Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome.

The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States - POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.

Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome

Abstract The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States – POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.

Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis.

INTRODUCTION: Oral appliances (OAs) have been widely used to treat snoring and sleep apnea, but their effects on craniofacial structures in patients after 5 years or more of wear have not yet been quantified. METHODS: Seventy-one patients who had worn adjustable mandibular repositioners to treat snoring or sleep apnea were evaluated. Upright lateral cephalometric radiographs in centric occlusion taken before treatment and after a mean of 7.3 +/- 2.1 years of OA use were compared. Baseline sleep studies and patient demographic data were included in the analysis. RESULTS: Cephalometric analyses after long term OA use showed significant (P < .01) changes in many variables, including increases in mandibular plane and ANB angles; decreases in overbite and overjet; retroclined maxillary incisors; proclined mandibular incisors; increased lower facial height; and distally tipped maxillary molars with mesially tipped and erupted mandibular molars. The initial deep overbite group had a significantly greater decrease in overbite. Duration of OA use correlated positively with variables such as decreased overbite and increased mandibular plane angle; changes in the dentition appeared to be progressive over time. CONCLUSIONS: After long-term use, OAs appear to cause changes in tooth positions that also might affect mandibular posture.

Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis.

INTRODUCTION: Side effects observed in the occlusion and dental arches of patients using an oral appliance (OA) to treat snoring or sleep apnea for more than 5 years have not yet been investigated. METHODS: Stone casts trimmed in centric occlusion before appliance placement and after an average of 7.4 +/- 2.2 years of OA use in 70 patients were compared visually by 5 orthodontists. RESULTS: Of these patients, 14.3% had no occlusal changes, 41.4% had favorable changes, and 44.3% had unfavorable changes. Significant changes in many variables were found. Patients with greater initial overbites and Class II Division 1 and Class II Division 2 malocclusions were more likely to have favorable or no changes. More favorable changes in overbite occurred in subjects with large baseline overbites. A greater baseline overjet and more distal mandibular canine relationship were correlated to favorable changes. A greater initial overjet was correlated to a more favorable change, a decrease in mandibular crowding, a smaller change in anterior crossbite, and a greater change in overjet. CONCLUSIONS: OA wear after a mean of 7.4 years induces clinically relevant changes in the dental arch and the occlusion.

A comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea.

INTRODUCTION: This retrospective study compared cephalometric variables between responders and nonresponders to a titratable oral appliance (OA) in a group of subjects matched for sex, pretreatment age, and body mass index (BMI). METHODS: Nine nonresponders as defined by an improvement in the apnea hypopnea index (AHI; <20%) and their individually matched responders were selected for this study. The difference in age for each matched pair was +/-5 years, and, for BMI, the difference was +/-15%. The pretreatment AHI was matched to the same category (moderate, >15 to < or =30; severe I, >30 to < or =45; and severe II, >45 AHI). RESULTS: Middle and inferior airway space and oropharyngeal airway cross-sectional area were significantly larger in the nonresponders. Position of the mandible relative to the cervical spine was the only significant skeletal variable and was larger in nonresponders. Changes in BMI between the groups were statistically significant; the averages were a 2.9% increase in the nonresponders and a 0.5% decrease in responders. The wider airway in nonresponders might reflect an enhanced neuromuscular compensation while awake. The weight gain in nonresponders was relatively small, but it might have reduced the effectiveness of the OA. CONCLUSION: When treating OSA patients with OA therapy, clinicians should pay particular attention to airway size and weight changes.