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Marklund, Marie E.
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Publications (10 of 30) Show all publications
Marklund, M. E. (2023). Starting mandibular advancement device therapy in patients with good protrusive capacity: a randomized pilot study. Turkish Journal of Orthodontics, 36(3), 158-164
Open this publication in new window or tab >>Starting mandibular advancement device therapy in patients with good protrusive capacity: a randomized pilot study
2023 (English)In: Turkish Journal of Orthodontics, ISSN 2528-9659, Vol. 36, no 3, p. 158-164Article in journal (Refereed) Published
Abstract [en]

Objective: Discomfort has been related to the poor acceptance of a mandibular advancement device (MAD) in patients with obstructive sleep apnea. The present study compared severe initial side effects between a smaller and a larger degree of mandibular advancement in patients with a good protrusive capacity.

Methods: Consecutive patients with obstructive sleep apnea and a good protrusive capacity (≥8 mm) were randomized to start treatment with the mandible advanced by either 70% of maximum protrusion (Adv70%) or by 4 mm (Adv4mm) in a pilot study with a parallel design. The main outcome was tenderness or pain in the teeth or jaws using a 0-10 visual analogue scale (VAS) (from “not at all” to “very extensive”) or excluded use because of side effects during the first week of treatment. Secondary outcomes included salivation problems and bite changes.

Results: Eighteen patients were randomly selected and 17 patients fulfilled the study protocol. Four patients in the Adv70% group and none in the Adv4mm group reported severe tenderness or pain (VAS ≥7) on five or more of the seven days (p=0.03). The degree of mandibular advancement measured in millimeters correlated with the number of days with severe side effects, r=0.64 (p=0.006). The secondary side effects were minor.

Conclusion: Starting MAD treatment with 70% mandibular advancement was related to more severe side effects during the first week of treatment compared with a smaller fixed millimeter value in patients with a good protrusive capacity in this pilot study.

Place, publisher, year, edition, pages
Galenos Yayinevi, 2023
Keywords
mandibular advancement devices, mandibular repositioning appliances, obstructive sleep apnoea, Oral appliances, side-effects
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-220879 (URN)10.4274/TurkJOrthod.2022.2022.54 (DOI)2-s2.0-85183953617 (Scopus ID)
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-02-15Bibliographically approved
Johal, A., Hamoda, M. M., Almeida, F. R., Marklund, M. E. & Tallamraju, H. (2023). The role of oral appliance therapy in obstructive sleep apnoea. European Respiratory Review, 32(168)
Open this publication in new window or tab >>The role of oral appliance therapy in obstructive sleep apnoea
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2023 (English)In: European Respiratory Review, ISSN 0905-9180, E-ISSN 1600-0617, Vol. 32, no 168Article in journal (Refereed) Published
Abstract [en]

There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made versus noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.

Place, publisher, year, edition, pages
European Respiratory Society, 2023
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-211783 (URN)10.1183/16000617.0257-2022 (DOI)37343962 (PubMedID)2-s2.0-85163087256 (Scopus ID)
Available from: 2023-07-12 Created: 2023-07-12 Last updated: 2023-08-03Bibliographically approved
Randerath, W., de Lange, J., Hedner, J., Ho, J. P. F., Marklund, M. E., Schiza, S., . . . Verbraecken, J. (2022). Current and novel treatment options for obstructive sleep apnoea. ERJ Open Research, 8(2), Article ID 00126-2022.
Open this publication in new window or tab >>Current and novel treatment options for obstructive sleep apnoea
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2022 (English)In: ERJ Open Research, E-ISSN 2312-0541, Vol. 8, no 2, article id 00126-2022Article, review/survey (Refereed) Published
Abstract [en]

Obstructive sleep apnoea is a challenging medical problem due to its prevalence, its impact on quality of life and performance in school and professionally, the implications for risk of accidents, and comorbidities and mortality. Current research has carved out a broad spectrum of clinical phenotypes and defined major pathophysiological components. These findings point to the concept of personalised therapy, oriented on both the distinct clinical presentation and the most relevant pathophysiology in the individual patient. This leads to questions of whether sufficient therapeutic options other than positive airway pressure (PAP) alone are available, for which patients they may be useful, if there are specific indications for single or combined treatment, and whether there is solid scientific evidence for recommendations. This review describes our knowledge on PAP and non-PAP therapies to address upper airway collapsibility, muscle responsiveness, arousability and respiratory drive. The spectrum is broad and heterogeneous, including technical and pharmaceutical options already in clinical use or at an advanced experimental stage. Although there is an obvious need for more research on single or combined therapies, the available data demonstrate the variety of effective options, which should replace the unidirectional focus on PAP therapy.

Place, publisher, year, edition, pages
European Respiratory Society, 2022
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-198267 (URN)10.1183/23120541.00126-2022 (DOI)000819461900004 ()35769417 (PubMedID)2-s2.0-85134080115 (Scopus ID)
Available from: 2022-08-02 Created: 2022-08-02 Last updated: 2022-08-02Bibliographically approved
Jacobowitz, O., Afifi, L., Penzel, T., Poyares, D., Marklund, M. & Kushida, C. (2022). Endorsement of: “treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of Sleep Medicine Clinical Practice Guideline” by World Sleep Society. Sleep Medicine, 89, 19-22
Open this publication in new window or tab >>Endorsement of: “treatment of adult obstructive sleep apnea with positive airway pressure: an American academy of Sleep Medicine Clinical Practice Guideline” by World Sleep Society
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2022 (English)In: Sleep Medicine, ISSN 1389-9457, E-ISSN 1878-5506, Vol. 89, p. 19-22Article in journal (Refereed) Published
Abstract [en]

Guidelines for the evaluation and management of sleep disorders from national societies provide recommendations that may be regionally appropriate but may not always be practical or relevant in other parts of the world. A task force of experts from the World Sleep Society's (WSS) International Sleep Medicine Guidelines Committee and Sleep and Breathing Disorders Taskforce reviewed the American Academy of Sleep Medicine's Clinical Practice Guideline on the Treatment of Adult Obstructive Sleep Apnea (OSA) with Positive Airway Pressure with respect to its relevance and applicability to the practice of sleep medicine by sleep specialists in various regions of the world. To improve the evaluation of the guideline, surveys were sent by the senior author and the WSS to approximately 800 sleep doctors around the world to query the availability of OSA treatments in their respective region. The task force and the WSS guidelines committee endorsed the AASM's CPAP guidelines with respect to the indications for PAP therapy, utilization of different PAP modalities, and concurrent strategies to improve outcomes, noting appropriate caveats for universal applicability.

Place, publisher, year, edition, pages
Elsevier, 2022
Keywords
APAP, Bilevel, CPAP, OSA, Polysomnography
National Category
Respiratory Medicine and Allergy Other Health Sciences
Identifiers
urn:nbn:se:umu:diva-190203 (URN)10.1016/j.sleep.2021.10.007 (DOI)000819947200002 ()34864508 (PubMedID)2-s2.0-85120436407 (Scopus ID)
Available from: 2021-12-09 Created: 2021-12-09 Last updated: 2023-09-05Bibliographically approved
Randerath, W., Verbraecken, J., de Raaff, C. A. L., Hedner, J., Herkenrath, S., Hohenhorst, W., . . . Wijkstra, P. (2021). European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea. European Respiratory Review, 30(162), Article ID 210200.
Open this publication in new window or tab >>European Respiratory Society guideline on non-CPAP therapies for obstructive sleep apnoea
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2021 (English)In: European Respiratory Review, ISSN 0905-9180, E-ISSN 1600-0617, Vol. 30, no 162, article id 210200Article in journal (Refereed) Published
Abstract [en]

Treatment of obstructive sleep apnoea (OSA) in adults is evolving, as new therapies have been explored and introduced in clinical practice, while other approaches have been refined or reconsidered. In this European Respiratory Society (ERS) guideline on non-continuous positive airway pressure (CPAP) therapies for OSA, we present recommendations determined by a systematic review of the literature. It is an update of the 2011 ERS statement on non-CPAP therapies, advanced into a clinical guideline. A multidisciplinary group of experts, including pulmonary, surgical, dentistry and ear-nose-throat specialists, methodologists and patient representatives considered the most relevant clinical questions (for both clinicians and patients) relating to the management of OSA. Eight key clinical questions were generated and a systematic review was conducted to identify published randomised clinical trials that answered these questions. We used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to assess the quality of the evidence and the strength of recommendations. The resulting guideline addresses gastric bypass surgery, custom-made dual-block mandibular advancement devices, hypoglossal nerve stimulation, myofunctional therapy, maxillo-mandibular osteotomy, carbonic anhydrase inhibitors and positional therapy. These recommendations can be used to benchmark quality of care for people with OSA across Europe and to improve outcomes.

Place, publisher, year, edition, pages
ERS Publications, 2021
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-191212 (URN)10.1183/16000617.0200-2021 (DOI)000769745400025 ()34853097 (PubMedID)2-s2.0-85122424172 (Scopus ID)
Available from: 2022-01-11 Created: 2022-01-11 Last updated: 2023-09-05Bibliographically approved
Marklund, M. E. (2021). Oral appliance therapy. In: Ki Beom Kim; Reza Movahed; Raman K. Malhotra; Jeffrey J. Stanley (Ed.), Management of obstructive sleep apnea: an evidence-based, multidisciplinary textbook (pp. 185-211). Switzerland: Springer
Open this publication in new window or tab >>Oral appliance therapy
2021 (English)In: Management of obstructive sleep apnea: an evidence-based, multidisciplinary textbook / [ed] Ki Beom Kim; Reza Movahed; Raman K. Malhotra; Jeffrey J. Stanley, Switzerland: Springer, 2021, p. 185-211Chapter in book (Other academic)
Place, publisher, year, edition, pages
Switzerland: Springer, 2021
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-191209 (URN)10.1007/978-3-030-54146-0_13 (DOI)978-3-030-54145-3 (ISBN)9783030541460 (ISBN)
Available from: 2022-01-11 Created: 2022-01-11 Last updated: 2022-01-13Bibliographically approved
Marklund, M. (2020). Subjective versus objective dental side effects from oral sleep apnea appliances. Sleep and Breathing, 24, 111-117
Open this publication in new window or tab >>Subjective versus objective dental side effects from oral sleep apnea appliances
2020 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 24, p. 111-117Article in journal (Refereed) Published
Abstract [en]

Purpose: Occlusal changes are common during long-term treatment with oral appliances (OAs) for sleep apnea. The aim of the present study was to compare subjectively reported bite changes with objective findings.

Methods: Consecutive adherent treated patients were asked to participate in this study. The patients responded to two questionnaires using numeric visual analogue scales (VAS), ranging from 0 (not at all) to 10 (very much). The first questionnaire included open questions and the second questionnaire comprised specific questions about side effects. Measurements of overjet, overbite, and space for the teeth were made on plaster casts taken before treatment start and at follow-up.

Results: Thirty-eight (12 women) patients with a median age of 64 years (interquartile range (IQR) 57 to 69 years) and a median treatment time of 9.5 years (IQR 5.8 to 14.3 years) were included. Overjet, overbite, the molar relationship, and the irregularity of the lower front teeth had changed significantly during treatment. There were no associations between any of the patients’ responses and the objectively measured bite changes. Younger patients, those with a small baseline overjet or overbite and those who developed an anterior crossbite were more likely to report bite changes.

Conclusions: Patients who choose to continue long-term treatment with oral appliances for sleep apnea are unaware of various types of bite changes. Such changes will, however, progressively increase in magnitude and be more difficult to take care of, if needed. It is therefore important continuously to follow up patients in regard to bite changes.

Place, publisher, year, edition, pages
Springer, 2020
Keywords
Mandibular advancement device, Mandibular advancement splint, Mandibular repositioning appliance, Oral appliance, Side-effects
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-169505 (URN)10.1007/s11325-019-01852-0 (DOI)000523299600014 ()31044371 (PubMedID)2-s2.0-85065253973 (Scopus ID)
Available from: 2020-04-02 Created: 2020-04-02 Last updated: 2020-08-07Bibliographically approved
Ngiam, J., Sutherland, K., Balasubramaniam, R., Marklund, M., Almeida, F. & Cistulli, P. (2019). Oral appliance therapy for sleep-disordered breathing (1ed.). In: Camile S. Farah; Ramesh Balasubramaniam; Michael J. McCullough (Ed.), Contemporary oral medicine: a comprehensive approach to clinical practice (pp. 2303-2331). Cham: Springer
Open this publication in new window or tab >>Oral appliance therapy for sleep-disordered breathing
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2019 (English)In: Contemporary oral medicine: a comprehensive approach to clinical practice / [ed] Camile S. Farah; Ramesh Balasubramaniam; Michael J. McCullough, Cham: Springer, 2019, 1, p. 2303-2331Chapter in book (Refereed)
Abstract [en]

Obstructive sleep apnea (OSA) is characterized by repetitive obstruction of the upper airway during sleep, resulting in sleep fragmentation and nocturnal oxygen desaturation. As a result, patients may present with signs and symptoms of daytime sleepiness, neurocognitive impairment, and cardiovascular morbidity and mortality. Mandibular advancement appliances (oral appliance mandibular, OAm) are recommended for patients with mild-to-moderate OSA, and for those with severe OSA, where continuous positive airway pressure is refused or not tolerated. The mechanism of action of OAm is based on holding the mandible in a protrusive position and hence reducing pharyngeal collapsibility during sleep. Two-thirds of patients show a minimum of 50% reduction in the apnea-hypopnea index (AHI) with OAm treatment. Further, OAm have been shown to have a positive effect on blood pressure and endothelial function that are markers of cardiovascular health. Despite OAm being inferior in therapeutic efficacy to CPAP in reducing the AHI, its higher compliance might translate to similar adjusted AHI and clinical effectiveness. There are side effects with OAm use, such as bite changes and jaw pain; however, most side effects are transient and rarely significant in the long term.

Place, publisher, year, edition, pages
Cham: Springer, 2019 Edition: 1
Keywords
Apnea-hypopnea index, Obstructive sleep apnea, Oral appliance, Snoring, Tongue stabilizing appliance
National Category
Dentistry Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:umu:diva-206198 (URN)10.1007/978-3-319-72303-7_43 (DOI)2-s2.0-85150532243 (Scopus ID)9783319723037 (ISBN)9783319723013 (ISBN)
Available from: 2023-04-04 Created: 2023-04-04 Last updated: 2023-04-24Bibliographically approved
Rietz, H., Franklin, K. A., Carlberg, B., Sahlin-Ingridsson, C. & Marklund, M. E. (2018). Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 7(13), Article ID e008642.
Open this publication in new window or tab >>Nocturnal Blood Pressure Is Reduced by a Mandibular Advancement Device for Sleep Apnea in Women: Findings From Secondary Analyses of a Randomized Trial
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2018 (English)In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 7, no 13, article id e008642Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Obstructive sleep apnea is associated with high blood pressure. The magnitude of blood pressure effects from sleep apnea treatment is unclear. We aimed to determine the effect of mandibular advancement device therapy on ambulatory nighttime and daytime blood pressure in women and men with daytime sleepiness and snoring or mild to moderate sleep apnea (apnea-hypopnea index, <30).

METHODS AND RESULTS: In this 4-month, double-blind, randomized controlled trial comprising 96 untreated patients, 27 women and 58 men, aged 31 to 70 years, completed the study. The active group received individually made adjustable mandibular advancement devices, and the control group was given individually made sham devices, to be used during sleep. Polysomnographic sleep recordings and ambulatory 24-hour blood pressure measurements were performed at baseline and at follow-up. In women with mandibular advancement devices, the mean nighttime systolic blood pressure was 10.8 mm Hg (95% confidence interval, 4.0-17.7 mm Hg; P=0.004) lower than in the women in the sham group, adjusted for baseline blood pressure, age, body mass index, and the apnea-hypopnea index. The mean nighttime adjusted diastolic blood pressure was 6.6 mm Hg (95% confidence interval, 2.7-10.4 mm Hg; P=0.002) lower in the mandibular advancement device group. In men, there were no significant differences in blood pressure at night or during the daytime between the intervention groups.

CONCLUSIONS: A mandibular advancement device for obstructive sleep apnea reduces nocturnal blood pressure in women.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT00477009.

Place, publisher, year, edition, pages
American Heart Association Inc., 2018
Keywords
hypertension, mandibular advancement device, obstructive sleep apnea, women
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154113 (URN)10.1161/JAHA.118.008642 (DOI)000452700100016 ()29929990 (PubMedID)2-s2.0-85049686449 (Scopus ID)
Funder
Swedish Research CouncilSwedish Heart Lung FoundationVästerbotten County Council
Available from: 2018-12-12 Created: 2018-12-12 Last updated: 2020-05-11Bibliographically approved
Norrhem, N., Nemeczek, H. & Marklund, M. (2017). Changes in lower incisor irregularity during treatment with oral sleep apnea appliances. Sleep and Breathing, 21(3), 607-613
Open this publication in new window or tab >>Changes in lower incisor irregularity during treatment with oral sleep apnea appliances
2017 (English)In: Sleep and Breathing, ISSN 1520-9512, E-ISSN 1522-1709, Vol. 21, no 3, p. 607-613Article in journal (Refereed) Published
Abstract [en]

Purpose: The purpose of this study is to test the hypothesis that a flexible oral appliance without incisor coverage (OAFlex) increases the irregularity of the front teeth compared with a rigid appliance with incisor coverage (OARigid) in patients treated for obstructive sleep apnea (OSA).

Method and patients: Nineteen patients (10 men) who had used OARigid and 22 patients (19 men) who had used OAFlex with a median age of 61 years (IQR of 56 to 67 years) who had been treated during a median period of 2.9 years (IQR of 2.7 to 3.1 years) were included in the study. There was no difference in age (p = 0.601) or treatment time (p = 0.432) between the two appliance groups. The patients had clinical examinations, responded to a questionnaire, and had impressions taken for plaster casts. The irregularity of the front teeth was measured by Little’s Index, where the combined linear displacement of all the front teeth is assessed. Changes between baseline and follow-up were compared between the two groups.

Results: The OAFlex group increased the irregularity of their lower front teeth by 0.3 mm (p = 0.018), while the OARigid group had unchanged frontal irregularity (p = 0.717). The difference between the groups was significant (p = 0.035). There were no changes in the irregularity of the upper front teeth in either group. Patient satisfaction with treatment did not differ between the two appliances.

Conclusions: The present results support the hypothesis that a flexible OA without incisor coverage increases the irregularity of the lower front teeth compared with a rigid OA with incisor coverage.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Oral appliances, Mandibular advancement devices, Side effects, Appliance design
National Category
Dentistry
Identifiers
urn:nbn:se:umu:diva-140473 (URN)10.1007/s11325-016-1456-3 (DOI)000411070700007 ()28116544 (PubMedID)2-s2.0-85010767443 (Scopus ID)
Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2023-03-24Bibliographically approved
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