross-sectional multicentre survey of OA therapy for the management of OSA called the JAMS (Japanese Cross-sectional Multicenter Survey) Study performed at 10 medical institutions. A total of 442 patients fulfilled the selection criteria, which patients had worn OA, and undergone overnight polysomnography to assess both the pre-treatment baseline and follow-up for OA. Age, sex, BMI and apnoea-hypopnea index (AHI) at the time of diagnosis and follow-up for OA were extracted. RESULTS: After OA treatment, the mean AHI decreased from 22.6 ± 13.8 to 10.0 ± 10.2/h, and the mean rate of decrease in the AHI was 52.5 ± 38.4%. Regarding the success rate to OA therapy, criterion 1 (AHI < 5/h), criterion 2 (AHI < 10/h), criterion 3 (AHI < 15/h) and criterion 4 (AHI reduction rate ≥ 50%) accounted for 33.5, 66.3, 80.5 and 63.3%, respectively. The success rate of OA treatment decreased according to the increase in OSA severity, obesity level (higher BMI) and older age. CONCLUSIONS: This study revealed the treatment success rate of OA on multiple criteria according to OSA severity, BMI and age. It may support for the clinician to make a decision on the OSA management.


Subject(s)
Sleep Apnea, Obstructive , Aged , Body Mass Index , Cross-Sectional Studies , Humans , Polysomnography , Treatment Outcome
2.
Article in English | MEDLINE | ID: mdl-31500221

ABSTRACT

We conducted a multicenter survey for oral appliance (OA) therapy to grasp and analyze the current situation of OA therapy, including efficacy, side effects, and follow-up, in Japan. The Japanese cross-sectional multicenter survey (JAMS) for obstructive sleep apnea (OSA) was undertaken by patients in 10 institutions associated with oral appliance therapy during two years, from 2014 to 2015, retrospectively. Age, sex, body mass index (BMI), baseline apnea-hypopnea index (AHI), OA type, adjustment, adverse reactions with OA, and AHI with OA were elicited from the patient clinical record. The number of included OSA patients was 3217. The number of patients with OA therapy was 2947. We evaluated 1600 patients for the OA treatment. The patients treated with OA, both male and female, were most commonly in their 50s. In terms of OSA severity, snoring was 2.3%, mild was 38.5%, moderate was 39.9%, and severe was 19.3%. The use of mono bloc appliance was 91.8%, bi bloc appliance was 7.9%, and tongue-retaining device (TRD) was 0.3%. After OA treatment, AHI decreased from 22.4/h to 9.3/h. The AHI reduction rate with OA was 52.0%. The rate of AHI <5 with OA was 35.6%. Adverse reactions developed in 14.7% of the subjects. OA reassessment was conducted for 54.3%. This study revealed the current situation of efficacy and side effects of OA therapy, and the problem that the reassessment rate of OA was low in Japan.


Subject(s)
Orthodontic Appliances, Removable , Sleep Apnea, Obstructive/therapy , Snoring/prevention & control , Tongue/physiopathology , Body Mass Index , Cross-Sectional Studies , Female , Humans , Japan , Male , Middle Aged , Retrospective Studies , Surveys and Questionnaires , Treatment Outcome , Young Adult
3.
Bull Tokyo Dent Coll ; 52(3): 135-42, 2011.
Article in English | MEDLINE | ID: mdl-21986395

ABSTRACT

The patient was a 51-year-old man who had been prescribed carbamazepine for right third-branch trigeminal neuralgia. He had stopped taking the medication after the neuralgia resolved. When the neuralgia recurred, he resumed medication, and about 1 month later he developed fever, fatigue, cervical lymphadenopathy, generalized skin flushing, facial edema and perioral vesicles, and was admitted to Ichikawa General Hospital, Tokyo Dental College. Oral findings showed reddening and erosion of the buccal mucosa. Routine laboratory examination revealed leukocytosis and hepatic dysfunction. Human herpesvirus 6 antibody titer remarkably increased during development of eruptions. These findings led to a diagnosis of drug-induced hypersensitivity syndrome. Carbamazepine was discontinued, and prednisolone (30 mg/day) was started and tapered based on improvement of symptoms. Because skin symptoms recurred after he was discharged 15 days after admission, the dose of prednisolone was increased and the symptoms finally disappeared. The patient has experienced no further recurrence.


Subject(s)
Analgesics, Non-Narcotic/adverse effects , Carbamazepine/adverse effects , Drug Hypersensitivity/etiology , Chemical and Drug Induced Liver Injury/etiology , Drug Eruptions/etiology , Facial Dermatoses/chemically induced , Herpesvirus 6, Human/drug effects , Humans , Leukocytosis/chemically induced , Male , Middle Aged , Mouth Diseases/chemically induced , Roseolovirus Infections/diagnosis , Syndrome , Trigeminal Neuralgia/drug therapy , Virus Activation/drug effects
4.
J Oral Maxillofac Surg ; 69(3): 877-84, 2011 Mar.
Article in English | MEDLINE | ID: mdl-21211878

ABSTRACT

PURPOSE: The objectives of the present study were to assess the changes in upper airway morphology and function in response to advancement of the maxilla and mandible. PATIENTS AND METHODS: Orthognathic surgery was performed. During the surgery, the maxilla and mandible were each advanced as a maxillomandibular advancement simulation. A total of 18 patients with a chief complaint of malocclusion were studied. The distance in jaw advancement and the anteroposterior and left-right diameters of the velopharyngeal space before and after jaw advancement were measured. After the anteroposterior and left-right dilation rates and area enlargement rates were calculated, we compared advancement of the maxilla with that of the mandible. RESULTS: Each of the jaw advancements resulted in statistically significant increases in the anteroposterior and left-right diameters of the velopharyngeal space, and the area was significantly enlarged. The anteroposterior dilation rate was significantly greater after advancement of the maxilla, and the left-right dilation rate was significantly greater after advancement of the mandible. The velopharyngeal space area enlargement rate was significantly greater with advancement of the maxilla. CONCLUSIONS: These data suggest that the mode of dilation of the velopharyngeal space differs between maxillary advancement and mandibular advancement. Jaw advancement affects the soft palate muscles, and the velopharyngeal space is expanded 3-dimensionally by each of those muscles. The difference in the pattern of expansion of the velopharyngeal space was related to differences in the functions of the soft palate muscles.


Subject(s)
Malocclusion/surgery , Mandibular Advancement , Osteotomy, Le Fort , Palate, Soft/anatomy & histology , Pharynx/anatomy & histology , Adolescent , Adult , Cephalometry , Endoscopy , Female , Humans , Male , Palatal Muscles/physiology , Young Adult
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