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Treatment Outcomes of Mandibular Advancement Devices between Rapid-Eye-Movement (REM)-Related and Not-REM-Related OSA Patients

  • Oh, Jae-Tak ;
  • Jang, Ji-Hee ;
  • Chung, Jin-Woo
  • Received : 2016.04.22
  • Accepted : 2016.04.27
  • Published : 2016.06.30

Abstract

Purpose: Mandibular advancement devices (MAD) are used effectively and widely for the treatment of obstructive sleep apnea (OSA) and rapid-eye-movement (REM) dependency of the patients can affect the treatment outcome of OSA. The aim of this study was to compare treatment outcomes of MAD between REM-related and not-REM-related OSA patients. Methods: Fifty-six consecutive patients with OSA who received MAD therapy were evaluated using full night polysomnography before and after insertion of the MADs. The patients were divided into REM-related (REM apnea-hypopnea index [AHI] at least two times higher than their non-REM AHI) and not-REM-related (REM AHI less than two times higher than their non-REM AHI) OSA groups. Results: MAD is used for the treatment of OSA effectively. In respect of AHI, MAD therapy were effective both in REM-related OSA and not-REM-related OSA, but MAD therapy was more effective in not-REM-related OSA than REM-related OSA in overall sleep and non-REM sleep. $SpO_2$ saturations were improved after MAD therapy, but were not different between two groups. Epworth sleepiness scale scores were not improved after MAD therapy. Percentage of REM sleep was increased after MAD therapy but was not different between two groups. Conclusions: MAD therapy was more effective in not-REM-related OSA than REM-related OSA and REM dependency can be a predictive factor of treatment outcome of oral appliance for OSA patients.

Keywords

Oral appliance;Polysomnography;Sleep apnea;Sleep, REM;Treatment outcome

References

  1. Arias MA, Sanchez AM. Obstructive sleep apnea and its relationship to cardiac arrhythmias. J Cardiovasc Electrophysiol 2007;18:1006-1014. https://doi.org/10.1111/j.1540-8167.2007.00891.x
  2. Fenik VB, Davies RO, Kubin L. REM sleep-like atonia of hypoglossal (XII) motoneurons is caused by loss of noradrenergic and serotonergic inputs. Am J Respir Crit Care Med 2005;172:1322-1330. https://doi.org/10.1164/rccm.200412-1750OC
  3. Gastaut H, Tassinari CA, Duron B. Polygraphic study of the episodic diurnal and nocturnal (hypnic and respiratory) manifestations of the Pickwick syndrome. Brain Res 1966;1:167-186. https://doi.org/10.1016/0006-8993(66)90117-X
  4. Conwell W, Patel B, Doeing D, et al. Prevalence, clinical features, and CPAP adherence in REM-related sleep-disordered breathing: a cross-sectional analysis of a large clinical population. Sleep Breath 2012;16:519-526. https://doi.org/10.1007/s11325-011-0537-6
  5. Findley LJ, Wilhoit SC, Suratt PM. Apnea duration and hypoxemia during REM sleep in patients with obstructive sleep apnea. Chest 1985;87:432-436. https://doi.org/10.1378/chest.87.4.432
  6. Quera-Salva MA, Guilleminault C, Partinen M, Jamieson A. Determinants of respiratory disturbance and oxygen saturation drop indices in obstructive sleep apnoea syndrome. Eur Respir J 1988;1:626-631.
  7. Haba-Rubio J, Janssens JP, Rochat T, Sforza E. Rapid eye movement-related disordered breathing: clinical and polysomnographic features. Chest 2005;128:3350-3357. https://doi.org/10.1378/chest.128.5.3350
  8. George CF, Millar TW, Kryger MH. Sleep apnea and body position during sleep. Sleep 1988;11:90-99. https://doi.org/10.1093/sleep/11.1.90
  9. Koo BB, Dostal J, Ioachimescu O, Budur K. The effects of gender and age on REM-related sleep-disordered breathing. Sleep Breath 2008;12:259-264. https://doi.org/10.1007/s11325-007-0161-7
  10. Resta O, Carpanano GE, Lacedonia D, et al. Gender difference in sleep profile of severely obese patients with obstructive sleep apnea (OSA). Respir Med 2005;99:91-96. https://doi.org/10.1016/j.rmed.2004.05.014
  11. Ng AT, Gotsopoulos H, Qian J, Cistulli PA. Effect of oral appliance therapy on upper airway collapsibility in obstructive sleep apnea. Am J Respir Crit Care Med 2003;168:238-241. https://doi.org/10.1164/rccm.200211-1275OC
  12. Gagnadoux F, Fleury B, Vielle B, et al. Titrated mandibular advancement versus positive airway pressure for sleep apnoea. Eur Respir J 2009;34:914-920. https://doi.org/10.1183/09031936.00148208
  13. Marklund M, Verbraecken J, Randerath W. Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy. Eur Respir J 2012;39:1241-1247. https://doi.org/10.1183/09031936.00144711
  14. Punjabi NM, Bandeen-Roche K, Marx JJ, Neubauer DN, Smith PL, Schwartz AR. The association between daytime sleepiness and sleep-disordered breathing in NREM and REM sleep. Sleep 2002;25:307-314.
  15. Campos-Rodriguez F, Fernandez-Palacin A, Reyes-Nunez N, Reina-Gonzalez A. Clinical and polysomnographic features of rapid-eye-movement-specific sleep-disordered breathing. Arch Bronconeumol 2009;45:330-334.
  16. Kutbay Ozcelik H, Akkoyunlu ME, Bostanli P, et al. The frequency and properties of REM related obstructive sleep apnea among the patients with mild related obstructive sleep apnea. Tuberk Toraks 2013;61:283-287. https://doi.org/10.5578/tt.6208
  17. Liu Y, Su C, Liu R, et al. NREM-AHI greater than REM-AHI versus REM-AHI greater than NREM-AHI in patients with obstructive sleep apnea: clinical and polysomnographic features. Sleep Breath 2011;15:463-470. https://doi.org/10.1007/s11325-010-0358-z
  18. Muraki M, Kitaguchi S, Ichihashi H, et al. Apnoea-hypopnoea index during rapid eye movement and non-rapid eye movement sleep in obstructive sleep apnoea. J Int Med Res 2008;36:906-913. https://doi.org/10.1177/147323000803600506
  19. Pevernagie DA, Stanson AW, Sheedy PF 2nd, Daniels BK, Shepard JW Jr. Effects of body position on the upper airway of patients with obstructive sleep apnea. Am J Respir Crit Care Med 1995;152:179-185. https://doi.org/10.1164/ajrccm.152.1.7599821
  20. Oksenberg A, Khamaysi I, Silverberg DS, Tarasiuk A. Association of body position with severity of apneic events in patients with severe nonpositional obstructive sleep apnea. Chest 2000;118:1018-1024. https://doi.org/10.1378/chest.118.4.1018
  21. Series F, Cormier Y, La Forge J. Influence of apnea type and sleep stage on nocturnal postapneic desaturation. Am Rev Respir Dis 1990;141:1522-1526. https://doi.org/10.1164/ajrccm/141.6.1522
  22. George E, Katerina V, Maria S, Lambros B, Konstantina N, Dimitrios G. Clinical features and polysomnographic findings in greek male patients with obstructive sleep apnea syndrome: differences regarding the age. Sleep Disord 2012. doi: 10.1155/2012/324635. https://doi.org/10.1155/2012/324635
  23. Peppard PE, Ward NR, Morrell MJ. The impact of obesity on oxygen desaturation during sleep-disordered breathing. Am J Respir Crit Care Med 2009;180:788-793. https://doi.org/10.1164/rccm.200905-0773OC
  24. Catcheside PG, Jordan AS. Reflex tachycardia with airway opening in obstructive sleep apnea. Sleep 2013;36:819-821. https://doi.org/10.5665/sleep.2698

Cited by

  1. Rapid Eye Movement-Related Obstructive Sleep Apnea: A Study on the Pathogenesis through Clinical and Polysomnographic Features vol.41, pp.4, 2016, https://doi.org/10.14476/jomp.2016.41.4.180