Maxillofacial Plastic and Reconstructive Surgery

Korean Association of Maxillofacial Plastic and Reconstructive Surgeons (대한악안면성형재건외과학회)
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Assessment of Treatment Outcome after Using Temporary Mandibular Advancement Devices in Obstructive Sleep Apnea Patients

폐쇄성 수면 무호흡 환자에서 임시 하악 전방 이동 장치를 이용한 치료결과 분석

  • Park, Joon-Hyung (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Suseok (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Hong, Jongrak (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Chang-Soo (Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Paeng, Jun-Young (Department of Oral and Maxillofacial Surgery, Kangbuk Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 박준형 (성균관대학교 의과대학 삼성서울병원 구강악안면외과) ;
  • 오수석 (성균관대학교 의과대학 삼성서울병원 구강악안면외과) ;
  • 홍종락 (성균관대학교 의과대학 삼성서울병원 구강악안면외과) ;
  • 김창수 (성균관대학교 의과대학 삼성서울병원 구강악안면외과) ;
  • 팽준영 (성균관대학교 의과대학 강북삼성병원 구강악안면외과)
  • Received : 2012.08.27
  • Accepted : 2012.11.27
  • Published : 2012.11.30
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Abstract

Purpose: The aim of this study was to evaluate the effect of temporary mandibular advancement devices (MAD) in obstructive sleep apnea (OSA) patients Methods: 28 patients (male 21, female 7) undergoing temporary mandibular advancement device treatment for OSA were selected from 2011.01. to 2012.02. in the department of Oral & Maxillofacial Surgery at SamsungMedicalCenter. Treatment efficacy was determined by polysomnography (PSG) at baseline & after MAD delivery. The response group was defined as >50% Apnea-Hypopnea Index (AHI) reduction plus post-MAD AHI <10, and the non-response group was defined as <50% AHI reduction. The lateral cephalogram was analysed including SNA, SNB, UL, MPH, PAS, PASU, and PAST using V-ceph$^{TM}$ (Cybermed, USA). Results: The responsers were 23 patients, and non-responsers were 5 patients. The AHI was significantly reduced with temporary MAD ($8.08{\pm}7.93$) compared with baseline ($28.51{\pm}20.56$) in the response group (n=23). No significant difference was observed between pre MAD and post MAD except SNB on cephalometric analysis. Among 11 patients successfully treated with the temporary device, 9 patients said that using permanent device brings better effect too. Conclusion: These results indicate that the Temporary MAD could not be the only effective tools on OSA but also be used to predict patient's reactivity about permanent appliance treatment. Further studies are warranted to evaluate the relations between temporary MAD and permanent MAD.

Keywords

References

  1. Ferguson KA, Ono T, Lowe AA, Keenan SP, Fleetham JA. A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea. Chest 1996;109:1269-75. https://doi.org/10.1378/chest.109.5.1269
  2. Aarab G, Lobbezoo F, Hamburger HL, Naeije M. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: a randomized, placebo-controlled trial. Respiration 2011;81:411-9. https://doi.org/10.1159/000319595
  3. Liu Y, Lowe AA, Fleetham JA, Park YC. 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. https://doi.org/10.1067/mod.2001.118782
  4. Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 2004;125:1270-8. https://doi.org/10.1378/chest.125.4.1270
  5. Bloch KE, Iseli A, Zhang JN, et al. A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment. Am J Respir Crit Care Med 2000;162:246-51. https://doi.org/10.1164/ajrccm.162.1.9908112
  6. Ghazal A, Sorichter S, Jonas I, Rose EC. A randomized prospective long-term study of two oral appliances for sleep apnoea treatment. J Sleep Res 2009;18:321-8. https://doi.org/10.1111/j.1365-2869.2009.00738.x
  7. Kuna ST, Giarraputo PC, Stanton DC, Levin LM, Frantz D. Evaluation of an oral mandibular advancement titration appliance. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2006;101:593-603. https://doi.org/10.1016/j.tripleo.2005.08.033
  8. Lettieri CJ, Paolino N, Eliasson AH, Shah AA, Holley AB. Comparison of adjustable and fixed oral appliances for the treatment of obstructive sleep apnea. J Clin Sleep Med 2011;7:439-45.
  9. Vroegop AV, Vanderveken OM, Van de Heyning PH, Braem MJ. Effects of vertical opening on pharyngeal dimensions in patients with obstructive sleep apnoea. Sleep Med 2012;13:314-6.
  10. Nikolopoulou M, Naeije M, Aarab G, Hamburger HL, Visscher CM, Lobbezoo F. The effect of raising the bite without mandibular protrusion on obstructive sleep apnoea. J Oral Rehabil 2011;38:643-7. https://doi.org/10.1111/j.1365-2842.2011.02221.x
  11. Pitsis AJ, Darendeliler MA, Gotsopoulos H, Petocz P, Cistulli PA. Effect of vertical dimension on efficacy of oral appliance therapy in obstructive sleep apnea. Am J Respir Crit Care Med 2002;166:860-4. https://doi.org/10.1164/rccm.200204-342OC
  12. Chan AS, Lee RW, Srinivasan VK, Darendeliler MA, Grunstein RR, Cistulli PA. Nasopharyngoscopic evaluation of oral appliance therapy for obstructive sleep apnoea. Eur Respir J 2010;35:836-42. https://doi.org/10.1183/09031936.00077409
  13. Tsuiki S, Kobayashi M, Namba K, et al. Optimal positive airway pressure predicts oral appliance response to sleep apnoea. Eur Respir J 2010;35:1098-105. https://doi.org/10.1183/09031936.00121608
  14. Bosshard V, Masse JF, Series F. Prediction of oral appliance efficiency in patients with apnoea using phrenic nerve stimulation while awake. Thorax 2011;66:220-5. https://doi.org/10.1136/thx.2010.150334