Cranio-The Journal of Craniomandibular & Sleep Practice最新文献

Objective: Mean apnea-hypopnea duration (AHD) is the mean duration of apnea-hypopneas experienced during sleep and was found as an indicator of blood oxygenation. The aim of this study was to compare and define the differences in clinical, demographic and polysomnographic characteristics of obstructive sleep apnea (OSA) patients in long and short AHD groups and investigate the relationship between apnea-hypopnea index (AHI), oxygen desaturation index (ODI), and sleepiness.

Methods: The cross-sectional analysis included 511 OSA patients who were >18 years and followed up between June 2019 and December 2019 in the Sleep Center of university hospital. The consecutive polysomnography reports and patient data were recorded retrospectively.

Results: Polysomnographic evaluation of different AHD groups showed obvious differences. Although there were no statistically significant differences in the overall AHI values. The Epworth measurements, ODI, time that saturation is below 90%, and N1 and N2 sleep were higher in the long AHD group. On the contrary, sleep efficiency, total sleep time, N3 and REM sleep, average oxygen saturation (AOS), and lowest oxygen saturation (LOS) were lower in the long AHD group.

Conclusions: The findings of this study showed that the AHD is a useful indicator of blood oxygenation and, therefore, tissue oxygenation, independent of the AHI. OSA patients with longer AHD have more vascular complications such as diabetes and hypertension. We suggest that the severity of OSA should be monitored with AHD for preventing potential complications of OSA.

Objective: Perform a clinimetric analysis of the visual analogue scale (VAS) and active pain-free mouth opening (PFMO) in patients with muscular temporomandibular disorder (mTMD).

Methods:  Reliability (intraclass correlation coefficient=ICC), construct validity, responsiveness (area under the curve=AUC), minimal detectable change (MDC), and minimal clinically important difference (MCID) values were calculated.

Results: The VAS-24hr (ICC=0.59), VAS-7day (ICC= 0.54), and PFMO (ICC=0.86) exhibited acceptable reliability. Both the VAS (AUC=0.96) and PFMO (AUC=0.87) exhibited a high level of responsiveness. The MCID was 15.5mm (VAS-24 and VAS-7day) and 3.5mm (PFMO) in the improved group; and 27.5mm (VAS-24), 21mm (VAS-7day), and 6.6mm (PFMO) in the much-improved group. The MDC was 9.6mm (VAS-24), 9.5mm (VAS-7day), and 6.1mm (PFMO). All outcomes demonstrated strong construct validity (Pearson's r; p<0.001) .

Conclusions: All three outcome measures demonstrated acceptable clinimetric properties in patients with mTMD at the 3-month follow-up. The MCID lies outside measurement error in all outcomes in the much-improved group.      .

Objective: To investigate several postural parameters and upper cervical functions in patients with temporomandibular disorders (TMD).

Methods: Patients diagnosed with different subtypes of TMD and healthy individuals without complaints of TMD were evaluated for pain, functional limitation, and anxiety by validated instruments. For evaluating upper cervical functions and postural parameters, cervical joint range of motion, cervical performance test, tragus wall distance, hamstring flexibility measurement, and measurement of the sacrum angle were recorded.

Results: Pain and jaw functional limitation scores were statistically higher in all groups with TMD. Patients with internal derangement and myofascial pain were significantly linked to a severe limiting of functions, higher anxiety, and depression scores. Postural parameters and cervical functions were similar between groups.

Conclusion: Although postural parameters and cervical functions remained unaffected, parameters such as pain, anxiety, and functional limitation that may affect the quality of life were related to unfavorable values in the TMD groups.

Objective: Evaluate the relationship between OSAS and floppy eyelid syndrome [FES], along with possible confounding factors such as gender, age, and BMI.

Methods: This was a multicenter, cross-sectional prospective study. Patients referred to the sleep clinic suspected of OSAS were included in the study. Polysomnography, ophthalmological examination, and standard sleep questionnaires were applied for all patients.

Results: A total of 617 patients, 68.4% of whom were men, with a mean age of 50.66 [±12.43] years were included. While FES was 70.2% in the group with OSAS for ≥5/h, OSAS was detected in 93.6% of the individuals with FES. In addition, a positive correlation was found between AHI and FES. Age and the male gender were independent risk factors for FES.

Conclusion: A direct relationship was found between FES and the severity of AHI and OSAS. However, there was no evidence that OSAS is an independent risk factor for FES.

Objective: To evaluate the prevalence of temporomandibular disorders (TMD) and their association with sociodemographic and psychosocial factors among 33- to 35-year-old Finnish adults in the Northern Finland Birth Cohort 1986 (NFBC1986).

Methods: The sample included 1788 NFBC1986 subjects that have been clinically examined in 2018-19. TMD symptoms were inquired, and clinical TMD examinations were performed based on the Diagnostic Criteria of TMD (DC/TMD). Sociodemographic factors and depression/anxiety symptoms based on Hopkins Symptoms Checklist-25 (HSCL-25) and Generalized Anxiety Disorder-7 (GAD-7) were inquired using questionnaire.

Results: The prevalence of at least one of TMD symptoms was 30.4%. Women had higher prevalence of TMD symptoms and diagnoses compared to men. Female sex, anxiety/depression symptoms and socioeconomic group associated significantly with TMD pain symptoms and pain-related diagnoses.

Conclusion: The most frequent TMD diagnosis was myalgia and 26.4% had at least one TMD diagnosis. Anxiety/depression symptoms were associated with TMD symptoms and pain-related diagnoses.

Objectives: To evaluate the efficacy, compliance, and side effects of the NOA® device compared to other mandibular advancement devices (MADs) in managing obstructive sleep apnea (OSA).

Methods: Thirty-three participants using the NOA® device were evaluated based on apnea-hypopnea index (AHI) reduction (criterion I: >50% reduction of AHI or criterion II: residual AHI < 5 events/hour), compliance, temporomandibular disorders (TMDs), and patient-reported side effects. These data were compared to retrospective data of 59 patients receiving a different MAD.

Results: Results showed that the NOA® device was effective in 78.8% (criterion 1) and 90.9% (criterion 2) of cases, requiring less mandibular advancement than other MADs. Participants used the device for an average of 6.94 ± 0.97 hours per night. Significant improvements were noted in morning headaches, sleep bruxism, and nocturnal urination.

Conclusions: The NOA® device demonstrated high efficacy, improved patient-reported outcomes, and caused no significant side effects or issues. It required less mandibular advancement than other devices and had high patient compliance.

Objective: This study aimed to assess consensus on various Temporomandibular Disorders (TMD) knowledge statements and examined differences in TMD knowledge among Lebanese licensed dentists based on demographic and professional characteristics.

Methods: A cross-sectional study was conducted using an electronic self-administered questionnaire comprising 36 TMD knowledge statements derived from existing literature and refined by TMD experts. Consensus was defined as ≥ 70% agreement or disagreement. Associations between knowledge statements and demographic or professional characteristics were analyzed using Chi-square or Fisher's exact tests for categorical variables and Kruskal-Wallis tests with Dunn's post-hoc comparisons for continuous variables, with Bonferroni correction for multiple comparisons.

Results: A total of 368 dentists participated. Consensus was achieved for 20 statements, of which 15 statements reflected correct, evidence-based knowledge. Significant associations (p < 0.007) were found between several demographic and professional characteristics and response patterns.

Conclusion: The findings revealed shared misconceptions and gaps in evidence-based TMD knowledge among Lebanese dentists, highlighting the need for targeted educational interventions.

Objective: To present a rare presentation of paroxysmal hemicrania (PH) in the orofacial region.

Methods: A retrospective record review was performed using the International Classification of Headache Disorders criteria for PH. Inclusion criteria were initial diagnosis of PH and at least one confirmatory diagnosis at follow-up.

Results: Four patients were diagnosed with orofacial PH 2015-2021. Average age was 56.5 years. Patients were most seen by dentists (n=7) and neurologists (n=5) and had a median of 19.5 months of diagnostic delay. Pain intensity was severe, episodes occurring daily and lasting 4-90 minutes. Lacrimation was the most common autonomic feature. All patients presented with intraoral pain and temporomandibular disorders. Maximum indomethacin dosage ranged from 75-225 mg/day. Verapamil was the most effective adjuvant therapy.

Conclusions: Orofacial PH presents a diagnostic challenge with significant delays, multiple referrals and unconventional pain locations. Intolerance to indomethacin resulted in the need for adjuvant treatment modalities.

Objective: This double-blinded randomized controlled trial investigated the immediate effects of myofascial release (MFR) and post-isometric relaxation (PIR) on muscle stiffness, tone, pain, and maximum mouth opening (MMO) in individuals with bruxism, compared with a control group.

Methods: Sixty participants were randomized into MFR (n = 20), PIR (n = 20), or control groups (n = 20). Each intervention was a single standardized session. The primary outcomes were muscle stiffness and tone, while secondary outcomes included pain severity (VAS), and MMO.

Results: Both MFR and PIR significantly reduced masseter and sternocleidomastoid stiffness and tone (p < .05), except left sternocleidomastoid stiffness in MFR, with no changes in controls. MFR was superior to control for pain (p = .010) and masseter stiffness (p = .030), while PIR showed superiority only for left tone (p = .034). Both interventions reduced VAS scores (p < .001) and improved MMO (p < .05).

Conclusion: A single MFR or PIR session reduced stiffness, tone, and pain and improved MMO in bruxism. MFR showed stronger effects, whereas PIR yielded limited benefits.

Objective: To evaluate changes in the oropharyngeal airway (OP) with Herbst appliances using either dental or skeletal anchorage (HDA vs. HSA) in growing patients with Class II division 1 malocclusion.

Design, setting, and participants: Forty patients (12.6 ± 1.4 years) at the peak of pubertal growth were randomized (HDA= 20; HSA= 20), for 12 months. Outcomes: change in OP volume, airway length and cross-sectional areas (minimum, maximum, average), by CBCT.

Results: Thirty-four patients completed the study (HDA= 19; HSA= 15); and intention-to-treat (ITT) analysis was applied. Within-group analysis revealed a significant improvement for minimum axial area (HDA, p = .0061). Between-group comparisons showed significantly higher mean values in the HSA group for volume (p = .0044), airway length (p = .004), maximum cross-sectional area (p = .0188), and average area (p = .0122).

Conclusions: HSA and HDA increased OP dimensions in growing Class II patients. Although HSA did not demonstrate a statistically superior effect, the dimensional changes represent morphological adaptations. Long-term studies are required to determine respiratory benefits.