Temporal association between leg movements and respiratory events in patients with obstructive sleep apnea: description and differences between the AASM and WASM scoring criteria.

PURPOSE: To describe the temporal association between leg movements (LMs) and respiratory events in patients with obstructive sleep apnea (OSA), and to quantify the difference in scoring respiratory-related leg movement (RRLM) between the American Academy of Sleep Medicine (AASM) criterion and the criterion recommended by the World Association of Sleep Medicine (WASM). METHODS: Patients with OSA who presented with > 10 LMs of any type per hour of sleep were included in this study. For each participant, RRLMs were scored using both the AASM criterion and the recommended WASM criterion. The occurrence of LMs in relation to respiratory events and the difference in scoring RRLM between the AASM criterion and the criterion recommended by the WASM were quantified. RESULTS: In 32 patients enrolled, mean age was 48.1 ± 11.0 years and 78% were men. LMs were significantly more frequent after respiratory events, followed by before respiratory events, and were rare during respiratory events (P < 0.01). Compared with the AASM criterion, more LMs were classified as RRLMs based on the recommended WASM criterion (P = 0.01). CONCLUSION: LMs are more frequent after respiratory events than before and during respiratory events, and more LMs are scored as RRLMs based on the recommended WASM criterion than based on the AASM criterion.

The Annoying Nature of Snoring Sounds Is Not Only about Intensity: A Pilot Study on Exposed Test Subjects.

This study aims to assess (i) which acoustic characteristics of snoring sounds are associated with the annoying nature of snoring sounds; (ii) whether listeners' heart rates correlate with their perceived annoyance; and (iii) whether perceived annoyance is different between listeners with different experiences with their bedpartners' snoring sounds. Six snoring epochs with distinct acoustic characteristics (viz., reference, high pitch, high intensity, short interval, irregular intensity, and irregular intervals) were collected from snoring patients. Twenty physicians and technicians were involved in the healthcare of snoring patients, and were divided into three groups based on personal experience with their bedpartners' snoring sounds (viz., non-snoring, snoring but not annoying, and snoring and annoying). The test subjects listened to each epoch and rated its level of annoyance. Listeners' heart rates were also recorded during the test using a finger plethysmograph. Within the limitations of this study, it was found that, compared with other snoring sounds, snoring sounds with high intensity and irregularity were associated with higher perceived annoyance. However, higher perceived annoyance of snoring sound was not reflected in heart rate-related parameters. In addition, listeners' personal experiences do not seem to affect their perceived annoyance.

Effects of demographic and sleep-related factors on snoring sound parameters.

OBJECTIVE: To investigate the effect of frequently reported between-individual (viz., age, gender, body mass index [BMI], and apnea-hypopnea index [AHI]) and within-individual (viz., sleep stage and sleep position) snoring sound-related factors on snoring sound parameters in temporal, intensity, and frequency domains. METHODS: This study included 83 adult snorers (mean ± SD age: 42.2 ± 11.3 yrs; male gender: 59%) who underwent an overnight polysomnography (PSG) and simultaneous sound recording, from which a total of 131,745 snoring events were extracted and analyzed. Data on both between-individual and within-individual factors were extracted from the participants' PSG reports. RESULTS: Gender did not have any significant effect on snoring sound parameters. The fundamental frequency (FF; coefficient = -0.31; P = 0.02) and dominant frequency (DF; coefficient = -12.43; P < 0.01) of snoring sounds decreased with the increase of age, and the second formant increased (coefficient = 22.91; P = 0.02) with the increase of BMI. Severe obstructive sleep apnea (OSA; AHI ≥30 events/hour), non-rapid eye movement sleep stage 3 (N3), and supine position were all associated with more, longer, and louder snoring events (P < 0.05). Supine position was associated with higher FF and DF, and lateral decubitus positions were associated with higher formants. CONCLUSIONS: Within the limitations of the current patient profile and included factors, AHI was found to have greater effects on snoring sound parameters than the other between-individual factors. The included within-individual factors were found to have greater effects on snoring sound parameters than the between-individual factors under study.

Associations between snoring and dental sleep conditions: A systematic review.

BACKGROUND: It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g. obstructive sleep apnea [OSA], sleep bruxism [SB], gastroesophageal reflux disease [GERD], xerostomia and oro-facial pain). If so, dentists could play a significant role in the early recognition and management of these conditions. OBJECTIVES: This systematic review aimed to: (i) investigate the associations between the presence of snoring and the presence of other dental sleep conditions; and (ii) determine if it is clinically relevant that dentists assess snoring in their population. METHODS: The literature search was performed in PubMed and Embase.com in collaboration with a medical librarian. Studies were eligible if they employed regression models to assess whether snoring was associated with other dental sleep conditions, and/or investigated the incidence of snoring in patients with other dental sleep conditions and vice versa. RESULTS: Of the 5299 retrieved references, 36 eligible studies were included. The available evidence indicates that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Due to limited evidence and conflicting findings, the currently available articles are not indicative of associations between the presence of snoring and the presence of SB and oral dryness. CONCLUSION: Within the limitations of this study, it can be concluded that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Therefore, it is clinically relevant that dentists assess snoring in their patient population.

Dental sleep-related conditions and the role of oral healthcare providers: A scoping review.

Dental sleep medicine as a discipline was first described about a quarter of a century ago. Snoring, obstructive sleep apnea, sleep bruxism, xerostomia, hypersalivation, gastroesophageal reflux disease, and orofacial pain were identified as dental sleep-related conditions. This scoping review aimed to: i) identify previously unidentified dental sleep-related conditions; and ii) identify the role of oral healthcare providers in the prevention, assessment, and management of dental sleep-related conditions in adults. A systematic literature search was conducted in PubMed, Embase.com, Web of Science, and Cochrane. Studies that reported an actual or likely role of oral healthcare providers in the prevention, assessment, and/or management of sleep-related conditions were included. Of the 273 included studies, 260 were on previously listed dental sleep-related conditions; the other 13 were on burning mouth syndrome. Burning mouth syndrome was therefore added to the list of dental sleep-related conditions for the first aim and categorized into sleep-related orofacial pain. For the second aim, the role of oral healthcare providers was found to be significant in the prevention, assessment, and management of obstructive sleep apnea and sleep bruxism; in the assessment and management of snoring, sleep-related orofacial pain, and oral dryness; and in the assessment of sleep-related gastroesophageal reflux condition.

Associated factors of primary snoring and obstructive sleep apnoea in patients with sleep bruxism: A questionnaire study.

BACKGROUND: By being aware of the associated factors of primary snoring (PS) and obstructive sleep apnoea (OSA) in sleep bruxism (SB) patients, dentists may contribute to the screening and early recognition of SB patients with PS or OSA. OBJECTIVE: To identify the associated factors of PS and OSA from questionnaire-based data in SB patients. METHODS: A total of 968 self-reported SB patients (31.6% men; median age 44.5 years) were retrospectively enrolled. Self-reported sleep-related breathing status (viz., no sleep-related breathing condition, PS and OSA) was the dependent variable. Independent variables were questionnaire-based data on demographics, lifestyle, psychological status, pain and sleep. RESULTS: For PS, no statistically significant associated factor was identified in analyses. For OSA, increased age (OR = 1.04 [1.03-1.06]), male gender (OR = 3.33 [2.17-5.00]), daily alcohol consumption (OR = 1.96 [1.18-3.33]), depression (OR = 1.10 [1.06-1.14]), daytime sleepiness (OR = 2.94 [1.85-4.76]) and high risk of gastroesophageal reflux disease (GERD; OR = 2.63 [1.52-4.76]) were found to be significant risk factors, while high risk of temporomandibular disorder (TMD) pain (OR = 0.51 [0.30-0.86]) and chronic pain (OR = 0.73 [0.59-0.90]) were significant protective factors. These results were confirmed in the subsequent network analysis. CONCLUSION: Within the limitations of this study, no associated factor is identified for PS. For OSA, dentists should keep in mind that increased age, male gender, daily alcohol consumption, depression, daytime sleepiness and high GERD risk are associated with increased OSA risk in SB patients, while high TMD-pain risk and chronic pain are associated with decreased OSA risk in this population.

Predicting upper airway collapse sites found in drug-induced sleep endoscopy from clinical data and snoring sounds in patients with obstructive sleep apnea: a prospective clinical study.

STUDY OBJECTIVES: The primary aim was to predict upper airway collapse sites found in drug-induced sleep endoscopy (DISE) from demographic, anthropometric, clinical examination, sleep study, and snoring sound parameters in patients with obstructive sleep apnea (OSA). The secondary aim was to identify the above-mentioned parameters that are associated with complete concentric collapse of the soft palate. METHODS: All patients with OSA who underwent DISE and simultaneous snoring sound recording were enrolled in this study. Demographic, anthropometric, clinical examination (viz., modified Mallampati classification and Friedman tonsil classification), and sleep study parameters were extracted from the polysomnography and DISE reports. Snoring sound parameters during DISE were calculated. RESULTS: One hundred and nineteen patients with OSA (79.8% men; age = 48.1 ± 12.4 years) were included. Increased body mass index was found to be associated with higher probability of oropharyngeal collapse (P < .01; odds ratio = 1.29). Patients with a high Friedman tonsil score were less likely to have tongue base collapse (P < .01; odd ratio = 0.12) and epiglottic collapse (P = .01; odds ratio = 0.20) than those with a low score. A longer duration of snoring events (P = .05; odds ratio = 2.99) was associated with a higher probability of complete concentric collapse of the soft palate. CONCLUSIONS: Within the current patient profile and approach, given that only a limited number of predictors were identified, it does not seem feasible to predict upper airway collapse sites found in DISE from demographic, anthropometric, clinical examination, sleep study, and snoring sound parameters in patients with OSA. CITATION: Huang Z, Bosschieter PFN, Aarab G, et al. Predicting upper airway collapse sites found in drug-induced sleep endoscopy from clinical data and snoring sounds in obstructive sleep apnea patients: a prospective clinical study. J Clin Sleep Med. 2022;18(9):2119-2131.

Prediction of the obstruction sites in the upper airway in sleep-disordered breathing based on snoring sound parameters: a systematic review.

BACKGROUND: Identification of the obstruction site in the upper airway may help in treatment selection for patients with sleep-disordered breathing. Because of limitations of existing techniques, there is a continuous search for more feasible methods. Snoring sound parameters were hypothesized to be potential predictors of the obstruction site. Therefore, this review aims to i) investigate the association between snoring sound parameters and the obstruction sites; and ii) analyze the methodology of reported prediction models of the obstruction sites. METHODS: The literature search was conducted in PubMed, Embase.com, CENTRAL, Web of Science, and Scopus in collaboration with a medical librarian. Studies were eligible if they investigated the associations between snoring sound parameters and the obstruction sites, and/or reported prediction models of the obstruction sites based on snoring sound. RESULTS: Of the 1016 retrieved references, 28 eligible studies were included. It was found that the characteristic frequency components generated from lower-level obstructions of the upper airway were higher than those generated from upper-level obstructions. Prediction models were built mainly based on snoring sound parameters in frequency domain. The reported accuracies ranged from 60.4% to 92.2%. CONCLUSIONS: Available evidence points toward associations between the snoring sound parameters in the frequency domain and the obstruction sites in the upper airway. It is promising to build a prediction model of the obstruction sites based on snoring sound parameters and participant characteristics, but so far snoring sound analysis does not seem to be a viable diagnostic modality for treatment selection.

Maxillomandibular advancement versus multilevel surgery for treatment of obstructive sleep apnea: A systematic review and meta-analysis.

Multilevel surgery (MLS) and maxillomandibular advancement surgery (MMA) are two established options in surgical management of obstructive sleep apnea (OSA), which target different levels of airway obstruction. The objective of this review was to comparatively evaluate the clinical efficacy and safety of MMA and MLS in the treatment of OSA. MEDLINE and Embase databases were searched for studies on MMA and/or MLS in OSA patients. Twenty MMA studies and 39 MLS studies were identified. OSA patients who underwent MMA showed significant improvements in AHI, LSAT, ODI, and ESS by -46.2/h, 13.5%, -30.3/h, and -8.5, respectively. The pooled rates of surgical success and cure for MMA were 85.0% and 46.3%, respectively. Patients who underwent MLS showed significant improvements in AHI, LSAT, ODI, and ESS by -24.7/h, 8.7%, -19.1/h, and -5.8, respectively. The pooled surgical success and cure rates for MLS were 65.1% and 28.1%, respectively. The rates of major complication of MMA and MLS were 3.2% and 1.1%, respectively, and the rate of minor complication of MMA was higher than that of MLS. We conclude that both MMA and MLS are effective treatment options for OSA. Compared to MLS, MMA may be more effective in improving OSA. However, the complication rate of MMA is higher.

The biocompatibility and mechanical properties of plasma sprayed zirconia coated abutment.

PURPOSE: The aim of this study was to evaluate the clinical performance and reliability of plasma sprayed nanostructured zirconia (NSZ) coating. MATERIALS AND METHODS: This study consisted of three areas of analysis: (1) Mechanical property: surface roughness of NSZ coating and bond strength between NSZ coating and titanium specimens were measured, and the microstructure of bonding interface was also observed by scanning election microscope (SEM). (2) Biocompatibility: hemolysis tests, cell proliferation tests, and rat subcutaneous implant test were conducted to evaluate the biocompatibility of NSZ coating. (3) Mechanical compatibility: fracture and artificial aging tests were performed to measure the mechanical compatibility of NSZ-coated titanium abutments. RESULTS: In the mechanical study, 400 µm thick NSZ coatings had the highest bond strength (71.22 ± 1.02 MPa), and a compact transition layer could be observed. In addition, NSZ coating showed excellent biocompatibility in both hemolysis tests and cell proliferation tests. In subcutaneous implant test, NSZ-coated plates showed similar inflammation elimination and fibrous tissue formation processes with that of titanium specimens. Regarding fatigue tests, all NSZ-coated abutments survived in the five-year fatigue test and showed sufficient fracture strength (407.65-663.7 N) for incisor teeth. CONCLUSION: In this study, the plasma-sprayed NSZ-coated titanium abutments presented sufficient fracture strength and biocompatibility, and it was demonstrated that plasma spray was a reliable method to prepare high-quality zirconia coating.

The osteoinduction of RGD and Mg ion functionalized bioactive zirconia coating.

The objective of this study was to investigate the adhesion, proliferation and mineralization of osteoblasts on arginine-glycine-aspartic acid (RGD)- and magnesium ion (Mg+)-decorated zirconia coatings. The zirconia coatings were prepared via a plasma spray; RGD and Mg+ were immobilized via a silane-coupling agent and ion implantation, respectively. This study employed scanning electron microscopy (SEM) to observe the surface morphology of RGD- and Mg+-decorated zirconia coatings; surface roughness and wettability were also measured. The initial adhesion of osteoblasts was measured, and cell morphology and focal adhesion were observed. In addition, the expressions of the integrins a1, a2, a5, av, and ß1 were measured using RT-PCR. A cell count was conducted to measure proliferation. The expressions of ALP and OCN were detected based on a western blot analysis, and mineralized nodules were observed to visualize the mineralization of osteoblasts. A nanoscale surface structure could be found on the Mg+-decorated zirconia coating, and the RGD-decorated zirconia coating showed better wettability (p < 0.05). Cells on the RGD- and Mg+-decorated zirconia coating possessed better spreading properties than did cells on nondecorated surfaces, and more focal adhesion was observed. The higher expressions of the integrins a5, av and ß1 were found on the RGD-decorated zirconia coating (p < 0.05). The western blot results demonstrated that the introduction of Mg+ heightened the expressions of ALP and OCN. More and bigger mineralized nodules were observed on the Mg+- and RGD-decorated zirconia coating, which consisted of small mineralized nodules. RGD- and Mg+-functionalized zirconia coating facilitates the osteogenic reaction of osteoblasts. RGD improves the adhesion of osteoblasts, and Mg+ benefits the mineralization of osteoblasts. In addition, a synergistic effect was found between RGD and Mg+, allowing better performances with regard to adhesion, proliferation and mineralization when the two were used together rather than as separate decorations.

Application of Plasma Sprayed Zirconia Coating in Dental Implant: Study in Implant.

The aim was to investigate the osseointegration of a novel coating-plasma-sprayed nanostructured zirconia (NSZ) in dental implant. Nanostructured zirconia coating on non-thread titanium implant was prepared by plasma spraying, the implant surface morphology, surface roughness and wettability were measured. In vivo, nanostructured zirconia-coated implants were inserted in rabbit tibia and animals were respectively sacrificed at 2, 4, 8 and 12 weeks after implantation. The bond strength between implant and bone was measured by removal torque (RTQ) test. The osseointegration was observed by scanning electron microscopy (SEM), micro computed tomography (Micro CT) and histological analyses. Quantified parameters were calculated, including removal torque, Bone Volume to Tissue Volume (BV/TV), Trabecular Thickness (Tb. Th), Trabecular Number (Tb. N), Trabecular Separation/Spacing (Tb. Sp), and Bone-Implant contact (BIC) percentage. The statistical differences were detected by two-tail Mann-Whitney U test (SPSS 20.0). The surface roughness (1.58µm) and wettability (54.61°) of nanostructured zirconia coated implant was more suitable than those of titanium implant (0.598µm and 74.38°) for osseointegration and hierarchical surface morphology could be seen on zirconia coating. The histological analyses showed that zirconia coated implant induced earlier and more condensed bone formation than titanium implant at 2 and 4 weeks. Quantified parameters showed the significant differences between these two groups at early healing period, but the differences between these two groups decreased with the increase of healing period. All these results demonstrated that plasma sprayed zirconia coated implant induced better bone formation than titanium implant at early stage.

Study of microRNAs targeted Dvl2 on the osteoblasts differentiation of rat BMSCs in hyperlipidemia environment.

Dishevelled 2 (Dvl-2), a key mediator of the wnt/ß-catenin signaling pathway, plays critical roles in osteoblasts differentiation in hyperlipidemia environment. In our previous study, we observed a strong correlation between increased dvl2 expression and decreased new bone formation around implants in a rat hyperlipidemia implant surgery model. However, transcriptional regulation of Dvl2 by microRNAs in this process remains unknown. In the current study, we searched in online database and identified four significantly up-regulated miRNAs, miR-21-5p, miR-29c-3p, miR-138-5p, and miR-351-5p that could potentially regulate Dvl2. Using Western blot and dual-luciferase assays, we confirmed that miR29c-3p suppresses Dvl2 expression by binding to its 3'-UTR. Our results suggest a novel transcriptional regulation mechanism of Dvl2 by miR-29c-3p in osteoblasts differentiation of BMSCs.