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The effect of mandibular advancement device on apneas and sleep in patients with obstructive sleep apnea
Umeå University, Faculty of Medicine, Odontology, Ortodontics.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Pulmonary Medicine.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Pulmonary Medicine.
Umeå University, Faculty of Medicine, Public Health and Clinical Medicine, Pulmonary Medicine.
1998 (English)In: Chest, ISSN 0012-3692, Vol. 113, 707-713 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To evaluate the effects of a mandibular advancement device on apneas and sleep in, mild, moderate and severe obstructive sleep apnea.

Design: Prospective study.

Subjects: Forty-four of 47 patients included.

Intervention: Individually adjusted mandibular advancement devices.

Measurements: Polysomnographic sleep recordings for 1 night without the device and 1 night with it, with a median of 1 day and no changes in weight, medication, or sleep position between the recordings.

Results: The device reduced the median apnea-hypopnea index from 11 (range, 7 to 19) to 5 (range, 0 to 17) (p<0.001) in 21 patients with mild sleep apnea, from 27 (range, 20 to 38) to 7 (range 1 to 19) (p<0.001) in 15 patients with moderate sleep apnea, and from 53 (range 44 to 66) to 14 (range, 2 to 32) (p=<0.05) in 8 patients with severe sleep apnea. The arousal index decreased and the sleep stage patterns improved in all severity groups. Twenty-eight of 44 patients were successfully treated with an obstructive apnea-hypopnea index of below 10 and a subjective reduction in snoring. Nine of 16 patients with treatment failure still reported a reduction in snoring. The success rate correlated inversely to the disease severity (r=-0.41; p<0.01).

Conclusions: A mandibular advancement device reduces apnea and improves sleep quality in patients with obstructive sleep apnea, especially in those with mild and moderate disease. A follow-up sleep recording during treatment is necessary because of the risk of silent obstructive apneas without subjective snoring with the device.

Place, publisher, year, edition, pages
1998. Vol. 113, 707-713 p.
Keyword [en]
Dental appiances, polysomnography, sleep apnea, sleep stages, snoring
National Category
Dentistry Dentistry Medical and Health Sciences
Research subject
Lung Medicine; Odontology
Identifiers
URN: urn:nbn:se:umu:diva-18867DOI: 10.1378/chest.113.3.707OAI: oai:DiVA.org:umu-18867DiVA: diva2:174998
Available from: 2009-02-26 Created: 2009-02-26 Last updated: 2009-03-12Bibliographically approved
In thesis
1. Sleep apnea and sleep: diagnostic aspects
Open this publication in new window or tab >>Sleep apnea and sleep: diagnostic aspects
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Patients with sleep apnea have frequent apneas and hypopneas during sleep. Apneas can be either central or obstructive. The apnea-hypopnea index (AHI) is the mean number of apneas and hypopneas per hour of sleep.

Aims: 1) To evaluate the effect of a mandibular advancement device on obstructive apneas and sleep; 2) to evaluate the influence of body position on central apnea frequency; 3) to investigate whether obstructive or central apnea is related to mortality in patients with stroke; and 4) to investigate sleep and sleeping positions in women.

Methods: Subjects were investigated during whole-night sleep respiratory recordings, either polysomnography including continuous recordings of EEG, EOG, EMG, airflow, respiratory effort, ECG, pulse oximetry and body position, or simplified sleep apnea recordings without EEG, EOG and EMG.

Results: The frequency of obstructive apneas, hypopneas and arousals decreased and rapid eye movement (REM) sleep increased in patients with mild, moderate and severe sleep apnea during treatment with a mandibular advancement device.

Central apneas were more prevalent in the supine position compared with the non-supine position in patients with Cheyne-Stokes respiration. The mean ± SD central AHI was 41 ± 13 in the supine position and 26 ± 12 in the non-supine position, p<0.001.

Stroke patients with obstructive sleep apnea ran an increased risk of death during 10 ± 0.6 years of follow-up with an adjusted hazard ratio of 1.76 (95% CI 1.05-2.95) compared with controls, independent of hypertension, age, body mass index, gender, smoking, diabetes mellitus, atrial fibrillation, Mini-Mental State Examination and Barthel-ADL. Central apnea was not related to early death.

Total sleep time, sleep efficiency, rapid eye movement sleep, slow wave and time in the supine position decreased with age in women. Sleep quality in women was reduced with age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension.

Conclusions: Obstructive sleep apneas and arousals are reduced and REM sleep is increased using a mandibular advancement device in patients with mild, moderate and severe sleep apnea. The frequency of central apneas and hypopneas is increased in the supine position in patients with Cheyne-Stokes respiration. Stroke patients with obstructive sleep apnea run an increased risk of early death. Central sleep apnea was not related to early death among the present patients. Normal values for sleep stages and sleeping positions are presented in a population-based sample of women. Age, body mass index, obstructive sleep apnea, smoking, alcohol and hypertension reduce sleep quality in women.

Place, publisher, year, edition, pages
Umeå: Department of Public Health and Clinical Medicine, Respiratory Medicine and Allegy, 2009. 63 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1246
Keyword
Sleep apnea, sleep stages, snoring, stroke, polysomnography, Cheyne-Stokes respiration, supine-dependency
National Category
Cardiac and Cardiovascular Systems Respiratory Medicine and Allergy
Research subject
Lung Medicine
Identifiers
urn:nbn:se:umu:diva-18959 (URN)978-91-7264-702-2 (ISBN)
Public defence
2009-04-03, Sal B, byggnad 1D, Norrlands universitetssjukhus, 90185 Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2009-03-09 Created: 2009-03-02 Last updated: 2010-01-18Bibliographically approved

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