Genetic Analysis of Obstructive Sleep Apnea and Its Relationship with Severe COVID-19.

Rationale: Although patients with obstructive sleep apnea (OSA) have a higher risk for coronavirus disease (COVID-19) hospitalization, the causal relationship has remained unexplored. Objectives: To understand the causal relationship between OSA and COVID-19 by leveraging data from vaccination and electronic health records, genetic risk factors from genome-wide association studies, and Mendelian randomization. Methods: We elucidated genetic risk factors for OSA using FinnGen (total N = 377,277), performing genome-wide association. We used the associated variants as instruments for univariate and multivariate Mendelian randomization (MR) analyses and computed absolute risk reduction against COVID-19 hospitalization with or without vaccination. Results: We identified nine novel loci for OSA and replicated our findings in the Million Veteran Program. Furthermore, MR analysis showed that OSA was a causal risk factor for severe COVID-19 (P = 9.41 × 10-4). Probabilistic modeling showed that the strongest genetic risk factor for OSA at the FTO locus reflected a signal of higher body mass index (BMI), whereas BMI-independent association was seen with the earlier reported SLC9A4 locus and a MECOM locus, which is a transcriptional regulator with 210-fold enrichment in the Finnish population. Similarly, multivariate MR analysis showed that the causality for severe COVID-19 was driven by BMI (multivariate MR P = 5.97 × 10-6, ß = 0.47). Finally, vaccination reduced the risk for COVID-19 hospitalization more in the patients with OSA than in the non-OSA controls, with respective absolute risk reductions of 13.3% versus 6.3%. Conclusions: Our analysis identified novel genetic risk factors for OSA and showed that OSA is a causal risk factor for severe COVID-19. The effect is predominantly explained by higher BMI and suggests BMI-dependent effects at the level of individual variants and at the level of comorbid causality.

Complications and Associated Risk Factors for Bimaxillary Osteotomies: A 15-Year Single-center Retrospective Study.

AIM: The aim of this study was to retrospectively investigate the risk factors and their association on bimaxillary osteotomies to be able to improve patient selection and bimaxillary osteotomy planning. MATERIAL AND METHODS: Patients treated with a bimaxillary osteotomy were included in the study. The complications were collected retrospectively from the patient data records. The effects of certain predictor variables on complication rates were also studied. RESULTS: Sixty-one patients (48.0%) suffered from peri- or postoperative complications, or both. Twenty-five various perioperative complications were reported on 25 patients (19.6%) and 63 postoperative complications on 46 patients (36.2%). Ten patients (7.8%) suffered from both perioperative and postoperative complications. The effect of various predictor variables (sex, age, general health, type of malocclusion, surgery planning, use of bone grafts, and type of maxillary or mandibular movement) on complications was investigated, but we could not find any single factor to affect significantly on complication rate. CONCLUSION: Both perioperative and postoperative complications are common in bimaxillary surgery, which must be noted in patient preoperative information. However, life-threatening complications are rare. Patient profile, bone grafting, type of osteosynthesis, or segmentation of the maxilla do not seem to affect the complication risk.

Genetic analysis of probable sleep bruxism and its associations with clinical and behavioral traits.

STUDY OBJECTIVES: Sleep bruxism (SB) can cause damage on teeth, headache and severe pain affecting both sleep and daily functioning. Yet despite the growing interest into bruxism, the underlying clinically relevant biological mechanisms remain unresolved. The aim of our study was to understand biological mechanisms and clinical correlates of SB including previously reported disease associations. METHODS: We used data from the FinnGen release R9 (N = 377 277 individuals) that are linked with Finnish hospital and primary care registries. We identified 12 297 (3.26%) individuals with International Classification of Diseases (ICD)-10 codes used for SB. In addition, we used logistic regression to examine the association between probable SB and its clinically diagnosed risk factors and comorbidities using ICD-10 codes. Furthermore, we examined medication purchases using prescription registry. Finally, we performed the first genome-wide association analysis for probable SB and computed genetic correlations using questionnaire, lifestyle, and clinical traits. RESULTS: The genome-wide association analysis revealed one significant association: rs10193179 intronic to Myosin IIIB (MYO3B) gene. In addition, we observed phenotypic associations and high genetic correlations with pain diagnoses, sleep apnea, reflux disease, upper respiratory diseases, psychiatric traits, and also their related medications such as antidepressants and sleep medication (p < 1e-4 for each trait). CONCLUSIONS: Our study provides a large-scale genetic framework to understand risk factors for SB and suggests potential biological mechanisms. Furthermore, our work strengthens the important earlier work that highlights SB as a trait that is associated with multiple axes of health. As part of this study, we provide genome-wide summary statistics that we hope will be useful for the scientific community studying SB.

Inflammatory and infectious upper respiratory diseases associate with 41 genomic loci and type 2 inflammation.

Inflammatory and infectious upper respiratory diseases (ICD-10: J30-J39), such as diseases of the sinonasal tract, pharynx and larynx, are growing health problems yet their genomic similarity is not known. We analyze genome-wide association to eight upper respiratory diseases (61,195 cases) among 260,405 FinnGen participants, meta-analyzing diseases in four groups based on an underlying genetic correlation structure. Aiming to understand which genetic loci contribute to susceptibility to upper respiratory diseases in general and its subtypes, we detect 41 independent genome-wide significant loci, distinguishing impact on sinonasal or pharyngeal diseases, or both. Fine-mapping implicated non-synonymous variants in nine genes, including three linked to immune-related diseases. Phenome-wide analysis implicated asthma and atopic dermatitis at sinonasal disease loci, and inflammatory bowel diseases and other immune-mediated disorders at pharyngeal disease loci. Upper respiratory diseases also genetically correlated with autoimmune diseases such as rheumatoid arthritis, autoimmune hypothyroidism, and psoriasis. Finally, we associated separate gene pathways in sinonasal and pharyngeal diseases that both contribute to type 2 immunological reaction. We show shared heritability among upper respiratory diseases that extends to several immune-mediated diseases with diverse mechanisms, such as type 2 high inflammation.

Psychiatric morbidity is common in orthognathic surgery patients-a retrospective study.

OBJECTIVE: The study aimed to clarify psychiatric morbidity in patients who underwent orthognathic surgery (OS) pre- and postoperatively. STUDY DESIGN: Patients ≥18 years undergoing OS were included in this retrospective study. The outcome variable was the incidence of new mild, moderate, or severe psychiatric morbidity or exacerbation of preexisting psychiatric morbidity postoperatively. Surgery and patient-related background variables for outcome were analyzed (SPSS for Macintosh, version 27; IBM SPSS, Inc., Armonk, NY, USA). RESULTS: Of 182 patients, 44 (24%) had preceding psychiatric morbidity. It was associated significantly with history of alcohol abuse (P < .001) and smoking (P = .046) and was more common in older patients (P = .042). During the postoperative phase, new psychiatric morbidity or exacerbation of a preexisting psychiatric condition was found in 12 patients (7%). Preceding psychiatric history (OR 8.88, P = .004) and high-dose perioperative dexamethasone (OR 9.81, P = .036) were independent predictors for postoperative psychiatric morbidity. No other evaluated variables were associated with outcome. CONCLUSIONS: Psychiatric conditions are common among OS patients. Treatment planning should consider the patient's mental health to minimize the risk of exacerbating psychiatric conditions, and collaboration with psychiatric professionals is recommended. Perioperative high-dose dexamethasone should be used with caution considering possible adverse psychiatric effects.

Craniofacial structures, occlusal features, and TMD symptoms in juvenile idiopathic arthritis patients: a retrospective study.

BACKGROUND: Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease in which temporomandibular joint (TMJ) arthritis commonly occurs. It may be asymptomatic and could cause problems in the growing joints. Our aim was to evaluate the craniofacial structures, occlusal features and temporomandibular dysfunction (TMD) symptoms of patients with JIA. METHODS: The study consisted of 195 JIA patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Finland between 2015 and 2019. We retrospectively screened their medical and dental records and classified them according to age at JIA diagnosis (<7 and ≥7 years). RESULTS: Most of the patients had Angle Class I occlusion in both sides. Among all the patients, the mean overjet, and overbite were 3.3 mm and 2.4 mm, respectively. There were more open bite patients in the ≥7 years old group than in the <7 years old group (P = 0.010). Of all patients, 47% reported at least one TMD symptom. The TMD symptoms were more common in participants ≥7 years old than those <7 years old (P = 0.005). CONCLUSION: Occlusal features and the incidence of malocclusions seem to have similar tendency among the JIA patients with systematic visits in rheumatologist and orthodontist as in the healthy population, except for open bite that is more common with JIA patients. While treating JIA patients, a well-functioning collaboration between paediatric rheumatologists and orthodontists is essential, as well as a clear screening protocol to detect potentially asymptomatic TMJ arthritis. Particular attention should be paid to children with JIA under school age.

The Frequency of Temporomandibular Disorders, Surgical Complications, and Self-Reported Mental Health Problems in Orthognathic Patients.

OBJECTIVE: To evaluate the frequency of signs and symptoms of temporomandibular disorders (TMD), surgical complications, and patient's self-reported mental health problems during orthognathic treatment. MATERIAL AND METHODS: The clinical records of 145 patients treated with orthognathic treatment were retrospectively studied. Variables regarding occlusal parameters, treatment duration, TMD symptoms, complications, and self-reported mental health status at time points of T0 (beginning of the treatment), T1 (before surgery), and T2 (final examination) were evaluated. The variables were statistically compared with significance level of P < 0.05. RESULTS: A total of 51% (n = 74) of the patients had TMD symptoms at 1 or several time points, women having significantly more TMD signs and symptoms ( P = 0.002). Temporomandibular disorder signs and symptoms decreased significantly after orthognathic treatment ( P <0.001). At least 1 self-reported mental health-related factor during 1 or several time points (T0-T2) was recorded in 17.2% (n = 25) of the patients. There was no significant difference in frequency of self-reported mental health problems in patients with TMD signs and symptoms compared with patients without TMD signs and symptoms ( P > 0.05). The frequency of postoperative complications was 39.3%, being significantly higher after Bilateral Sagittal Split Osteothomy (BSSO, 48.7%). There was no difference in treatment duration of patients with self-reported mental health problems compared with patients without ( P > 0.05). CONCLUSIONS: In this study population, TMD signs and symptoms seem to be typical both in patients with or without self-reported mental health problems. Women had significantly more TMD symptoms. Orthognathic surgery treatment seems to have a positive effect on TMD signs and symptoms.

Peri- and postoperative complications in Le Fort I osteotomies.

This retrospective study was performed to report the peri- and postoperative complications encountered by patients who underwent Le Fort I osteotomy, as well as predictor variables affecting the risk of complications. Patients who underwent only Le Fort I osteotomy were included in the study. Information on peri- and postoperative complications were collected from the patient data records. The effects of certain predictor variables on complication rates were also studied. Twenty-four per cent of the patients suffered from complications, six (6.1%) of whom were reoperated. Most of the complications were minor and transient. Compared with one-piece osteotomy, segmental osteotomy was a significant risk factor predisposing patients to postoperative complications (p = 0.04619). Additionally, the use of patient-specific implants seemed to increase the risk of both perioperative and postoperative complications (p = 0.0248). Currently, the conventional plate fixation method is the primary method in Le Fort I osteotomies. Careful patient selection, surgical planning, and selection of surgical technique seem to be the most important factors in reducing the complication risk. Special attention should be paid with segmental osteotomy surgery.

Reasons for failure of mandibular advancement splint therapy in the treatment of obstructive sleep apnea.

Objective: To investigate the reasons for poor adaptation to mandibular advancement splint (MAS) treatment.Methods: The study consisted of 44 patients with obstructive sleep apnea who had unsuccessful MAS treatment. Data were collected on age, body mass index, gender, general and mental diseases, continuous positive airway pressure (CPAP) tryout, usage of occlusal splint, dental overjet, temporomandibular disorders, shortened dental arch, sleep apnea severity, and Apnea-Hypopnea Index. Sixty patients who underwent successful MAS treatment were controls.Results: Patients with missing molars failed significantly more often in MAS therapy than the controls (p = 0.020). Patients with CPAP tryout prior to MAS treatment had a tendency to fail MAS treatment. MAS treatment was more likely to be successful in patients with prior occlusal splint experience (p = 0.050).Conclusion: The study could not identify a single reason for MAS failure.

Sleep apnoea is a risk factor for severe COVID-19.

BACKGROUND: Obstructive sleep apnoea (OSA) is associated with higher body mass index (BMI), diabetes, older age and male gender, which are all risk factors for severe COVID-19.We aimed to study if OSA is an independent risk factor for COVID-19 infection or for severe COVID-19. METHODS: OSA diagnosis and COVID-19 infection were extracted from the hospital discharge, causes of death and infectious diseases registries in individuals who participated in the FinnGen study (n=260 405). Severe COVID-19 was defined as COVID-19 requiring hospitalisation. Multivariate logistic regression model was used to examine association. Comorbidities for either COVID-19 or OSA were selected as covariates. We performed a meta-analysis with previous studies. RESULTS: We identified 445 individuals with COVID-19, and 38 (8.5%) of them with OSA of whom 19 out of 91 (20.9%) were hospitalised. OSA associated with COVID-19 hospitalisation independent from age, sex, BMI and comorbidities (p-unadjusted=5.13×10-5, OR-adjusted=2.93 (95% CI 1.02 to 8.39), p-adjusted=0.045). OSA was not associated with the risk of contracting COVID-19 (p=0.25). A meta-analysis of OSA and severe COVID-19 showed association across 15 835 COVID-19 positive controls, and n=1294 patients with OSA with severe COVID-19 (OR=2.37 (95% 1.14 to 4.95), p=0.021). CONCLUSION: Risk for contracting COVID-19 was the same for patients with OSA and those without OSA. In contrast, among COVID-19 positive patients, OSA was associated with higher risk for hospitalisation. Our findings are in line with earlier works and suggest OSA as an independent risk factor for severe COVID-19.

The relation of severe malocclusion to patients' mental and behavioral disorders, growth, and speech problems.

BACKGROUND: Severe malocclusions appear in up to 20 per cent of the population. Many neuropsychiatric diseases are likely to have a neurodevelopmental, partially genetic background with their origins as early as fetal life. However, the possible relationship between neurodevelopmental disorders and severe malocclusions is unclear. The aim of this study was in a population-based setting (270 000 inhabitants) to investigate whether patients with severe malocclusions have more mental and behavioural disorders and growth or speech problems than controls without severe malocclusion. MATERIAL AND METHODS: The study group consisted of patients from the Espoo Health Care Center, Finland, born in year 2000, who were retrospectively screened for their medical and dental records, including their possible mental and behavioural disorders (i.e. attention deficit hyperactivity disorder, Asperger's syndrome, autism, mood disorder, or broadly defined behavioural abnormalities, learning problems, mental disorders, sleep disturbances, anxiety symptoms, depressive symptoms, and eating-related symptoms) and their need of orthodontic treatment according to the Treatment Priority Index (TPI). The study group consisted of a severe malocclusion group (n =1008; TPI 8-10) and a control group (n = 1068) with no severe malocclusion (TPI 0-7). RESULTS: Patients with severe mandibular retrognatia (P < 0.000), lip incompetence (P = 0.006), or neurodevelopmental disorders (mental and behavioural; P = 0.002) were found to have significantly more speech problems than the controls. The patients with severe malocclusions were leaner, that is, body mass index (kg/m2) <17, underweight; 17-25, normal weight; >25, overweight) than controls (P = 0.003), and underweight patients had a significant association with retrognathic maxilla (P < 0.000) compared to normal or overweight patients. No significant relationship between neurodevelopmental disorders and severe malocclusions, that is, retrognatia of maxilla, hypodontia, and severe dental crowding was observed. CONCLUSION: Our results indicate that patients with severe mandibular retrognatia, lip incompetence, or neurodevelopmental disorders were found to have significantly more speech problems than controls. During orthodontic treatment of patients with severe malocclusion, special attention should be paid to patients with severe mandibular retrognatia, lip incompetence, and speech problems to detect signs of possible neurodevelopmental disorders and record if potential follow-up measures are in place.

Genetic analysis of obstructive sleep apnoea discovers a strong association with cardiometabolic health.

There is currently limited understanding of the genetic aetiology of obstructive sleep apnoea (OSA). We aimed to identify genetic loci associated with OSA risk, and to test if OSA and its comorbidities share a common genetic background.We conducted the first large-scale genome-wide association study of OSA using the FinnGen study (217 955 individuals) with 16 761 OSA patients identified using nationwide health registries.We estimated 0.08 (95% CI 0.06-0.11) heritability and identified five loci associated with OSA (p<5.0×10-8): rs4837016 near GAPVD1 (GTPase activating protein and VPS9 domains 1), rs10928560 near CXCR4 (C-X-C motif chemokine receptor type 4), rs185932673 near CAMK1D (calcium/calmodulin-dependent protein kinase ID) and rs9937053 near FTO (fat mass and obesity-associated protein; a variant previously associated with body mass index (BMI)). In a BMI-adjusted analysis, an association was observed for rs10507084 near RMST/NEDD1 (rhabdomyosarcoma 2 associated transcript/NEDD1 γ-tubulin ring complex targeting factor). We found high genetic correlations between OSA and BMI (rg=0.72 (95% CI 0.62-0.83)), and with comorbidities including hypertension, type 2 diabetes, coronary heart disease, stroke, depression, hypothyroidism, asthma and inflammatory rheumatic disease (rg>0.30). The polygenic risk score for BMI showed 1.98-fold increased OSA risk between the highest and the lowest quintile, and Mendelian randomisation supported a causal relationship between BMI and OSA.Our findings support the causal link between obesity and OSA, and the joint genetic basis between OSA and comorbidities.

CAD/CAM Engineered Patient-Specific Impants as a Reposition Device in Le Fort I and Modified Subcondylar Osteotomies: Case Report of Facial Deformity Correction in Acromegaly.

Acromegaly is a medical condition where elevated growth hormone or insulin-like growth factor I levels cause several changes in the craniofacial soft and hard features. We report the correction of facial deformity and posterior open bite with Le Fort I and modified subcondylar osteotomies in a patient affected by acromegaly. Computer-aided design and manufacturing generated saw and drill guides were used to perform osteotomies and segment removal. The placement of the patient-specific implants (PSIs) was guided by predesigned drill holes ensuring the required and planned movement of the jaws and position of the PSIs. After segment removal, the PSIs fitted the predesigned drill holes with high precision and were secured without problems. The planned amount of mandibular and maxillary movement was achieved. The occlusion and osteotomies remained stable for the follow-up of 22 months. The use of PSIs combined with guided surgery can be beneficial for selected cases with asymmetry or posterior open bite enabling new approaches and yielding good functional and aesthetic outcome. The modification of conventional ramus osteotomy combined with utilization of ramus segment removal and the use of PSI for reposition is an interesting and promising technique for rare conditions with ramus height asymmetry.

Practical Aspects of Interface Application in CPAP Treatment.

While continuous positive airway pressure (CPAP) is an effective first-line therapy for sleep apnea, CPAP fails in one third of patients mainly due to poor adherence to the CPAP device and masks. The role of the medical team is to guide the patient in choosing the best mask, thus insuring good CPAP therapy adherence. Once a suitable mask is found, the brand of the mask does not affect patient satisfaction or CPAP adherence. For the majority of patients, nasal masks are by far more suitable than oronasal masks. Orosanal masks are indicated in case of nasal stuffiness or when an air leak manifests through the mouth. Re-evaluation of the efficacy of CPAP therapy is recommended when switching to oronasal masks.

Comparison of postoperative skeletal stability of maxillary segments after Le Fort I osteotomy, using patient-specific implant versus mini-plate fixation.

BACKGROUND: Three-dimensionally (3D) designed osteotomies and customised osteosynthesis are rapidly becoming standard in maxillofacial reconstructive and deformity surgery. Patient-specific implants (PSIs) have been in use for a few years in orthognathic surgery as well. In Le Fort I osteotomy, wafer-free fixation of the maxillary segment can be performed by individually manufactured cutting and drill guides together with PSIs. AIM: This retrospective study was performed to compare the postoperative skeletal stability of the maxillary segment fixed by patient-specific implants versus mini-plates after Le Fort I osteotomy. PATIENTS: Fifty-one patients were divided into subgroups according to the fixation method and the advancement of the sub-spinal point. The postoperative skeletal stability of the maxillary segment was evaluated from lateral cephalometric radiographs one year postoperatively. RESULTS: No statistically significant differences were found between the postoperative skeletal stability of the PSI and mini-plate fixed maxillae. Prospective studies, possibly with 3D fusion analysis, are warranted to confirm the results. CONCLUSION: The choice between the two fixation methods does not seem to affect the postoperative skeletal stability of the maxillary segments.

Obstructive sleep apnoea and the risk for coronary heart disease and type 2 diabetes: a longitudinal population-based study in Finland.

OBJECTIVE: To evaluate if obstructive sleep apnoea (OSA) modifies the risk of coronary heart disease, type 2 diabetes (T2D) and diabetic complications in a gender-specific fashion. DESIGN AND SETTING: A longitudinal population-based study with up to 25-year follow-up data on 36 963 individuals (>500 000 person years) from three population-based cohorts: the FINRISK study, the Health 2000 Cohort Study and the Botnia Study. MAIN OUTCOME MEASURES: Incident coronary heart disease, diabetic kidney disease, T2D and all-cause mortality from the Finnish National Hospital Discharge Register and the Finnish National Causes-of-Death Register. RESULTS: After adjustments for age, sex, region, high-density lipoprotein (HDL) and total cholesterol, current cigarette smoking, body mass index, hypertension, T2D baseline and family history of stroke or myocardial infarction, OSA increased the risk for coronary heart disease (HR=1.36, p=0.0014, 95% CI 1.12 to 1.64), particularly in women (HR=2.01, 95% CI 1.31 to 3.07, p=0.0012). T2D clustered with OSA independently of obesity (HR=1.48, 95% CI 1.26 to 1.73, p=9.11×[Formula: see text]). The risk of diabetic kidney disease increased 1.75-fold in patients with OSA (95% CI 1.13 to 2.71, p=0.013). OSA increased the risk for coronary heart disease similarly among patients with T2D and in general population (HR=1.36). All-cause mortality was increased by OSA in diabetic individuals (HR=1.35, 95% CI 1.06 to 1.71, p=0.016). CONCLUSION: OSA is an independent risk factor for coronary heart disease, T2D and diabetic kidney disease. This effect is more pronounced even in women, who until now have received less attention in diagnosis and treatment of OSA than men.

Comparison between patient specific implants and conventional mini-plates in Le Fort I osteotomy with regard to infections: No differences in up to 3-year follow-up.

Individually designed osteotomies and milled or printed patient-specific osteosynthesis materials are rapidly becoming a standard in maxillofacial reconstructive surgery. The benefits of using patient-specific implants (PSIs) in orthognathic surgery are especially clear in complex cases, and for this reason they are rapidly becoming common practice. We have earlier reported the benefits related to the use of PSIs as reposition and fixation system in Le Fort I osteotomy. The aim of this study was to compare complications associated with fixation with PSIs (31 patients) versus conventional mini-plates (37 patients) in Le Fort I osteotomy. No statistically significant differences in infection, reoperations or soft tissue problems were observed between the two systems used. Interestingly, three of the 37 patients in the mini-plate group underwent reoperation due to insufficient advancement or malocclusion, whereas none of the patients in the PSI group needed reoperation. In conclusion, PSIs are reliable for use in orthognathic surgery, with no signs of infection associated complications.

The Effect of mandible advancement splints in mild, moderate, and severe obstructive sleep apnea-the need for sleep registrations during follow up.

OBJECTIVE AND DESIGN: Our aim was to evaluate the effect of mandible advancement splint (MAS) in mild, moderate, and severe obstructive sleep apnea (OSA). We also determined, if and in which OSA-groups the adequate forward movement in MAS could be quantified without sleep registration for different OSA levels. A retrospective study. SETTINGS: The effect of MAS was measured with clinical methods and by sleep registration. PARTICIPANTS: The series consisted of 103 patients, 75 males and 28 females (mean age 52 years) suffering from mild (32 per cent), moderate (32 per cent), or severe (36 per cent) OSA, who were treated with MAS at Helsinki University Hospital, Finland during the years 2011-2012. Seventy per cent of the patients had tried continuous positive airway pressure (CPAP) before MAS. RESULTS: The lower the body mass index (BMI) was the bigger the probability was to get apnea/hypopnea index (AHI) values <5 per hour with MAS (P < 0.01). The total AHI decreased significantly from the baseline with MAS: 23 per hour (range 5-89) to 6 per hour (range 0.3-54), (P < 0.001). The mean oxygen desaturation index (ODI4%) improved significantly from 16 per hour (range 1-76) to 5.3 per hour (range 0.2-49), (P < 0.01), and the minimum oxygen saturation improved significantly from 84 per cent (67-91) to 87 per cent (68-93), (P < 0.01). The reduction of AHI with MAS was significantly bigger in patients with a previous CPAP experience (73 per cent) than those who did not tried CPAP therapy. The positive correlation was found between the decrease in AHI and the increase of the protrusion in MAS. CONCLUSION: Both sleep recordings and subjective indicators demonstrated that MAS therapy was successful in OSA based on ESS, total AHI, ODI4%, and minimum oxygen saturation values. It seems useful to increase the protrusion at its maximal clinical tolerance. An experienced dentist could make therapeutically decision concerning the follow up of MAS efficacy regardless of the result of sleep study. We suggest that MAS is a valuable treatment alternative for CPAP. However, the previous use of CPAP with MAS as well as lower baseline BMI seem to have a positive correlation with the success of MAS therapy.

Oral appliance in sleep apnea treatment: respiratory and clinical effects and long-term adherence.

PURPOSE: There is an increasing tendency to use oral appliance (OA) as an alternative treatment for sleep apnea. Here we report the long-term adherence and clinical effects of OA therapy. METHODS: All sleep apnea patients treated at the Department of Dentistry between the years 2006 and 2013 (n = 1208) were reviewed. A questionnaire about OA adherence, asthma symptoms (Asthma Control Test™, ACT), and general health was sent to all patients who continued OA therapy after the 1-month follow-up visit (n = 811). OA was adjusted to obtain at least 70 % of the maximal protrusion of the mandible. RESULTS: The response rate was 37.4 % (99 women, 204 men). The mean ± SD age and BMI were 58.7 ± 10.3 years and 27.3 ± 4.0 kg/m(2), respectively. During the mean follow-up period of 3.3 years, there was no significant variation in BMI. Forty-one patients abandoned OA therapy yielding an adherence rate of 86 %. Ninety-seven percent of patients used OA ≥4 h/day, and the mean daily use was 7.2 ± 1.1 h. The ACT score improved with OA use from 16.0 ± 5.9 to 20.1 ± 3.8 (p = 0.004), indicating better asthma control. The apnea and hypopnea index decreased significantly from 27 ± 19 at baseline to 10 ± 10 with OA therapy (p = 0.001). CONCLUSIONS: After a 1-month trial period, the long-term adherence to oral appliance was good. OA therapy decreased apneas and hypopneas significantly, and its long-term use was associated with an improvement in respiratory and asthma symptoms.