Clinical Efficacy of a Position-Responding Mandibular Advancement Device in Patients With Obstructive Sleep Apnea
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Objectives. Although mandibular advancement device (MAD) treatment is effective for obstructive sleep apnea (OSA), some concerns remain regarding its potential therapeutic impact and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. We conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Methods. Fourteen patients diagnosed with OSA participated in this study. Polysomnography (PSG) was performed at the beginning of the clinical trial, and after 3 months of treatment, PSG with AMAD in situ was conducted. Results. The mean scores for the Epworth Sleepiness Scale (ESS) and STOP-Bang were 8.21±4.21 and 5.00±1.00, respectively. After 3 months of AMAD treatment, the STOP-Bang scores improved to 3.75±1.06; however, the ESS scores did not show a significant change. Additionally, we observed statistically significant improvements in several respiratory parameters in the PSG data following AMAD treatment. These included reductions in the apnea-hypopnea index (AHI) (from 32.85±21.71 to 12.93±10.70), supine AHI (from 45.91±23.58 to 15.59±12.76), and lateral AHI (from 13.94±10.95 to 5.49±7.40). Improvements were also noted in the lowest O2 saturation (from 79.71±6.22 to 84.00±5.71), total arousal number (from 191.14±112.07 to 86.57±48.80), and arousal index (from 33.76±21.00 to 15.05±8.42). However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, no major side effects were observed during treatment, specifically related to tooth or jaw pain. Conclusion. Our clinical trial found that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.
Abstract
Objectives. Although mandibular advancement device (MAD) treatment is effective for obstructive sleep apnea (OSA), some concerns remain regarding its potential therapeutic impact and side effects. Thus, we developed a novel MAD that auto-titrates depending on its position in patients with OSA. We conducted a clinical trial to determine the efficacy of an auto-titrating mandibular advancement device (AMAD) for treating OSA. Methods. Fourteen patients diagnosed with OSA participated in this study. Polysomnography (PSG) was performed at the beginning of the clinical trial, and after 3 months of treatment, PSG with AMAD in situ was conducted. Results. The mean scores for the Epworth Sleepiness Scale (ESS) and STOP-Bang were 8.21±4.21 and 5.00±1.00, respectively. After 3 months of AMAD treatment, the STOP-Bang scores improved to 3.75±1.06; however, the ESS scores did not show a significant change. Additionally, we observed statistically significant improvements in several respiratory parameters in the PSG data following AMAD treatment. These included reductions in the apnea-hypopnea index (AHI) (from 32.85±21.71 to 12.93±10.70), supine AHI (from 45.91±23.58 to 15.59±12.76), and lateral AHI (from 13.94±10.95 to 5.49±7.40). Improvements were also noted in the lowest O2 saturation (from 79.71±6.22 to 84.00±5.71), total arousal number (from 191.14±112.07 to 86.57±48.80), and arousal index (from 33.76±21.00 to 15.05±8.42). However, there were no significant changes in total sleep time, sleep efficiency, or mean oxygen saturation. Additionally, no major side effects were observed during treatment, specifically related to tooth or jaw pain. Conclusion. Our clinical trial found that AMAD improved PSG parameters and reduced the incidence of common side effects. Therefore, AMAD may be an effective alternative treatment for OSA.
참고문헌 (32)
- Sankri-Tarbichi AG, "Obstructive sleep apnea-hypopnea syndrome : etiology and diagnosis", Avicenna J Med, 2(1), pp.3~8 (2012)
- "Correction to: obstructive sleep apnea and cardiovascular disease: a scientific statement from the American Heart Association", Circulation, 145(12), pp.e775~ (2022)
- Yeghiazarians Y, "Obstructive sleep apnea and cardiovascular disease : a scientific statement from the American Heart Association", Circulation, 144(3), pp.e56~e67 (2021)
- Lin WC, "Obstructive sleep apnea and severe mental illness : evolution and consequences", Curr Psychiatry Rep, 14(5), pp.503~510 (2012)
- Patil SP, "Treatment of adult obstructive sleep apnea with positive airway pressure : an American Academy of Sleep Medicine systematic review, meta-analysis, and GRADE assessment", J Clin Sleep Med, 15(2), pp.301~334 (2019)
- Xanthopoulos MS, "Self-efficacy and short-term adherence to continuous positive airway pressure treatment in children", Sleep, 40(7), pp.zsx096~ (2017)
- Stepnowsky CJ Jr, "Determinants of nasal CPAP compliance", Sleep Med, 3(3), pp.239~247 (2002)
- Weaver TE, "Adherence to continuous positive airway pressure therapy : the challenge to effective treatment", Proc Am Thorac Soc, 5(2), pp.173~178 (2008)
- Ramar K, "Clinical practice guideline for the treatment of obstructive sleep apnea and snoring with oral appliance therapy : an update for 2015", J Clin Sleep Med, 11(7), pp.773~827 (2015)
- Jayesh SR, "Mandibular advancement device for obstructive sleep apnea : an overview", J Pharm Bioallied Sci, 7(Suppl 1), pp.S223~S225 (2015)
- Ferguson KA, "A short-term controlled trial of an adjustable oral appliance for the treatment of mild to moderate obstructive sleep apnoea", Thorax, 52(4), pp.362~368 (1997)
- Fritsch KM, "Side effects of mandibular advancement devices for sleep apnea treatment", Am J Respir Crit Care Med, 164(5), pp.813~818 (2001)
- Ishida E, "Dental and occlusal changes during mandibular advancement device therapy in Japanese patients with obstructive sleep apnea : four years follow-up", J Clin Med, 11(24), pp.7539~ (2022)
- Jo SY, "Effect of long-term oral appliance therapy on obstruction pattern in patients with obstructive sleep apnea", Eur Arch Otorhinolaryngol, 275(5), pp.1327~1333 (2018)
- Zhu Y, "The effectiveness of oral appliances for obstructive sleep apnea syndrome : a meta-analysis", J Dent, 43(12), pp.1394~1402 (2015)
- Ghazal A, "A randomized prospective long-term study of two oral appliances for sleep apnoea treatment", J Sleep Res, 18(3), pp.321~328 (2009)
- Zhou J, "A randomised titrated crossover study comparing two oral appliances in the treatment for mild to moderate obstructive sleep apnoea", hypopnoea syndrome, 2012, pp.39(12), 914~922
- Umemoto G, "Therapeutic efficacy of twin-block and fixed oral appliances in patients with obstructive sleep apnea syndrome", J Prosthodont, 28(2), pp.e830~e836 (2019)
- Bloch KE, "A randomized, controlled crossover trial of two oral appliances for sleep apnea treatment", Am J Respir Crit Care Med, 162(1), pp.246~251 (2000)
- Segu M, "Pilot study of a new mandibular advancement device", Dent J(Basel), 10(6), pp.99~ (2022)
- El Ibrahimi M, "Pilot study of a new adjustable thermoplastic mandibular advancement device for the management of obstructive sleep apnoea-hypopnoea syndrome : a brief research letter", Open Respir Med J, 10, pp.46~50 (2016)
- Shi X, "Comparisons of the effects of two types of titratable mandibular advancement devices on respiratory parameters and upper airway dimensions in patients with obstructive sleep apnea : a randomized controlled trial", Clin Oral Investig, 27(5), pp.2013~2025 (2023)
- Martins OFM, "Side effects of mandibular advancement splints for the treatment of snoring and obstructive sleep apnea : a systematic review", Dental Press J Orthod, 23(4), pp.45~54 (2018)
- Doff MH, "Oral appliance versus continuous positive airway pressure in obstructive sleep apnea syndrome : a 2-year follow-up", Sleep, 36(9), pp.1289~1296 (2013)
- Ahn HK, "Analysing the impact of body position shift on sleep architecture and stage transition : a comprehensive multidimensional study using event-synchronised polysomnography data", J Sleep Res, 33(4), pp.e14115~ (2024)
- Sharples LD, "Clinical effectiveness and cost-effectiveness of endobronchial and endoscopic ultrasound relative to surgical staging in potentially resectable lung cancer : results from the ASTER randomised controlled trial", Health Technol Assess, 16(18), pp.1~75 (2012)
- Sharples LD, "Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea", Sleep Med Rev, 27, pp.108~124 (2016)
- Marklund M, "Update on oral appliance therapy for OSA", Curr Sleep Med Rep, 3(3), pp.143~151 (2017)
- Schwartz M, "Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients : a systematic review and meta-analysis", Sleep Breath, 22(3), pp.555~568 (2018)
- Phillips CL, "Health outcomes of continuous positive airway pressure versus oral appliance treatment for obstructive sleep apnea : a randomized controlled trial", Am J Respir Crit Care Med, 187(8), pp.879~887 (2013)
- Marklund M, "Non-CPAP therapies in obstructive sleep apnoea : mandibular advancement device therapy", Eur Respir J, 39(5), pp.1241~1247 (2012)
- Ferguson KA, "Oral appliances for snoring and obstructive sleep apnea : a review", Sleep, 29(2), pp.244~262 (2006)