Dental sleep medicine education among undergraduate dental students in France.

INTRODUCTION: Dental sleep medicine (DSM) is an emerging discipline that studies the oral and maxillofacial causes and consequences of sleep-related problems. DSM is of upmost importance given the major medical challenge it represents. Therefore, to verify whether the future generation of dentists would be ready to face this challenge, the main objective of this study was to assess the degree of involvement of the French dental schools in teaching DSM at the undergraduate level. MATERIALS AND METHODS: All 16 dental schools in France were asked to participate in the study by answering to an online survey concerning the DSM curriculum during the 2018-2019 academic year. The survey was addressed to the head of the dental school and/or to relevant course coordinators and contained 10 questions related to the type, content and amount of DSM teaching to undergraduate dental students. RESULTS: Nine of the 16 (56.2%) French dental schools responded to the questionnaire. All these nine reported the inclusion of DSM in their undergraduate curriculum. The total average hours dedicated to teaching DSM was 5.6 h (SD 4.2; range 1-15 h). Seven of the 9 dental schools spent most of their DSM curriculum teaching time in the fifth year. All of them reviewed obstructive sleep apnoea and sleep-related bruxism and covered some topics related to therapies for sleep-related breathing disorders, such as the use of oral appliance. CONCLUSION: The results of this survey showed that, although the average hourly volume is relatively high, the DSM teaching in French dental schools appeared to be non-standardised, heterogeneous and often lacunar. It is therefore essential to develop a common curriculum and implement it in all dental schools to provide undergraduate students a comprehensive and updated teaching in DSM.

Mandibular advancement device: prescription in adult dental sleep medicine - guideline of the German Society of Dental Sleep Medicine.

PURPOSE: Obstructive sleep apnea (OSA) may result in severe health onditions, reduces quality of live, and affects high percentages of the adult population. Due to recent changes in the German health care regulations, mandibular advancement devices (MAD) will become available as a treatment option for OSA to a greater extent for general dentists and their patients. METHODS: A guideline development group consisting of nine members representing four German dental and medical organizations was formed, in order to provide critical information and orientation to the main stakeholders (dentists and patients), regarding the use of MAD for the treatment of OSA within dental sleep medicine. RESULTS: This guideline aims to inform physicians and dentists, particularly those with acquired qualification/specialization in sleep medicine (or in the diagnosis and treatment of sleep-related breathing disorders), as well as experts, payers, and patients. It delivers recommendations on technical requirements for MAD prescription and fabrication, clinical procedures, maintenance, and follow-up procedures. CONCLUSION: A MAD should be designed for long-term therapy and must be a custom made, adjustable, bimaxillary retained two-splint system equipped with adjustable protrusive elements. The fabrication in a dental laboratory should be based on dental impressions or scans and three-dimensional registrations of the starting position taken with a bite gauge.

Drug-induced sleep endoscopy improves intervention efficacy among patients treated for obstructive sleep apnea with a mandibular advancement device.

PURPOSE: To compare the short-term treatment effect of a mandibular advancement device (MAD) with and without previous drug-induced sleep endoscopy (DISE) on polysomnography (PSG) and other sleep apnea-related treatment outcomes (Short Form Health Survey [SF-36] and Epworth Sleepiness Scale [ESS]) among adults with mild, moderate, and severe obstructive sleep apnea (OSA). We hypothesized that using DISE would improve the efficacy of MADs on the sleep apnea parameters. METHODS: The study sample consisted of patients with OSA who were unable or unwilling to tolerate a CPAP device, divided into an experimental (with DISE) and a control (without DISE) group. RESULTS: Of 50 patients with OSA, 40 men (80%), mean age was 48.8 ± 12,3 years. The mean apnea-hypopnea index (AHI) score of both groups decreased significantly between baseline and the 8-week follow-up titration PSG with MAD in situ, from 31.7 ± 17.3 (mean ± SD) apnea-hypopnea episodes/h to 7.0 ± 6.4/h (p < 0.0001) in the experimental group, and from 22.5 ± 16.6 episodes/h to 11.4 ± 8.0/h (p < 0.024) in the control group. Capillary oxygen saturation (SpO2) levels did not change significantly between the two timepoints for either group. The SF-36 (p < 0.023) and ESS (p < 0.036) results of both groups improved significantly between baseline and the 8-week follow-up after starting MAD treatment; however, the improvement in quality of life was significantly more pronounced in the experimental group than in the control group (p < 0.0001). CONCLUSION: DISE provides a significant benefit to patients with OSA undergoing MAD treatment. It can be used as a valuable prediction tool in clinical practice for the management of patients with OSA, even those with moderate and severe disease.

Research routes on improved sleep bruxism metrics: Toward a standardised approach.

A recent report from the European Sleep Research Society's task force "Beyond AHI" discussed an issue that has been a long-term subject of debate - what are the best metrics for obstructive sleep apnoea (OSA) diagnosis and treatment outcome assessments? In a similar way, sleep bruxism (SB) metrics have also been a recurrent issue for >30 years and there is still uncertainty in dentistry regarding their optimisation and clinical relevance. SB can occur alone or with comorbidities such as OSA, gastroesophageal reflux disorder, insomnia, headache, orofacial pain, periodic limb movement, rapid eye movement behaviour disorder, and sleep epilepsy. Classically, the diagnosis of SB is based on the patient's dental and medical history and clinical manifestations; electromyography is used in research and for complex cases. The emergence of new technologies, such as sensors and artificial intelligence, has opened new opportunities. The main objective of the present review is to stimulate the creation of a collaborative taskforce on SB metrics. Several examples are available in sleep medicine. The development of more homogenised metrics could improve the accuracy and refinement of SB assessment, while moving forward toward a personalised approach. It is time to develop SB metrics that are relevant to clinical outcomes and benefit patients who suffer from one or more possible negative consequences of SB.

The face of Dental Sleep Medicine in the 21st century.

It becomes increasingly clear that some sleep disorders have important diagnostic and/or management links to the dental domain, hence the emergence of the discipline 'Dental Sleep Medicine'. In this review, the following topics are discussed: 1. the reciprocal associations between oro-facial pain and sleep; 2. the associations between sleep bruxism and other sleep-related disorders; 3. the role of the dentist in the assessment and management of sleep bruxism; and 4. the dental management of obstructive sleep apnoea. From these topics' descriptions, it becomes clear that the role of the dentist in the recognition and management of sleep-related oro-facial pain, sleep bruxism and obstructive sleep apnoea is large and important. Since many dental sleep disorders can have severe consequences for the individual's general health and well-being, it is imperative that dentists are not only willing to take on that role, but are also able to do so. This requires more attention for Dental Sleep Medicine in the dental curricula worldwide, as well as better postgraduate training of dentists who are interested in specialising in this intriguing domain. This review contributes to increasing the dental researcher's, teacher's and care professional's insight into the discipline 'Dental Sleep Medicine' as it has taken shape in the 21st century, to the benefit of all patients suffering from dental sleep disorders.

Vertical dimension in dental sleep medicine oral appliance therapy.

The objective of this pilot study was to evaluate the effect of a multidimensional approach to occlusal registration, including vertical dimension as assessed using pharyngometry, on the success of oral appliance therapy. Successful medical improvements resulting from therapy were determined by secondary polysomnographic studies. Thirty patients were enrolled in this pilot study. Their initial apnea-hypopnea index (AHI) scores ranged from 6.0 (mild obstructive sleep apnea) to 81.6 (severe obstructive sleep apnea). Occlusal registrations were taken using pharyngometer readings to establish vertical and anteroposterior (AP) positions for each patient and compared to the AP-only position in the same patient, determined using a George Gauge at 70% protrusion. All follow-up sleep tests occurred 31-45 days after the delivery of oral appliances set at the multidimensional vertical and AP positions determined by pharyngometry. No appliance titration was required. In the 26 patients who completed the study, the mean AHI before therapy was 20.7, and the mean AHI after therapy was 7.8, a 62.3% decrease. Within the limitations of this study, the pharyngometer-established occlusal position was effective in lowering AHI without the need for appliance titration procedures, which are typically required when the 70% protrusive George Gauge occlusal registration method is used. Additionally, the position determined with the 70% George Gauge was, on average, 5.0 mm more protrusive than the pharyngometer registration.

Role of dental sleep medicine in management of patients with obstructive sleep apnea disorders using a team approach.

OBJECTIVE: Obstructive sleep apnea (OSA) is a significant social and health issue. An integrated multidisciplinary approach to OSA management may be the most effective owing to its multifactorial etiology. In this study, we evaluated the frequency and efficacy of various treatment modalities for OSA administered via an integrated care delivery model, and assessed the role of dental sleep medicine as part of a multidisciplinary team. MATERIALS AND METHODS: We retrospectively evaluated 1115 patients with OSA treated at the Tokyo Medical University Hospital's Outpatient Clinic for OSA by a multidisciplinary team under one roof. The various treatment methods included the following: continuous positive airway pressure (CPAP), oral appliance (OA), surgery, and behavioral treatment. RESULTS: The patient number of study group was as follows: 771 (69.1%) CPAP; 240 (21.5%) OA; 76 (6.8%) behavioral treatment and 28 (3%) surgery. Because significantly fewer patients underwent surgery, there was a discrepancy between the recommended first-choice treatment and the actual treatment. A statistically significant number of younger patients in each treatment group underwent surgery. Success rate of OA and MMA were 74.4 and 80%, respectively. CONCLUSIONS: Proper selection of primary treatment to manage patients with OSA was possible under one-roof system that included dental sleep medicine.

Interactions between sleep disorders and oral diseases.

Dental sleep medicine is a rapidly growing field that is in close and direct interaction with sleep medicine and comprises many aspects of human health. As a result, dentists who encounter sleep health and sleep disorders may work with clinicians from many other disciplines and specialties. The main sleep and oral health issues that are covered in this review are obstructive sleep apnea, chronic mouth breathing, sleep-related gastroesophageal reflux, and sleep bruxism. In addition, edentulism and its impact on sleep disorders are discussed. Improving sleep quality and sleep characteristics, oral health, and oral function involves both pathophysiology and disease management. The multiple interactions between oral health and sleep underscore the need for an interdisciplinary clinical team to manage oral health-related sleep disorders that are commonly seen in dental practice.

Focus of dental sleep medicine on obstructive sleep apnea in older adults: A narrative review.

PURPOSE: To review dental sleep medicine in older adults based on the literature. STUDY SELECTION: This narrative review focuses on sleep physiology, common sleep disorders, and obstructive sleep apnea (OSA) in older adults and their management. RESULTS: Sleep physiology differs between older and younger adults, with sleep disturbances occurring more frequently in older adults. The prevalence of insomnia increases in older adults due to age-related changes in sleep physiology. Insomnia, sleep-disordered breathing, periodic limb movement disorder, restless legs syndrome, and rapid eye movement (REM) sleep behavior disorder are common sleep disorders in older adults. OSA is more prevalent in older adults, and its effects on them are considered more substantial than those on younger adults. The treatment of older patients with mandibular advancement devices may be less effective and more complex owing to potential impairments in oral and dental health. Furthermore, the prevalence of edentulism in older adults is decreasing while life expectancy is increasing. CONCLUSIONS: As older adults have comorbidities that affect sleep quality, dentists should consider the effects of sleep physiology and sleep disorders in these patients. OSA may decrease the quality of life and increase the risk of developing other diseases. Therefore, dentists proposing treatment with mandibular advancement devices need to inform patients of their potential lack of efficacy and the requirement for careful follow-up owing to known and unknown side effects.

The Evolving Field of Dental Sleep Medicine.

Dental sleep medicine is a dynamic field focused on the relationship between oral health and sleep disorders, particularly sleep apnea. Dentists play a crucial role in diagnosing and treating sleep-related breathing issues. As awareness of the impact of sleep on overall health grows, the field is evolving rapidly with advancements in technology, diagnostic tools, and treatment modalities. Interdisciplinary collaboration between dentists, sleep physicians, and other health care professionals is becoming increasingly important. The integration of innovative approaches and a patient-centric focus make dental sleep medicine a pivotal player in addressing the complex interplay between oral health and sleep quality.

Development and initial validation of a questionnaire to measure patient experience with oral appliance therapy.

STUDY OBJECTIVES: To develop and validate a questionnaire to measure patient experience with oral appliance therapy. METHODS: The AMEE Guide No. 87 was followed in the development and validation of a patient questionnaire to assess patient experience with oral appliance therapy. RESULTS: Our search identified 522 articles; 5 of these articles described the use and/or validation of questionnaires to measure changes in symptoms and patient-reported outcomes in the treatment of obstructive sleep apnea. A total of 27 questions were developed. Five patients participated in pilot testing. A final review of the questionnaire was conducted by an expert panel. CONCLUSIONS: The creation and validation of a questionnaire to assess patient experience with oral appliance therapy may provide new methods for advancing research in the field of dental sleep medicine. CITATION: Ng ET, Perez-Garcia A, Lagravère-Vich MO. Development and initial validation of a questionnaire to measure patient experience with oral appliance therapy. J Clin Sleep Med. 2023;19(8):1437-1445.

Dental Sleep Medicine Education Amongst Accredited Orthodontic Programmes in Thailand.

BACKGROUND: Dental sleep medicine education (DSME) should be emphasised in postgraduate orthodontic training; however, there appears to be no clear guideline for its implementation into the curriculum. OBJECTIVE: The aim was to investigate the current status of DSME as well as its feasibility and implementation in postgraduate orthodontic programmes. METHODS: A structured interview with predetermined response options was chosen as a data collection method to gather relevant information from representatives of all accredited postgraduate orthodontic programmes in Thailand. These interviews were conducted online via the Cisco Webex Meeting platform. A combination of data analysis techniques was employed to achieve a thorough comprehension of the research findings, including descriptive statistics, quantitative content analysis, thematic analysis, and alignment analysis. RESULTS: All participating programmes reported the inclusion of DSME in their curricula. A didactic approach was adopted by all programmes. However, only 2 out of 7 programmes offered clinical sessions for their students. Several challenges in implementing DSME within orthodontic programmes were identified, including a shortage of expertise and limited patient access. The participants also suggested that knowledge and resource sharing amongst institutions could serve as a potential solution to enhance the feasibility of DSME. CONCLUSIONS: This research highlighted the significant disparities and inadequacy of DSME within postgraduate orthodontic programmes in Thailand due to various challenges. Consequently, there is a compelling need to place greater emphasis on DSME and establish a national-level standardisation within orthodontic programmes. This effort is essential for enhancing the awareness and competency of orthodontists in the field of DSME.

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.

Evaluating a dental sleep apnea mini-residency program using the Kirkpatrick model.

OBJECTIVE: The aim of this retrospective study was to evaluate a Dental Sleep Medicine Mini-Residency (DSMMR) continuing education (CE) program using the Kirkpatrick model. METHODS: After receiving ethical approval, data from participants in the 2019-2020 DSMMR CE course were included for the Kirkpatrick evaluation. The analysis was stratified and all the Kirkpatrick levels were integrated: level 1 (satisfaction) was assessed via Likert scale and open-ended questions; level 2 (learning) was evaluated using pretest and posttest knowledge data following Module 1 (M1) and an assessment of multiple-choice questions (MCQs) developed by participants; level 3 (behavior) was evaluated using Likert scale questions; and level 4 (results) was assessed via the percentage of participants who passed the American Board of Dental Sleep Medicine (ABDSM) examination on their first attempt. RESULTS: A total of 90 participants were included in the study. At least 83.1% of participants agreed/strongly agreed with positively worded statements about satisfaction. Knowledge scores significantly increased from pre-M1 to post-M1 (p < 0.001); however, only 15.2% of MCQs were evaluated as well-formulated. At least 88.6% of participants agreed/strongly agreed with positively worded statements about transfer of knowledge/skills to their practice. 91.1% passed the ABDSM examination on their first attempt. CONCLUSION: The evaluation of the 2019-2020 DSMMR using the Kirkpatrick model suggests its overall positive impact as a training program. The Kirkpatrick model provided information that can be used to improve the quality of a program. Future studies should assess other dental CE programs using the Kirkpatrick model or another evaluation model.

Orofacial myofunctional reeducation assisted by a prefabricated reeducation appliance: a systematic review of the literature / Rééducation myofonctionnelle orofaciale assistée par gouttière de rééducation préfabriquée : une revue systématique de la littérature

Introduction: Several cross-sectional studies have shown the association of a dysfunctional orofacial environment with a greater prevalence of malocclusions. Orofacial myofunctional reeducation (OFMR) is the rehabilitation of the muscles, functions and resting postures of the orofacial complex. It is used in the therapeutic management of orofacial dysfunction in patients of all ages and with a wide range of disorders and comorbidities. RMOF mainly uses isotonic and isometric exercises targeting the oral and oropharyngeal structures, combined with specific exercises for ventilation, swallowing and mastication. It may involve the use of prefabricated reeducation appliances (PRAs), which may also be prescribed to modify the shape and relationship of the dental arches. Objectives: The primary objective of this systematic review of the literature was to describe and evaluate the efficacy of prefabricated reeducation appliance-assisted OFMR in orthodontics, occlusodontics and dental sleep medicine. Its secondary objective was to assess whether the use of currently available PRAs is associated with adverse effects. Materials and Methods: The systematic literature review was undertaken using five electronic databases: Medline (via PubMed), Web of Science, Cochrane Library, Embase, and Google Scholar, to identify studies evaluating the efficacy of PRA-assisted OFMR in the treatment of orofacial dysfunctions and parafunctions, temporo-mandibular dysfunction (TMD) or obstructive sleep apnea (OSA) in children, adolescents and adults, published until 20 March 2023. The primary outcome of interest was the therapeutic efficacy of PRA-assisted OFMR. In patients with obstructive sleep apnoea (OSA), efficacy was assessed primarily by a decrease in the apnoea/hypopnoea index (AHI) of at least five episodes per hour from baseline, improvement in subjective sleep quality, sleep quality measured by nocturnal polysomnography and subjectively measured quality of life. In patients with orofacial dysfunctions, parafunctions or TMD, efficacy was assessed mainly by electromyography (EMG), history and clinical examination. Secondary outcomes were dentoalveolar or skeletal improvements, and possible adverse effects of the PRAs used, including adverse effects on occlusion. Results: Only fourteen studies met all inclusion criteria: two randomised controlled trials, one non-randomised controlled trial, five prospective case-control studies, two retrospective case-control studies, two prospective case series and two retrospective case series. The two randomised controlled trials were assessed as "low risk of bias" according to the Cochrane Back Review Group's 12 risk of bias criteria. The methodological quality of the remaining 12 included studies was assessed using the ROBINS-I tool, according to the recommendations of the Cochrane Handbook. One was judged to have a measured risk of bias, eight a significant risk of bias and three a critical risk of bias. Based on the available evidence, PRA-assisted OFMR results in a statistically significant (p=0.0425) reduction in AHI in children with mild to moderate obstructive sleep apnea. In children with obstructive sleep apnoea undergoing adenoid and/or tonsil surgery, postoperative OFMR combined with a flexible PRA leads to a greater reduction in AHI compared to a control group and an improvement in SaO2 at 6 months and 12 months after surgery (p<0.01). It also contributes to greater improvement in sleep disturbance, physical fitness, daytime lethargy in the treated group than in the control group 6 months and 12 months after surgery (p<0.05). PRA-assisted OFMR provides correction of atypical swallowing and improvement in orofacial muscle balance. GRPs are generally less effective than activators for the treatment of Class II Division 1 malocclusions and appear to cause more adverse effects, mainly vestibuloversion of the mandibular incisors. The use of PRA-assisted OFMR for the management of TMD is not validated by current evidence. Conclusions: Published data, albeit of uneven methodological quality, appear to show the superiority of OFMR combined with the use of a PRA, compared with the implementation of OFMR without PRA. Prospective studies with large sample sizes would be useful to better evaluate the new therapeutic possibilities brought by the combination of OFMR with a PRA. Continued attention should be paid to the monitoring of possible adverse effects of PRA-assisted OFMR on the dental arches, especially the vestibuloversion of the mandibular incisors. It might be useful to reflect on the relevance of the arguments put forward by manufacturers about the particularities of their devices and their supposed effects. PRA-assisted OFMR appears to be a necessary paradigm shift , which it seems useful to bring to our patients. Protocol registration: This protocol was registered on March 02, 2023 in the International Prospective Register of Systematic Review (PROSPERO) and received the CRD number: CRD42023400421.

Introduction: Plusieurs études transversales ont montré l'association d'un environnement orofacial dysfonctionnel avec une plus grande prévalence de malocclusions. La rééducation myofonctionnelle orofaciale (RMOF) est la rééducation des muscles, des fonctions et des postures de repos du complexe orofacial. Elle est utilisée dans la prise en charge thérapeutique des dysfonctionnements orofaciaux chez des patients de tous âges et présentant un large éventail de troubles et de comorbidités. La RMOF met principalement en œuvre des exercices isotoniques et isométriques ciblant les structures buccales et oropharyngées, associés à des exercices spécifiques pour optimiser la ventilation, la déglutition et la mastication. Elle peut faire appel à des gouttières de rééducation préfabriquées (GRP) dont la prescription peut également viser l'objectif d'une modification des formes et des rapports d'arcades dentaires. Objectif: L'objectif principal de cette revue systématique de la littérature était de décrire et d'évaluer l'efficacité de la RMOF assistée par gouttières de rééducation préfabriquées en orthodontie, en occlusodontie et en médecine dentaire du sommeil. Son objectif secondaire était d'évaluer si l'emploi des GRP, actuellement disponibles, s'accompagne d'effets indésirables. Matériels et méthodes: La revue systématique de la littérature fut entreprise à partir de cinq bases de données électroniques : Medline (via PubMed), Web of Science, Cochrane Library, Embase et Google Scholar, afin d'identifier les études évaluant l'efficacité de la RMOF assistée par GRP dans le traitement des dysfonctions orofaciales et des parafonctions, des dysfonctionnements temporaux-mandibulaires (DTM) ou des syndromes d'apnées obstructives du sommeil (SAOS) de l'enfant, de l'adolescent et de l'adulte, publiées jusqu'au 20 mars 2023. Le critère de jugement principal de cette revue systématique était l'efficacité thérapeutique de la RMOF assistée par GRP. Chez les patients souffrant d'apnée obstructive du sommeil (AOS), l'évaluation de l'efficacité s'appuyait principalement sur une diminution statistiquement significative de l'indice d'apnée/hypopnée (IHA) et sur une amélioration de la qualité subjective du sommeil, de la qualité du sommeil mesurée par polysomnographie nocturne et de la qualité de vie mesurée subjectivement. Chez les patients présentant des dysfonctions orofaciales, des parafonctions ou des DTM, l'évaluation de l'efficacité l'était principalement par l'électromyographie (EMG), l'anamnèse et l'examen clinique. Les critères de jugement secondaires étaient les améliorations dentoalvéolaires ou squelettiques, et les éventuels effets indésirables des GRP employées, dont des effets indésirables sur l'occlusion. Résultats: Seulement quatorze études répondaient à tous les critères d'inclusion : deux essais contrôlés randomisés, un essai contrôlé non randomisé, cinq études cas témoins prospectives, deux études cas-témoins rétrospectives, deux séries de cas prospectives et deux séries de cas rétrospectives. Les deux essais cliniques contrôlés randomisés ont été évalués à « faible risque de biais ¼ d'après les douze critères de risque de biais du Cochrane Back Review Group. La qualité méthodologique des 12 autres études incluses a été évaluée à l'aide de l'outil ROBINS-I, conformément aux recommandations du Cochrane Handbook. L'une a été jugée comme présentant un risque de biais mesuré, huit un risque de biais important et trois un risque de biais critique. D'après les données probantes disponibles, la RMOF assistée par GRP permet une réduction statistiquement significative (p = 0,0425) de l'IAH d'enfants souffrant d'apnée obstructive du sommeil légère à modérée. Chez des enfants souffrant d'apnée obstructive du sommeil et opérés des adénoïdes et/ou des amygdales, une RMOF postopératoire associée au port d'une GRP souple conduit à une plus grande réduction de l'IAH, comparativement à un groupe témoin, et une amélioration de la saturation en oxygène (SaO2), 6 mois et 12 mois après l'opération (p < 0,01). Elle contribue également à une amélioration des troubles du sommeil, de la condition physique, de la léthargie diurne plus importante dans le groupe traité que dans le groupe témoin, 6 mois et 12 mois après l'opération (p < 0,05). La RMOF assistée par GRP permet une correction jusqu'à 100 % de la déglutition atypique et une amélioration de l'équilibre musculaire orofacial. Les GRP sont généralement moins efficaces que les activateurs pour le traitement des malocclusions de classe II, division 1 et semblent entraîner davantage d'effets indésirables, principalement une vestibuloversion des incisives mandibulaires. L'utilisation de la RMOF assistée par GRP pour la prise en charge des DTM n'est pas validée par les preuves actuelles. Conclusions: Les données publiées, même de qualité méthodologique inégale, semblent montrer la supériorité d'une RMOF associée au port d'une GRP comparée à la mise en œuvre d'une RMOF sans GRP. La mise en œuvre d'études prospectives avec de grands échantillons serait utile pour mieux évaluer les nouvelles possibilités thérapeutiques apportées par l'association de la RMOF avec une GRP. Une attention constante devra être portée à la surveillance des éventuels effets indésirables sur les arcades dentaires des GRP associées à la RMOF, notamment la vestibuloversion des incisives mandibulaires. Il pourrait être utile de conduire une réflexion quant à la pertinence des arguments avancés par les fabricants sur les particularités de leurs dispositifs et leurs effets supposés. La RMOF assistée par GRP apparaît comme un nécessaire changement de paradigme, dont il semble utile de faire bénéficier nos patients. Enregistrement du protocole: Ce protocole a été enregistré le 2 mars 2023 dans l'International Prospective Register of Systematic Review (PROSPERO) et a reçu le numéro CRD : CRD42023400421.

Patients with Obstructive Sleep Apnea and Cardiovascular Diseases: What, When, and Why Is Mandibular Advancement Device Treatment Required? A Short Review.

Obstructive sleep apnea is a potentially dangerous condition with significant risks of comorbidities if left untreated. It represents a cardiovascular risk factor in the general population, and a higher prevalence is observed in patients already suffering from cardiovascular diseases. The gold standard treatment, continuous positive airway pressure, is not always accepted or tolerated. The mandibular advancement device represents an alternative treatment that we propose to implement in our study. The objective here is to first present a brief review of the topic. Due to poor evidence in the field, we propose a pilot study to evaluate the effect of a mandibular advancement device in patients with cardiovascular disease who are not treated for their sleep pathology in order to improve their therapeutic management.

Treatment of Obstructive Sleep Apnea Using Oral Appliances in Saudi Arabia: Are We following the Guidelines?

BACKGROUND: This study aimed to assess sleep medicine physicians' knowledge and attitudes toward the role of oral appliances (OAs) in managing obstructive sleep apnea (OSA) in Saudi Arabia. METHODS: An online questionnaire was administered to the registered physicians practicing sleep medicine (otolaryngology, internal medicine, pulmonology, and family medicine) in Saudi Arabia. The questionnaire included 26 questions under five domains. All the collected data were analyzed using descriptive statistics and Chi-square tests. RESULTS: One hundred sleep physicians (43% Saudi, 75% male) from Saudi Arabia participated in this study. Almost 43% of participants reported inadequate knowledge of the treatment of OSA patients using OAs. Half of the participants were unaware of how OAs work in managing OSA. Most physicians (62%) never referred the patient for treatment of OSA using OAs, whereas 4% referred at least one patient every month. The majority (60%) believed that there are barriers to referring a case for OA treatment, mainly the lack of knowledge of the suitable cases (60%) and the lack of qualified dentists in this area (43%). CONCLUSION: Most sleep physicians reported poor knowledge of OA indications and mechanism of use, with most never referring a case for OA therapy.

Development of a physiological-based model that uses standard polysomnography and clinical data to predict oral appliance treatment outcomes in obstructive sleep apnea.

STUDY OBJECTIVES: Oral appliance (OA) therapy is a well-tolerated alternative to continuous positive airway pressure. However, it is less efficacious. A major unresolved clinical challenge is the inability to accurately predict who will respond to OA therapy. We recently developed a model to estimate obstructive sleep apnea pathophysiological endotypes. This study aimed to apply this physiological-based model to predict OA treatment responses. METHODS: Sixty-two men and women with obstructive sleep apnea (aged 29-71 years) were studied to investigate the efficacy of a novel OA device. An in-laboratory diagnostic followed by an OA treatment efficacy polysomnography were performed. Seven polysomnography variables from the diagnostic study plus age and body mass index were included in our machine-learning-based model to predict OA therapy response according to standard apnea-hypopnea index (AHI) definitions. Initially, the model was trained on data from the first 45 participants using 10-fold cross-validation. A blinded independent validation was then performed for the remaining 17 participants. RESULTS: Mean accuracy of the trained model to predict OA therapy responders vs nonresponders (AHI < 5 events/h) using 10-fold cross-validation was 91% ± 8%. In the independent blinded validation, 100% (AHI < 5 events/h); 59% (AHI < 10 events/h); 71% (50% reduction in AHI); and 82% (50% reduction in AHI to < 20 events/h) of the 17 participants were correctly classified for each of the treatment outcome definitions respectively. CONCLUSIONS: While further evaluation in larger clinical data sets is required, these findings highlight the potential to use routinely collected sleep study and clinical data with machine learning-based approaches underpinned by obstructive sleep apnea endotype concepts to help predict treatment outcomes to OA therapy for people with obstructive sleep apnea. CITATION: Dutta R, Tong BK, Eckert DJ. Development of a physiological-based model that uses standard polysomnography and clinical data to predict oral appliance treatment outcomes in obstructive sleep apnea. J Clin Sleep Med. 2022;18(3):861-870.

The role of orthodontics in management of obstructive sleep apnea.

Dental sleep medicine is the field of dental practice that deals with the management of sleep-related breathing disorders, which includes obstructive sleep apnea (OSA) in adults and children. Depending on the developmental age of the patient and the cause of the apnea dental treatment options may vary. For adult patients, treatment modalities may include oral appliance therapy (OAT), orthognathic surgery and surgical or miniscrew supported palatal expansion. While for children, treatment may include non-surgical maxillary expansion and orthodontic functional appliances. Many physicians and dentists are unaware of the role dentistry, particularly orthodontics, may play in the interdisciplinary management of these disorders. This review article is an attempt to compile evidence-based relevant information on the role of orthodontists/sleep dentists in the screening, diagnosis, and management of sleep apnea. Oral sleep appliance mechanisms of action, selective efficacy, and the medical physiological outcomes are discussed. The purpose of this review is to provide a comprehensive understanding of how orthodontists and sleep physicians can work in tandem to maximize the benefits and minimize the side effects while treating patients with OSA.

Dental Sleep Medicine among dental practitioners: Preliminary findings from the National Dental Practice-Based Research Network.

Objectives/Introduction: Dental sleep medicine (DSM) focuses on oral appliance therapy (OAT) to manage sleep-disordered breathing (SDB), including obstructive sleep apnea (OSA). This brief poll aimed to assess the interest and practices of dental practitioners in DSM. To this day lack of data exists regarding how DSM practices function in the clinical setting. Therefore, identifying knowledge gaps in DSM among dental practitioners may improve patient outcomes. Methods: A preliminary brief questionnaire ("Quick Poll") on DSM was conducted through the National Dental Practice-Based Research Network (Network) members (n=311). The poll contained five questions about DSM. Results: Results showed that 66% of practitioners have involvement in DSM patient care. A total of 44% of practitioners who answered the Quick Poll do not screen for snoring or SDBs. About 40% of respondents are either interested in continuing education courses on the topic or had already taken multiple courses on DSM. The top three topics of DSM research of interest to practitioners were various DSM practice models, response to OAT, and compliance with OAT. Conclusion: Network dental practitioner respondents face challenges regarding the treatment of SDBs. Despite these challenges, most practitioners are interested in engaging in DSM. Based on these preliminary findings, there are informational needs regarding the current state of clinical care, side effects of OAT, choice of OAT, titration protocols, and patient outcomes.