Mandibular Advancement Devices in Patients with Symptoms of Obstructive Sleep Apnea: A Review.

Obstructive sleep apnea (OSA) is a sleep disorder resulting from the repetitive narrowing and collapse of the upper respiratory tract. The results of previous epidemiological studies confirm a significant impact of OSA on the health situation around the world. Untreated OSA is associated with many adverse health effects, such as hypertension, coronary artery disease, stroke, atrial fibrillation, congestive heart failure, and daytime sleepiness. Excessive mortality of OSA patients, especially in men under 50 years of age, associated with advanced disease, obesity, cardiovascular complications, and a greater risk of road accidents, requires an urgent extension of the diagnostic-therapeutic database dealing with this problem. It is estimated that in the adult population, OSA occurs in 4% of men and in 2% of women. In recent years, intraoral devices have become an increasingly common method of OSA and snoring treatment. Nevertheless, the use of devices producing continuous positive airway pressure (CPAP) remains the most effective treatment method. However, intraoral devices have the advantage of not requiring a source of electricity and are less troublesome in everyday use. Intraoral devices are well tolerated by the majority of patients, and their therapeutic efficacy is confirmed. Since such devices become commoner, the purpose of this work was to present the procedures, indications, and recommendations involved with intraoral devices while taking into consideration a variety of dental conditions. The side effects of the use of intraoral devices and their influence on the entire stomatognathic system were also described.

Mandibular Advancement Devices in Obstructive Sleep Apnea Patients Intolerant to Continuous Positive Airway Pressure Treatment.

Obstructive sleep apnea (OSA) is defined as episodes of upper airway obstruction occurring during sleep. Conservative treatment of OSA consists of continuous positive airway pressure (CPAP). An alternative treatment in mild-to-moderate OSA could be the use of intraoral mandibular advancement devices (MAD). The aim of this study was to evaluate therapeutic efficacy of MAD in OSA patients intolerant to CPAP. The study group included 8 patients, who fulfilled specific inclusion criteria during a dental examination, out of the 30 CPAP intolerant patients who were referred for the possible use of MAD. The selected patients used MAD for 30 days and then switched to CPAP for 10 days to compare the effectiveness of both treatment methods. They had 3 polysomnographic (PSG) examination: baseline before treatment, and at the end of MAD and CPAP. We found that either treatment method resulted in comparable symptomatic improvements in OSA patients. In detail, the apnea-hypopnea index decreased, along with the overall number of obstructive, central, and mixed apneic episodes during sleep time. The mean arterial oxygen saturation (SaO2) improved and the minimum SaO2 level noted during night time got enhanced. Differences in the sleep apnea indices after MAD and CPAP treatments were insignificant, but there was a consistent impression that CPAP was superior to MAD as it tended to improve symptoms to a somehow greater extent. We conclude that MAD is a sufficiently effective treatment alternative for OSA patients who are intolerant to CPAP or in whom CPAP therapy fails.

Therapeutic Efficacy of Mandibular Advancement Devices in Patients with Severe Sleep Apnea: A Preliminary Report.

Obstructive sleep apnea (OSA) is defined as episodes of upper airway obstructions during sleep. The method of choice in conservative treatment of OSA is the use of devices that produce positive airway pressure (CPAP). In patients with mild-moderate form of OSA, intraoral mandibular advancement devices (MAD) are applied. The aim of the study was to evaluate the therapeutic efficacy of MAD in patients with severe OSA who were unable to use CPAP. In this preliminary study three patients from a group of 25 severe OSA sufferers who failed to use CPAP, were included. The three patients underwent a triple polysomnographic (PSG) investigation: on CPAP, before MAD treatment, and during MAD. The patients completed the Epworth Sleepiness Scale questionnaire twice. We found significant improvements of subjective symptoms and PSG-evaluated variables after application of MAD in all three patients in comparison with both baseline and CPAP-recorded data. We conclude that MAD can be an alternative treatment option for severe OSA patients who are non-compliant with CPAP therapy.

Mandibular Advancement Appliance for Obstructive Sleep Apnea Treatment.

A combination of abnormal anatomy and physiology of the upper airway can produce its repetitive narrowing during sleep, resulting in obstructive sleep apnea (OSA). Treatment of sleep-breathing disorder ranges from lifestyle modifications, upper airway surgery, continuous positive airway pressure (CPAP) to the use of oral appliances. A proper treatment selection should be preceded by thorough clinical and instrumental examinations. The type and number of specific oral appliances are still growing. The mandibular advancement appliance (MAA) is the most common type of a dental device in use today. The device makes the mandible protrude forward, preventing or minimizing the upper airway collapse during sleep. A significant variability in the patients' response to treatment has been observed, which can be explained by the severity of sleep apnea at baseline and duration of treatment. In some trials, patients with mild OSA show a similar treatment effect after the use of CPAP or MAA. It is worthwhile to give it a try with an oral appliance of MAA type in snoring, mild-to-moderate sleep apnea, and in individuals who are intolerant to CPAP treatment.

[The occurrence of the Enterobacter genus rods in the clinical materials and materials taken from hospital environment]. / Wystepowanie paleczek z rodzaju Enterobacter w materialach klinicznych i pobranych ze srodowiska szpitalnego.

Due to continuously existing essential meaning of strains of Enterobacter spp. in human infections we investigated the occurrence of Enterobacter spp. in different clinical materials and in materials taken from hospital environment. Amongst 26,025 materials taken from patients there were 249 (1.0%) Enterobacter strains and respectively amongst 954 environmental materials--there were 11 (1.2%) Enterobacter spp. In isolated Enterobacter strains the percentage occurrence was: hospital materials: E. cloacae--65.6%, E. agglomerans--12.1%, E. aerogenes--6.25%, E. sakazakii--5.4%, E. gergoviae--1.3%, E. amnigenus--0.9%, E. intermedius--0.9% and Enterobacter spp.--7.6%; outpatient materials: E. cloacae--72.0%, E. sakazakii--12.0%, E. agglomerans--8.0%, E. aerogenes--4.0% and E. amnigenus--4.0%; hospital community: E. cloacae--63.6%, E. agglomerans--18.2% and E. sakazakii--18.2%.