Sleep-disordered breathing: choosing the right cephalometric analysis.

PURPOSE: Cephalometry can be helpful for choosing the optimal treatment of sleep apnea. The presence or absence of maxillomandibular retrusion can contribute to the choice of treatment with an oral appliance or a skeleton-based or soft tissue surgery. To measure the position of the maxillomandibular complex, the analysis of Tweed has been cited most often. It uses dental landmarks. The analysis of Delaire relies on deeper skeletal points. The present study compared these 2 analyses for the diagnosis of maxillomandibular retrusion in a context of sleep-disordered breathing by determining the correlation between retrusion and the apnea-hypopnea index (AHI) for both methods. MATERIALS AND METHODS: A retrospective cohort study was conducted in a tertiary care university hospital. The population consisted of patients diagnosed with sleep-disordered breathing for whom polysomnographic and cephalometric data were available. Tweed and Delaire cephalometric analyses were performed for each case. The main outcome was the correlation between the degree of maxillomandibular retrusion and the AHI, as determined by Pearson coefficients. RESULTS: A total of 243 patients (42 females and 201 males) were included. For maxillary retrusion, the correlation coefficient with the AHI was -0.109 (P = .089) for Tweed and -0.160 (P = .012) for Delaire. For mandibular retrusion, the coefficient was -0.090 (P = .16) for Tweed and -0.201 (P = .002) for Delaire. Statistical significance was found only for the analysis of Delaire. CONCLUSION: The correlation between maxillomandibular retrusion and the AHI was better using the analysis of Delaire. If cephalometry is to be included in the workup of sleep-disordered breathing, the analysis of Delaire might be preferable.

Snoring intensity after a first session of soft palate radiofrequency: predictive value of the final result.

OBJECTIVES/HYPOTHESIS: To determine whether snoring sound intensity measured after a first soft palate radiofrequency (RF) session for simple snoring helps predict the final result of the treatment. STUDY DESIGN: Observational retrospective study. METHODS: We conducted a retrospective review of 105 subjects presenting with simple snoring or mild sleep apnea. All patients underwent two to three sessions of RF-assisted stiffening of the soft palate. In addition, uvulectomy was performed in case of a long uvula, and two paramedian trenches were created in the presence of palatal webbing. Snoring sound intensity was evaluated by the bed partner after each session. RESULTS: Eighty-six men and 19 women were included in the study. Mean age was 51.7 ± 9.8 years, and mean body mass index was 24.7 ± 4.4 kg/m(2) . The mean apnea/hypopnea index was 6.6 ± 4.2/h. The mean snoring sound intensity, as evaluated on a 10-cm visual analog scale (VAS), decreased from 8.2 ± 1.5 to 3.5 ± 2.2 after all sessions (P < .0001). A score of 3 was determined as being a score that satisfied the bed partner. Two groups were formed according to the final snoring sound intensity, using 3 as a threshold. Both groups had similar preoperative characteristics, but the snoring sound intensity was significantly lower after the first session in the group with final score <3 (P = .01). Similarly, a VAS score >7 after the first session was associated with a final score <3 in 30% of the cases. CONCLUSIONS: Snoring sound intensity after the first RF session helps predict the final outcome of RF-assisted stiffening of the soft palate for simple snoring.

Does propulsion mechanism influence the long-term side effects of oral appliances in the treatment of sleep-disordered breathing?

BACKGROUND: Mandibular advancement appliances (MAAs) can be used to treat sleep-disordered breathing, and differences in their designs have been thought to influence the occurrence of secondary effects. With bibloc devices, the lateral attachments producing mandibular propulsion can be inserted to generate traction or compression. We evaluated the clinical impact of this difference by comparing the long-term secondary effects and compliance of two devices. METHODS: One hundred sixty-two records of patients fitted with a traction-based or compression-based MAA before January 2008 were reviewed retrospectively for physical examination findings and cephalometry. Patients were sent a postal survey and contacted by phone 2 weeks later. They were offered a follow-up medical visit with repeat cephalometry. Main outcomes were long-term (> 2 years) secondary effects, compliance, or satisfaction. RESULTS: Of the patients who attended the follow-up visit, 48 had worn the MAA for > 2 years (16 traction based and 32 compression based), and nine for < 6 months (used as control subjects). Mean follow-up times for the traction and compression groups were 3.7 ± 1.2 years and 3.6 ± 1.2 years, respectively. No difference was found between the MAAs for subjective and objective side effects, except for greater early pain to the masticatory muscles (P = .02) and residual tongue pain (P = .04) in the compression group. However, pain intensity was low and clinical relevance was uncertain. No difference was found for compliance, satisfaction, and objective or subjective efficacy. CONCLUSIONS: This study suggests that traction-based appliances are similar to compression-based devices with regard to secondary effects and compliance.