• Journal of Oral Medicine and Pain
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• 제23권4호
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• pp.419-432
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• 1998

The purpose of this Study was to examine the efficacy and compliance of a mandibular advancement device(MAD) according to the severity of sleep apnea in the snorers and obstructive sleep apnea patients. Fifty-four patients (45 males, 9 females, aged 20 - 68years ) who visited Seoul National Uiversity Dental Hospital(SNUDH) to seek for the treatment of snoring and sleep apnea were classified into four groups according to the results of the nocturnal polysomnography and they were instructed to wear MAD regularly which was designed to increase the size of the upper airway by advancing the mandible. The evaluation of the efficacy and compliance of the MAD according to the severity of apnea and the duration after the usage of MAD ( 1week, 1month, 3months, 6months, 12months) was made by using quesionnaires mad in Department of Oral Medicine and Oral diagnosis, SNUDH. The obtained results were as follows : 1. All subjects results were habitual snoreres and 43 patients(79.6%) complained the loudness of snoring that can be heard out of the room. 2. Apnea index(AI) of the total subjects was mean 29.4$\pm$26.9 and respiratory disturbance index(RDI)was mean 37.6$\pm$28.0. And there was nodifference in the efficacy and the compliances of MAD according to the severity of apnea. 3. The severityi of apnea by the questionnaires significantly corresponded with the results of nocturnal polysomnography, and this fact potentiated the diagnostic value of the questionnaire. 4. after the usage of MAD, there was significant improvement in the frequency of snoring, the loudness of snoring, frequency of apnea, daytime sleepiness nad the refreshment after sleep(p<0.001) regardless of the apnea index(AI) and respiratory distrubance index(RDI). 5. The degree of the satisfaction with MAD was mean 74.4$\pm$18.4% and that of the discomfort with the MAD was 31.4$\pm$19.6%. But there was no serious complication in occlusion and temporomandibular joint with the usage of MAD and the duration of the discomfort was mean 3.3$\pm$2.2 weeks. 6. Forty-one patients(75.9%) continued the usage of MAD but thirteen patients(24.1%) stopped the use of MAD because of the discomforts and insufficient results with it.

• 디지털융복합연구
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• 제15권10호
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• pp.307-314
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• 2017

본 연구에서는 하악전방이동 코골이 장치의 종류에 따라 최소한의 수직 교합량을 각각 다르게 확보하여 1급 교합을 가진 대상이 각 장치를 착용한 뒤, 수직 교합량이 하악의 위치, 근육의 변화, 혀의 위치등을 부가적으로 변화시켜 상기도의 면적에 영향을 주는 지 알아보고자 하였다. 수직량이 높을수록 상기도의 면적은 감소했으며, 혀의 위치를 후방으로 처지지 않게 할수록 상기도의 면적이 증가함을 알 수 있다. 코골이 감소를 위해 의사들은 환자들의 교합관계를 정확하게 진단하여 그 교합에 맞는 하악전방이동 코골이 장치를 선택해야 하고, 선택된 장치를 제작하는 치과 기공사 또한 장치의 효과를 높이기 위해 수직 교합량, 후방연 설정과 장치의 두께 등 디자인 설정을 고려해야 한다.

• Journal of Oral Medicine and Pain
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• 제33권4호
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• pp.305-316
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• 2008

본 연구의 목적은 하악전방이동장치요법으로 코골이와 수면무호흡증에 대한 치료를 시작한 후 1년이 경과한 한국인 환자들을 대상으로 하악전방이동장치의 지속적 사용 여부, 사용 빈도, 사용 중단 시까지의 사용 기간, 부작용 발생 여부, 그리고 장치사용의 중단 원인 등을 조사하여 하악전방이동장치의 장기적 사용에 영향을 주는 요인을 분석하는 것이다. 경북대학교병원 구강내과에서 코골이와 수면무호흡증을 주소로 내원한 환자들 중에 수면다원검사를 받고 하악전방이동장치요법을 시술받은 후 1년 이상 경과한 환자 103명 중에 전화를 통한 설문조사가 가능했던 49명의 환자를 대상으로 의무기록 조사 및 설문조사를 실하였다. 이들 중 현재까지 장치를 사용하고 있는 환자는 25명이었으며 사용을 중단한 환자는 24명이었다. 이들을 각각 계속사용군과 사용중단군으로 분류하여 두 군 사이에 초진 시의 연령, 성별분포, 체질량지수, 호흡장애지수, 구강장치요법을 시행하기 전의 코골이 빈도와 강도, 구강장치요법 시행 후의 코골이 감소 정도, 본인과 동침자의 구강장치요법에 대한 만족정도 등을 비교하였으며, 사용중단군에 대해서는 중단 사유를 물어봄으로서 다음과 같은 결론을 얻었다. 1. 계속사용군과 사용중단군 사이에 치료 시작 시점의 연령, 성별분포, 체질량지수, 호흡장애지수의 유의한 차이는 없었다. 2. 계속사용군과 사용중단군 사이에 치료 시작 전 코골이 빈도와 강도에서 유의한 차이가 없었다. 3. 계속사용군이 사용중단군에 비해 코골이의 개선정도가 높았다. 4. 계속사용군이 사용중단군에 비해 구강장치요법에 대한 만족도가 높았다. 5. 계속사용군이 사용중단군에 비해 동침자의 구강장치요법에 대한 만족도가 높은 경향을 보였다. 6. 구강장치 사용을 중단하게 된 사유 중에는 턱의 통증(25%), 치아 통증(20%), 장치 파손(20%) 등이 많았으나, 효과가 없어서 사용을 중단한 경우는 4.2%에 불과하였다. 7. 전체 조사대상자의 1년 사용자비율(1년 순응도)은 79.59%로 나타났다.

• 대한임상검사과학회지
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• 제43권2호
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• pp.82-88
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• 2011

Mandibular advancement devices (MAD) are therapeutic options for obstructive sleep apnea (OSA). The aim of study was to investigate treatment outcomes of before and after insertion of MAD in OSA patients. We retrospectively selected a total of 13 patients who were diagnosed with OSA syndrome. All sleep-related parameters including apnea-hypopnea index (AHI), oxygen desaturation index (ODI), wake after sleep onset (WASO), total arousal were measured by before and after MAD. The use of MAD proves to be efficient in reducing snoring, apnea-hypopne index ($17.2{\pm}14.6$ vs $20.9{\pm}14.6$), WASO ($27.4{\pm}28.8$ vs $47.9{\pm}43.6$), oxygen desaturation index ($9.0{\pm}11.6$ vs $16.4{\pm}11.7$), stage N3 ($54.8{\pm}45.2$ vs $36.6{\pm}22.0$), REM sleep times ($73.3{\pm}19.4$ vs $66.0{\pm}31.0$) and increases sleep efficiency ($92.6{\pm}6.6$ vs $87.2{\pm}11.2$). The decreases in apnea index based on a reduction in the overall and supine AHI values after MAD therapy were significantly greater for the positional OSA than nonpositional OSA patients. The use of MAD proves to be efficient in snoring, WASO, sleep efficiency, reduced AHI and associated with good compliance of patients.

• Journal of Oral Medicine and Pain
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• 제41권1호
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• pp.7-15
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• 2016

Purpose: Mandibular advancement device (MAD) is widely recognized as an important treatment option for obstructive sleep apnea (OSA) and is readily accepted than any other treatment options owing to its simplicity and ambulatory nature. At this time, there are a multitude of MAD designs and their efficacies may be influenced by adjustment and retention mechanism. The MAD with the anterior connector (anteriorly adjustable mandibular advancement device, AAMAD) was newly developed in the Department of Oral Medicine, Dankook University Dental Hospital (Cheonan, Korea) and was prescribed for the OSA patients including snoring patients. Thus, this study was aimed to objectively investigate the effectiveness of the AAMAD on the OSA patients using the self-applied portable device (ApneaLink), and evaluate the treatment outcomes among patients with various severity of OSA level. Methods: Results of the treatment of fourteen patients (13 male, 1 female) with the AAMAD were retrospectively analyzed. Each patient underwent home sleep test before treatment and were divided into two groups, i.e., those with mild (apnea-hypopnea index [AHI] ${\geq}5$ and <15) to moderate OSA (AHI ${\geq}15$ and <30) and severe OSA (AHI ${\geq}30$). After treatment, home sleep test was conducted again and treatment outcomes were compared between mild to moderate and severe OSA patients. Results: Of all patients, 78.6% showed more than 50% AHI reduction. We found a significant reduction (85.3%) of AHI in the severe OSA patients. Patients with mild to moderate OSA showed the reduced AHI (56.1%). Conclusions: We concluded that AAMAD is an effective oral appliance for the majority of OSA patients.

• 대한치과의사협회지
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• 제57권5호
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• pp.279-287
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• 2019

Obstructive sleep apnea syndrome (OSAS) is characterized by obstructive events of the upper airway (UAW) during sleep, which can be associated with clinical signs and symptoms such as snoring, excessive daytime sleepiness, impaired memory, and fatigue. It is associated with many problems like psychosocial problems, physiologic alterations in the cardiovascular and respiratory systems as a result of hypoxia and repeated awakenings during sleep. Conservative treatments such as weight loss, sleep positioning, improvement of sleep hygiene, CPAP and MAD can be performed for the obstructive sleep apnea. However, their effect for the OSA is limited and differs by patient's individual properties. Accordingly, surgical reconstructions of the upper airway must be carried out for the treatment of OSA.