Browse > Article
http://dx.doi.org/10.14476/jomp.2013.38.2.203

Treatment Outcome of Mandibular Advancement Device in Obstructive Sleep Apnea Patients- Polysomnographic and Cephalometric analyses  

Chung, Jin-Woo (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University)
Kim, Ebee (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University)
Kim, Sung-Hun (Department of Oral Medicine and Oral Diagnosis School of Dentistry, Seoul National University)
Publication Information
Journal of Oral Medicine and Pain / v.38, no.2, 2013 , pp. 203-213 More about this Journal
Abstract
Objecives : The purpose of the study was to evaluate treatment outcome of mandibular advancement device(MAD) in obstructive sleep apnea (OSA) patients using full night polysomnography and cephalometry. Methods : Twenty-seven OSA patients were confirmed by full night, lab-attended polysomnography. Cephalometric examinations were conducted to obtain SNA, ANB, $AH{\bot}MP$, AH-C3, SPT, PNS-U, NAS, SOAS, MOAS, and HAS. Mandibular advancement devices (MADs) were fabricated and delivered for all subjects. After acclimation period of MAD, the second polysomnographic examinations were conducted in the same manner. Polysomnographic variables were compared between before and after MAD placement. Also, correlation coefficients were calculated between apnea-hypopnea index (AHI) and each item of cephalometric parameters. Results : There were significant improvements in total AHI, lowest $SpO_2$, and total arousal index after MAD therapy. Also, there were significant improvements in NREM $SpO_2$ and NREM AHI, but not in REM $SpO_2$ and REM AHI with MAD. Stratifying the sleep stage, there were significant decrease in stage I and significant increases in stage II and REM, but change in stage III was not significant. SNA and SOAS were significantly correlated with total AHI and NAS was significantly correlated with supine AHI. ANB was significantly associate with the effect of MAD. Conclusions : MAD is an effective treatment in OSA patients comparing polysomnographic variables before and after treatment. Cephalometric examination can be useful to evaluate OSA patients and predict treatment outcome of MAD.
Keywords
Sleep apnea; Polysomnography; Cephalometry; Sleep stage; Mandibular advancement device;
Citations & Related Records
연도 인용수 순위
  • Reference
1 Chae KY. Physiology of sleep. Korean J Pediatr 2007;50:711-7.   DOI   ScienceOn
2 Hoffstein V, Viner S, Mateika S, Conway J. Treatment of obstructive sleep apnea with nasal continuous positive airway pressure. Patient compliance, perception of benefits, and side effects. Am Rev Rspir Dis 1992;145:841-5.   DOI
3 Riolfe I, Olson LG, Saunders NA. Long-term acceptance of continuous positive airway pressure in obstructive sleep apnea. Am Rev Respir Dis 1991; 144:1130-3.   DOI   ScienceOn
4 Miljeteig H, Mateika S, Haight JS. Subjective and objective assessment of uvulopalatopharyngoplasty for treatment of snoring and obstructive sleep apnea. Am J Respir Crit Care Med 1994;150:1286-90.   DOI   ScienceOn
5 Wilhelmsson B, Tegelberg A, Walker-Engstrom ML, Ringqvist M, Andersson L, Krekmanov L, Ringqvist IA. A prospective randomized study of a dental appliance compared with uvulopalatopharyngoplasty in the treatment of obstructive sleep apnoea. Acta Otolaryngol 1999;119:503-9.   DOI   ScienceOn
6 Clark GT, Blumenfeld I, Yoffe N, Peled E, Lavie P. A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibulat positioning devices on patients with obstructive sleep apnea. Chest 1996;109:1477-83.   DOI   ScienceOn
7 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 apnea. Thorax 1997;52: 362-8.   DOI   ScienceOn
8 Aber WR, Block AJ, Hellard DW, Webb WB. Consistency of respiratory measurements from night to night during the sleep of elderly men. Chest 1989;96:747-51.   DOI   ScienceOn
9 Chediak AD, Acevedo-Crespo JC, Seiden DJ, Kim HH, Kiel MH. Night variability in the indices of sleep-disordered breathing in men being evaluated for impotence with consecutive night polysomnograms. Sleep 1996;19:589-92.
10 Keenan SP, Anderson B, Wiggs B, Ryan CF, Fleetham JA. The predictive accuracy of home oximetry in patients with suspective obstructive sleep apnea. Sleep 1993;16:133-4.
11 Manser RL, Rochford P, Naughton MT, et al. Measurement variability in sleep disorders medicine: the Victorian experience. Intern Med J 2002;32: 386-93.   DOI   ScienceOn
12 Littner M. Polysomnography in the diagnosis of the obstructive sleep apnea-hypopnea syndrome: where do we draw the line? Chest 2000;118:286-8.   DOI   ScienceOn
13 Meyer TJ, Eveloff SE, Kline LR, Millman RP. One negative polysomnogram does not exclude obstructive sleep apnea. Chest 1993;103:756-60.   DOI   ScienceOn
14 Kushida CA, Littner MR, Morgenthaler T, et al. Practice parameters for the indications for polysomnography and related procedures: An update for 2005. Sleep 2005;28:499-519.
15 Sforza E, Bacon W, Weiss T, et al. Upper airway collapsibility and cephalometric variables in patients with obstructive sleep apnea. Am J Respir Crit Care Med 2000; 161: 347-52.   DOI   ScienceOn
16 Choi JK, Choi JM, Ahn HJ. Cephalometric characteristics and their relationship to Respiratory Disturbance Indices in snorer and patients with Obstructive Sleep Apnea. Korean J Oral Med 2001; 26: 369-76.
17 Chang ET, Shiao GM. Craniofacial abnormalities in Chinese patients with obstructive and positional sleep apnea. Sleep Med 2008;9:403-10.   DOI   ScienceOn
18 Liu Y, Lowe AA, Fleetham JA, Park Y-C. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 2001;120:639-47.   DOI   ScienceOn
19 Clark GT, Arand D, Chung E, Tong D. Effect of anterior mandibular positioning on obstructive sleep apnea. Am Rev Respir Dis 1993;147:624-9.   DOI   ScienceOn
20 Schmidt-Nowara W, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995;18:501-10.
21 Marklund M, Franklin kA, Sahlin C, Lundgren R. The effect of a mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea. Chest 1998;113:707-13.   DOI   ScienceOn
22 Mehta A, Qian J, Petocz P, Daredeliler MA, Cistulli PA. A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 2001;163:1457-61.   DOI   ScienceOn
23 Tsuiki S, Lowe AA, Almeida FR, Kawahata N, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir J 2004;23:263-8.   DOI
24 Chung JW, Enciso R, Levendowski DJ, Morgan TD, Westbrook PR, Clark GT. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;109:724-31.   DOI   ScienceOn
25 Yoshida K. Influence of sleep posture on response to oral appliance therapy for sleep apnea syndrome. 2001 Aug1;24(5):538-544.
26 Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathingclinical and polysomnographic features. Chest 2005;128:3350-7.   DOI   ScienceOn
27 Umemoto G, Yoshimura C, Aoyagi N, Toyoshima H, Matsumoto T, Watanabe K, Maki H, Kikuta T. Treatment outcome of the two-part semi-rigid oral appliance in obstructive sleep apnea. Oral Science Int 2012;9:49-54.   DOI   ScienceOn