Figure - available from: European Archives of Oto-Rhino-Laryngology
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Change of obstruction degree according to the upper airway site between before and after mandibular advancement device
Source publication
Purpose:
Oral appliance therapy is an alternative treatment modality for obstructive sleep apnea (OSA). However, there have been no studies to determine whether changes in the obstructive pattern occur following long-term use of oral devices. Therefore, we examined whether the obstructive pattern changes in patients with OSA who undergo long-term...
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Objective:
To describe a series of pediatric cases of obstructive sleep apnea (OSA) with paradoxical vocal cord movement noted on drug-induced sleep endoscopy (DISE).
Materials and methods:
Case series and chart review of children who had undergone DISE for OSA that showed PVCM.
Results:
Three cases where paradoxical vocal cord motion (PVCM) w...
Citations
... More than a third of patients have difficulty using continuous positive airway pressure (CPAP), the gold standard of treatment for OSA [2]. Alternative treatments include ENT, maxillofacial and bariatric surgery [3,4], stimulating device implantation [5,6] and oral appliance therapy [7,8]. The key aspect of alternative treatments is selecting the appropriate one to tackle the specific anatomical issues in a given patient [3,9]. ...
Multidisciplinary Sleep Clinics for sleep apnea have long existed, bringing together neurologists, sleep specialists, dentists, orthodontists and surgeons. In Belgium, a shift in funding for obstructive sleep apnea treatment was implemented from January 1st, 2017. Funding was allowed for moderate to severe obstructive sleep apnea and the rules shifted for treatments delivery and monitoring by authorised medical opinion. We aimed to assess whether a shift in treatment funding was associated with a change in the multidisciplinary sleep practice. Sample consisted of all patients discussed in the sleep multidisciplinary team meetings of the University Hospital of Liege from January 2016 to December 2018. Interrupted times series, Mann–Whitney U tests and descriptive statistics were produced. There were no differences in patients age, male sex preponderance, body mass index, clinical presentation and level of obstruction. Baseline obstructive sleep apnea severity was significantly lower (mean apnea–hypopnea index and mean oxygen desaturation index lowered with p = 0.0189 and p = 0.0466, respectively) after the funding rules changed. Oral appliance and ENT surgery were more often offered after the shift in funding. The key changes of the new funding rules for obstructive sleep apnea were reflected in the patient selection and management by sleep multidisciplinary team meeting. Funding terms could influence the care we give, not only in treatment options, but also in patients selection.
The sedation outcomes associated with dexmedetomidine compared with those of propofol during drug-induced sleep endoscopy (DISE) remains unclear. Electronic databases (i.e., the Cochrane controlled trials register, Embase, Medline, and Scopus) were searched from inception to 25 December 2020 for randomized controlled trials (RCTs) that evaluated the sedation outcomes with dexmedetomidine or propofol in adult patients diagnosed with obstructive sleep apnea (OSA) receiving DISE. The primary outcome was the difference in minimum oxygen saturation (mSaO2). Five RCTs (270 participants) published between 2015 and 2020 were included for analysis. Compared with dexmedetomidine, propofol was associated with lower levels of mSaO2 (mean difference (MD) = −7.24, 95% confidence interval (CI) −12.04 to −2.44; 230 participants) and satisfaction among endoscopic performers (standardized MD = −2.43, 95% CI −3.61 to −1.26; 128 participants) as well as a higher risk of hypoxemia (relative ratios = 1.82, 95% CI 1.2 to 2.76; 82 participants). However, propofol provided a shorter time to fall asleep and a lower risk of failed sedation compared with dexmedetomidine. No significant difference was found in other outcomes. Compared with propofol, dexmedetomidine exhibited fewer adverse effects on respiratory function and provided a higher level of satisfaction among endoscopic performers but was associated with an elevated risk of failed sedation.
Objective
Although oral appliance therapy is considered a validated treatment for obstructive sleep apnea, its therapeutic success varies significantly among patients. Drug-induced sleep endoscopy is often employed in order to identify candidates for upper airway surgery; however, it remains unknown whether its findings can be associated with success of oral appliance therapy. This study tested the hypothesis that drug-induced sleep endoscopy variables can predict the outcome of oral appliance therapy in obstructive sleep apnea patients.
Methods
Forty-nine obstructive sleep apnea patients [45 men; mean apnea-hypopnea index 25.3 ± 7.5 events/h; mean body mass index 28.2 ± 3.0 kg/m²] underwent drug-induced sleep endoscopy, followed by a one-month of oral appliance therapy, and subsequently a follow-up polysomnography to assess outcome.
Results
Thirty-three patients (67.3%) were responders and sixteen were non-responders (32.6%). Non-responders had a higher occurrence of complete or partial circumferential collapse at velum in comparison with responders. Multivariate logistic regression analysis revealed that, among baseline clinical and polysomnographic characteristics and sleep endoscopy findings, the presence of complete circumferential collapse at velum and increased body mass index were the only independent predictors of oral appliance therapy failure.
Conclusion
Drug-induced sleep endoscopy can be used to predict a higher likelihood of success to oral appliance therapy in obstructive sleep apnea patients.
Résumé
Introduction
Les orthèses d’avancée mandibulaires sont une option de traitement du syndrome d’apnées-hypopnées obstructives du sommeil. Il en existe de nombreux designs. Cependant, dans la littérature, elles sont regroupées en une unique entité sans considérer que l’efficacité, la tolérance, la compliance ou les effets secondaires sont inhérents au design de chacune d’elles. Une revue de la littérature est donc justifiée pour le lecteur qui s’interroge sur l’efficacité relative de chaque orthèse.
État des connaissances
Les auteurs ont donc réalisé une recherche bibliographique en utilisant les critères « oral appliance » et « obstructive sleep apnea » sur Pubmed, Embase et Cochrane. Elle a permis de recueillir ces paramètres par classe d’orthèse et de mettre en lumière les rares études comparant différentes orthèses.
Conclusions
Les orthèses ne sont pas une entité homogène. L’usage courant ne retient que les orthèses en propulsion (à biellettes et à vérins) et en rétention. Cependant, les rares études comparatives disponibles ne permettent pas de déterminer le ou les types les plus efficaces ou avec un rapport efficacité/tolérance optimal.
Perspectives
Il reste maintenant à poursuivre les comparaisons d’orthèses afin de déterminer le ou les types les plus efficaces ou avec un rapport efficacité/tolérance optimal.
