Hypothesis: Augmentation of a mandibular advancement oral appliance (OA) by pharmacotherapy (ondansetron+fluoxetine) will increase therapeutic efficacy in moderate to severe obstructive sleep apnea (OSA) patients. Methods: Fifteen subjects met inclusion criteria and were enrolled. Subjects with moderate-severe OSA were treated with a TAP3 Elite® OA plus placebo medication for two weeks, followed by a combination regimen of ondansetron (24 mg/day) and fluoxetine (10 mg/day) with continued use of the OA for four weeks. Results: Seven subjects (5 male and 2 female, BMI 39.1±6.6) completed the study. AHI OA + Medications (22.1±16.3) was lower than the AHI baseline (31.7±11.2). Sleep efficiency and oxygen desaturation indices improved. Subjective (ESS) and objective (PVT) daytime sleepiness showed improvement. Mean total airway volume at end inspiration increased by 35% with OA compared to without OA. Minimum cross sectional area (CSA) increased by 48.8% with OA compared to without OA Conclusions: Combination of pharmacotherapy and oral appliance maybe a viable option in treating patients with moderate to severe OSA.
假设:通过药物治疗(昂丹司琼+氟西汀)增强下颌前移口腔矫治器(OA)将提高中重度阻塞性睡眠呼吸暂停(OSA)患者的治疗效果。方法:15例符合纳入标准的受试者入组。中重度OSA患者接受TAP3 Elite®OA +安慰剂药物治疗2周，随后接受昂丹西酮(24 mg/天)和氟西汀(10 mg/天)联合治疗，持续使用OA 4周。结果:7例受试者(男5例，女2例，BMI 39.1±6.6)完成研究。AHI OA +用药(22.1±16.3)低于基线(31.7±11.2)。睡眠效率和氧饱和度指数有所提高。主观(ESS)和客观(PVT)日间睡眠有所改善。与无OA相比，OA患者末吸气时平均气道总容积增加了35%。结论:药物联合口腔矫治器治疗中重度OSA患者可能是一种可行的选择。
{"title":"Oral Appliance and Pharmacologic Agents in the Treatment of Sleep Apnea: A Pilot Clinical Study","authors":"R. Stache","doi":"10.15331/jdsm.7224","DOIUrl":"https://doi.org/10.15331/jdsm.7224","url":null,"abstract":"Hypothesis: Augmentation of a mandibular advancement oral appliance (OA) by pharmacotherapy (ondansetron+fluoxetine) will increase\u0000therapeutic efficacy in moderate to severe obstructive sleep apnea\u0000(OSA) patients.\u0000\u0000Methods: Fifteen subjects met inclusion criteria and were enrolled.\u0000Subjects with moderate-severe OSA were treated with a TAP3 Elite® OA\u0000plus placebo medication for two weeks, followed by a combination\u0000regimen of ondansetron (24 mg/day) and fluoxetine (10 mg/day) with\u0000continued use of the OA for four weeks.\u0000\u0000Results: Seven subjects (5 male and 2 female, BMI 39.1±6.6) completed\u0000the study. AHI OA + Medications (22.1±16.3) was lower than the AHI\u0000baseline (31.7±11.2). Sleep efficiency and oxygen desaturation indices\u0000improved. Subjective (ESS) and objective (PVT) daytime sleepiness\u0000showed improvement. Mean total airway volume at end inspiration\u0000increased by 35% with OA compared to without OA. Minimum cross\u0000sectional area (CSA) increased by 48.8% with OA compared to without\u0000OA\u0000\u0000Conclusions: Combination of pharmacotherapy and oral appliance maybe a viable option in treating patients with moderate to severe OSA.","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44365927","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mandibular advancement devices (MADs) may enhance upper airway patency during sleep by enlarging the upper airway and/or by decreasing upper airway collapsibility, thereby helping to prevent obstruction of the upper airway. Although MADs are commonly used for the management of obstructive sleep apnea (OSA) in adults, their use in pediatric patients is less common, with limited information available regarding their efficacy. However, for pediatric patients in whom continuous positive airway pressure (CPAP) has failed, who are interested in nonsurgical interventions, or who are awaiting future surgical interventions, an MAD may be an option. This report details one such case, and the successful treatment of OSA with an MAD after failure to tolerate CPAP in a pediatric patient awaiting orthognathic surgery.
{"title":"Severe Obstructive Sleep Apnea Managed with Mandibular Advancement Device in Pediatrics: An Interdisciplinary Case Report","authors":"Devon M. Ptak, Ruba Alkadhi, Ilho Tae, L. Correa","doi":"10.15331/JDSM.7074","DOIUrl":"https://doi.org/10.15331/JDSM.7074","url":null,"abstract":"Mandibular advancement devices (MADs) may enhance upper airway patency during sleep by enlarging the upper airway and/or by decreasing upper airway collapsibility, thereby helping to prevent obstruction of the upper airway. Although MADs are commonly used for the management of obstructive sleep apnea (OSA) in adults, their use in pediatric patients is less common, with limited information available regarding their efficacy. However, for pediatric patients in whom continuous positive airway pressure (CPAP) has failed, who are interested in nonsurgical interventions, or who are awaiting future surgical interventions, an MAD may be an option. This report details one such case, and the successful treatment of OSA with an MAD after failure to tolerate CPAP in a pediatric patient awaiting orthognathic surgery.","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47099546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
I am not the one saying this! Rather, the person who forecast the disappearance of orthodontists is Dr. Laurent Alexandre, a French physician, in his book about artificial intelligence entitled in French “La guerre des intelligences” (which can be loosely translated as “The War of the Intelligences”). Dr. Alexandre writes that an American company from Silicon Valley called Invisalign will use artificial intelligence to provide patients with better adapted orthodontic treatment protocols. In turn, this will very soon make the orthodontic profession irrelevant, just as the job of lamplighter became obsolete when electrical lighting was introduced. One does not have to agree with his view, but if you consider that Dr. Alexandre is a medical specialist with an MBA from HEC Paris (the Harvard Business School of France) who sold his website, Doctissimo (the French equivalent of WebMD), 12 years ago for 156 million US dollars, he certainly is more a visionary than a lunatic... After reading the book, I somewhat agree with Dr. Alexandre: if the orthodontic profession does not evolve, it could disappear. I know orthodontists who are aware of this. But, they are only moderately worried as orthodontics is now changing at an accelerated rate: we now see treatments involving the use of miniscrews, Carriere Motion Appliance, MARPE, PAOO, sometimes combined with Invisalign and the list goes on. The field of straightening teeth is certainly very different today from what it was only ten years ago. Why should this concern us? Just like orthodontists, we need to change too. Our model needs to evolve, and it should start in our universities. If you think that dental sleep medicine is the frontier of our field, it certainly does not appear to be so, as most universities are teaching only traditional dentistry. Now is the time to be moving into the expanded concept of dental medicine. With a little less than 6000 new dentists joining the US work force in 2016 alone and the prevalence of tooth decay steadily going down, educators need to wake up quickly. The only good news I find is that the AADSM took upon itself to gather as many university professors in DSM as possible and allowed them to meet at their last annual meeting in Baltimore. I understand that this gathering will occur again at this year’s annual AADSM meeting. While many universities are slowly awakening to the need for crucial change, we as clinicians also need to improve our clinical expertise. If one looks back at the major review done by Ferguson et al. 13 years ago and compares what was found then to the more recent studies on oral appliance therapy, the reduction of the apneahypopnia index (AHI) as a result of OAT has surprisingly not changed that much. Granted, we make better, sturdier, more hygienic and comfortable appliances now but in order to expand our field we also need to look elsewhere. One of the areas where we need to do better is case selection. At a time when the field of sleep medicin
不是我说的！相反，预测正畸医生消失的人是法国医生Laurent Alexandre博士，他在关于人工智能的书中用法语命名为“La guerre des intelligences”（可以粗略地翻译为“智能之战”）。Alexandre博士写道，来自硅谷的一家名为Invisalign的美国公司将使用人工智能为患者提供更适合的正畸治疗方案。反过来，这将很快使正畸专业变得无关紧要，就像电灯灯的工作在引入电灯时已经过时一样。人们不必同意他的观点，但如果你考虑到Alexandre博士是一位医学专家，拥有巴黎高等商学院（法国哈佛商学院）的MBA学位，12年前以1.56亿美元的价格出售了他的网站Doctissimo（相当于WebMD的法语版），他肯定更像是一个有远见的人，而不是一个疯子。。。读完这本书后，我有点同意亚历山大博士的观点：如果正畸专业不发展，它可能会消失。我知道正畸医生知道这一点。但是，他们只是适度担心，因为牙齿矫正现在正在加速变化：我们现在看到的治疗方法包括使用迷你矫正器、Carriere Motion Appliance、MARPE、PAOO，有时还与Invisalign结合，等等。今天的矫正牙齿领域肯定与十年前大不相同。我们为什么要担心这一点？就像正畸医生一样，我们也需要改变。我们的模式需要发展，它应该从我们的大学开始。如果你认为牙科睡眠医学是我们领域的前沿，那么事实并非如此，因为大多数大学只教授传统牙科。现在是时候进入牙科医学的扩展概念了。仅在2016年，就有不到6000名新牙医加入美国劳动力队伍，蛀牙的流行率也在稳步下降，教育工作者需要迅速清醒过来。我发现的唯一好消息是，AADSM主动召集了尽可能多的大学教授参加DSM，并允许他们在巴尔的摩举行的最后一次年会上会面。据我所知，这次聚会将在今年的AADSM年度会议上再次举行。虽然许多大学正在慢慢意识到关键变革的必要性，但作为临床医生，我们也需要提高我们的临床专业知识。如果回顾Ferguson等人13年前所做的主要综述，并将当时的发现与最近关于口腔矫治器治疗的研究进行比较，令人惊讶的是，OAT导致的呼吸暂停低通气指数（AHI）的降低并没有那么大变化。诚然，我们现在生产更好、更坚固、更卫生、更舒适的电器，但为了扩大我们的领域，我们还需要寻找其他地方。我们需要做得更好的领域之一是案例选择。在睡眠医学领域正在发生重大变化的时候，甚至神圣不可侵犯的AHI指数的价值也受到质疑，通过使用精准医学原理，更好地选择病例，可以大大提高OAT的成功率，并给予口腔矫治器真正应得的认可。这就是为什么我强烈邀请你们看看Victor Lai、Jayne Carberry博士和Danny Eckert博士在本期JDSM中的论文。他们为我们提供了一个关于OSA的全新视角。他们的工作不仅仅是对我们未来的一瞥。请注意，Eckert博士也将出席在圣安东尼奥举行的AADSM年会。当然，也可以随意阅读本期的其余部分，因为它非常好。。。。引文
{"title":"Will the orthodontic profession disappear?","authors":"J. Masse","doi":"10.15331/JDSM.7066","DOIUrl":"https://doi.org/10.15331/JDSM.7066","url":null,"abstract":"I am not the one saying this! Rather, the person who forecast the disappearance of orthodontists is Dr. Laurent Alexandre, a French physician, in his book about artificial intelligence entitled in French “La guerre des intelligences” (which can be loosely translated as “The War of the Intelligences”). Dr. Alexandre writes that an American company from Silicon Valley called Invisalign will use artificial intelligence to provide patients with better adapted orthodontic treatment protocols. In turn, this will very soon make the orthodontic profession irrelevant, just as the job of lamplighter became obsolete when electrical lighting was introduced. One does not have to agree with his view, but if you consider that Dr. Alexandre is a medical specialist with an MBA from HEC Paris (the Harvard Business School of France) who sold his website, Doctissimo (the French equivalent of WebMD), 12 years ago for 156 million US dollars, he certainly is more a visionary than a lunatic... After reading the book, I somewhat agree with Dr. Alexandre: if the orthodontic profession does not evolve, it could disappear. I know orthodontists who are aware of this. But, they are only moderately worried as orthodontics is now changing at an accelerated rate: we now see treatments involving the use of miniscrews, Carriere Motion Appliance, MARPE, PAOO, sometimes combined with Invisalign and the list goes on. The field of straightening teeth is certainly very different today from what it was only ten years ago. Why should this concern us? Just like orthodontists, we need to change too. Our model needs to evolve, and it should start in our universities. If you think that dental sleep medicine is the frontier of our field, it certainly does not appear to be so, as most universities are teaching only traditional dentistry. Now is the time to be moving into the expanded concept of dental medicine. With a little less than 6000 new dentists joining the US work force in 2016 alone and the prevalence of tooth decay steadily going down, educators need to wake up quickly. The only good news I find is that the AADSM took upon itself to gather as many university professors in DSM as possible and allowed them to meet at their last annual meeting in Baltimore. I understand that this gathering will occur again at this year’s annual AADSM meeting. While many universities are slowly awakening to the need for crucial change, we as clinicians also need to improve our clinical expertise. If one looks back at the major review done by Ferguson et al. 13 years ago and compares what was found then to the more recent studies on oral appliance therapy, the reduction of the apneahypopnia index (AHI) as a result of OAT has surprisingly not changed that much. Granted, we make better, sturdier, more hygienic and comfortable appliances now but in order to expand our field we also need to look elsewhere. One of the areas where we need to do better is case selection. At a time when the field of sleep medicin","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45215161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Allen Lee Khai, N. Vranješ, K. Schulze, G. Santucci, D. Kuhns
Study Objectives: The objective of this study was to test a proprietary hard-acrylic computer-aided design/computer-aided manufacturing (CAD/CAM) oral appliance with “retainer-like fit” and determine whether it resulted in tooth movement upon regular wear over a minimum 2-year period. Additionally, this study focused on determining patient acceptance of said device considering any reported side effects. Methods: The 2-year clinical study reports on selected patients in whom sleep apnea has been diagnosed (n=18) recruited from The Snore Center in Calgary. Patients were fitted with a ProSomnus® Sleep Appliance. Impressions were taken at baseline, after approximately 1 year, and after 2 years of use with the oral appliance. Models were marked, scanned, and scored; upper and lower anterior teeth crowding was assessed; and overjet and overbite were measured independently at the University of Pacific. Patients were surveyed on compliance, satisfaction with the appliance, and quality of life using the Sleep Apnea Quality of Life Index (SAQLI-10). Results: This study shows a rigid OA made with proprietary CAD/CAM technology demonstrated no significant change in tooth position during the 2.3-year test period, or in bite changes per maximum intercuspation (MIP), as measured by overjet and overbite. At 2 years, the mean change in Little Irregularity Index for the lower anterior teeth was 0.007 mm (95% confidence interval = [-0.03, 0.05]), which was not statistically different from zero (P>0.05). Patients were highly satisfied with the device and considered it beneficial. Conclusions: A key component to any treatment is patient's acceptance of the appliance and the willingness to wear the OA long term. When patient compliance is observed, hard-acrylic sleep appliances have little effect on tooth movement and MIP bite changes as shown by overjet/overbite. Clinical Trial Registration: Health Research Ethics Board of Alberta: CTC-16-0108
{"title":"Assessment of potential tooth movement and bite changes with a hard-acrylic sleep appliance: A 2-year clinical study.","authors":"Allen Lee Khai, N. Vranješ, K. Schulze, G. Santucci, D. Kuhns","doi":"10.15331/JDSM.7070","DOIUrl":"https://doi.org/10.15331/JDSM.7070","url":null,"abstract":"Study Objectives: The objective of this study was to test a proprietary hard-acrylic computer-aided design/computer-aided manufacturing (CAD/CAM) oral appliance with “retainer-like fit” and determine whether it resulted in tooth movement upon regular wear over a minimum 2-year period. Additionally, this study focused on determining patient acceptance of said device considering any reported side effects. Methods: The 2-year clinical study reports on selected patients in whom sleep apnea has been diagnosed (n=18) recruited from The Snore Center in Calgary. Patients were fitted with a ProSomnus® Sleep Appliance. Impressions were taken at baseline, after approximately 1 year, and after 2 years of use with the oral appliance. Models were marked, scanned, and scored; upper and lower anterior teeth crowding was assessed; and overjet and overbite were measured independently at the University of Pacific. Patients were surveyed on compliance, satisfaction with the appliance, and quality of life using the Sleep Apnea Quality of Life Index (SAQLI-10). Results: This study shows a rigid OA made with proprietary CAD/CAM technology demonstrated no significant change in tooth position during the 2.3-year test period, or in bite changes per maximum intercuspation (MIP), as measured by overjet and overbite. At 2 years, the mean change in Little Irregularity Index for the lower anterior teeth was 0.007 mm (95% confidence interval = [-0.03, 0.05]), which was not statistically different from zero (P>0.05). Patients were highly satisfied with the device and considered it beneficial. Conclusions: A key component to any treatment is patient's acceptance of the appliance and the willingness to wear the OA long term. When patient compliance is observed, hard-acrylic sleep appliances have little effect on tooth movement and MIP bite changes as shown by overjet/overbite. Clinical Trial Registration: Health Research Ethics Board of Alberta: CTC-16-0108","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45190057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
New knowledge of obstructive sleep apnea (OSA) pathophysiology has highlighted the heterogeneity of this common chronic health condition. Recent advances in OSA ‘phenotyping’ concepts have provided a novel framework in which to understand OSA pathophysiology on an individual patient basis. This has also provided new potential precision medicine strategies to optimize efficacy and success rates with current OSA treatments including mandibular advancement therapy.
{"title":"Sleep Apnea Phenotyping: Implications for Dental Sleep Medicine","authors":"Victor Lai, J. Carberry, D. Eckert","doi":"10.15331/JDSM.7072","DOIUrl":"https://doi.org/10.15331/JDSM.7072","url":null,"abstract":"New knowledge of obstructive sleep apnea (OSA) pathophysiology has highlighted the heterogeneity of this common chronic health condition. Recent advances in OSA ‘phenotyping’ concepts have provided a novel framework in which to understand OSA pathophysiology on an individual patient basis. This has also provided new potential precision medicine strategies to optimize efficacy and success rates with current OSA treatments including mandibular advancement therapy.","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47311374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Harmeet K. Chiang, R. Robinson, A. Best, T. Brickhouse, D. Leszczyszyn
Study Objectives: To determine whether pediatric snoring during sedation could be used to screen for obstructive sleep apnea (OSA) by pediatric dentists. Methods: Pediatric dental patients requiring moderate sedation with American Society of Anesthesiologists (I or II) or Brodsky classification (grade 1 and 2) were identified, recruited, separated in groups of snorers and nonsnorers, and then matched based on body mass index to within ±5%. Parents completed a Pediatric Symptom Checklist (PSC), and Pediatric Sleep Questionnaire (PSQ). OSA was diagnosed using a home sleep monitoring device. Groups were compared using a t-test. Results: Overall, 19 children were screened for eligibility and 17 enrolled: 10 who snored (59%) and 7 control participants. Although children who snored during sedation had a nominally higher respiratory disturbance index (RDI) (mean = 5.3 vs. 4.3), this difference was not statistically significant (p > 0.7). Using a cutoff RDI > 5 to indicate significant OSA, 5 of 8 in the snorer group and 2 of 4 in the nonsnorer group met this criterion. Conversely, one nonsnoring participant had a maximum relative loudness of 27dB, which resulted in a nominally higher group mean than the snoring group. The questionnaire results of both the PSC and PSQ average was 5 points higher in the snoring group but the difference was not statistically significant (PSQ p = 0.056, PSC p > 0.4). Conclusions: Snoring alone during pediatric dental procedures does not appear to be indicative of obstructive sleep apnea. Recognition of pediatric sleep apnea may be enhanced through questionnaires and adding snore analysis to home-based sleep apnea screening.
{"title":"A Pilot Study: Is Snoring During Pediatric Dental Procedures Indicative of Obstructive Sleep Apnea?","authors":"Harmeet K. Chiang, R. Robinson, A. Best, T. Brickhouse, D. Leszczyszyn","doi":"10.15331/JDSM.7068","DOIUrl":"https://doi.org/10.15331/JDSM.7068","url":null,"abstract":"Study Objectives: To determine whether pediatric snoring during sedation could be used to screen for obstructive sleep apnea (OSA) by pediatric dentists. Methods: Pediatric dental patients requiring moderate sedation with American Society of Anesthesiologists (I or II) or Brodsky classification (grade 1 and 2) were identified, recruited, separated in groups of snorers and nonsnorers, and then matched based on body mass index to within ±5%. Parents completed a Pediatric Symptom Checklist (PSC), and Pediatric Sleep Questionnaire (PSQ). OSA was diagnosed using a home sleep monitoring device. Groups were compared using a t-test. Results: Overall, 19 children were screened for eligibility and 17 enrolled: 10 who snored (59%) and 7 control participants. Although children who snored during sedation had a nominally higher respiratory disturbance index (RDI) (mean = 5.3 vs. 4.3), this difference was not statistically significant (p > 0.7). Using a cutoff RDI > 5 to indicate significant OSA, 5 of 8 in the snorer group and 2 of 4 in the nonsnorer group met this criterion. Conversely, one nonsnoring participant had a maximum relative loudness of 27dB, which resulted in a nominally higher group mean than the snoring group. The questionnaire results of both the PSC and PSQ average was 5 points higher in the snoring group but the difference was not statistically significant (PSQ p = 0.056, PSC p > 0.4). Conclusions: Snoring alone during pediatric dental procedures does not appear to be indicative of obstructive sleep apnea. Recognition of pediatric sleep apnea may be enhanced through questionnaires and adding snore analysis to home-based sleep apnea screening.","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42998884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tongue restraint may provide additional benefit in mandibular advancement splint (MAS) therapy. However, previous methods of tongue restraint are based on applying active force, resulting in a substantial degree of discomfort for most users. This report describes a novel method called Tongue Tamer (TT), which uses the natural passive ‘flow’ of the tongue to fill the space available to it when relaxed. The TT has been added to the lower plate of patients with an incomplete response to MAS therapy. In a series of 17 cases, the addition of TT has resulted in an additional reduction of -41.8 ± 67.3% (mean ± standard deviation) in apnea-hypopnea Index (AHI) compared to MAS therapy alone and 30% of patients were converted to complete responders (AHI<5 events/h). This novel method of passive restraint of the tongue may be a useful adjunct to MAS therapy.
{"title":"A novel device for passive restraint of the tongue as an adjunct to mandibular advancement therapy in incomplete responders","authors":"Gregory Turek","doi":"10.15331/JDSM.7076","DOIUrl":"https://doi.org/10.15331/JDSM.7076","url":null,"abstract":"Tongue restraint may provide additional benefit in mandibular advancement splint (MAS) therapy. However, previous methods of tongue restraint are based on applying active force, resulting in a substantial degree of discomfort for most users. This report describes a novel method called Tongue Tamer (TT), which uses the natural passive ‘flow’ of the tongue to fill the space available to it when relaxed. The TT has been added to the lower plate of patients with an incomplete response to MAS therapy. In a series of 17 cases, the addition of TT has resulted in an additional reduction of -41.8 ± 67.3% (mean ± standard deviation) in apnea-hypopnea Index (AHI) compared to MAS therapy alone and 30% of patients were converted to complete responders (AHI<5 events/h). This novel method of passive restraint of the tongue may be a useful adjunct to MAS therapy.","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46761290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is the position of the American Academy of Dental Sleep Medicine (AADSM) that oral appliance therapy (OAT) should be reimbursed as a first-line therapy for the treatment of obstructive sleep apnea (OSA). OAT has been deemed an alternate therapy for OSA,, and numerous studies have indicated that OAT is an effective treatment for sleep-related breathing disorders. The American Academy of Sleep Medicine (AASM) has also acknowledged that OAT should be considered if a patient does not wish to use Continuous Positive Airway Pressure (CPAP) therapy. In their joint clinical practice guideline, the AADSM and the AASM stated that “[p]atient preference for OAs versus CPAP should be considered by the treating sleep physician before therapy is prescribed.” Patient treatment preference and choice can be critical in ensuring that patients experience positive health outcomes. This paper explores evidence regarding patient preference for OAT and how preference may lead to greater adherence and health improvement.
{"title":"Oral Appliance Therapy Should be Reimbursed as a First-Line Therapy for OSA","authors":"Jennifer Q. Le, J. Rodgers, Kevin Postol","doi":"10.15331/JDSM.7058","DOIUrl":"https://doi.org/10.15331/JDSM.7058","url":null,"abstract":"It is the position of the American Academy of Dental Sleep Medicine (AADSM) that oral appliance therapy (OAT) should be reimbursed as a first-line therapy for the treatment of obstructive sleep apnea (OSA). OAT has been deemed an alternate therapy for OSA,, and numerous studies have indicated that OAT is an effective treatment for sleep-related breathing disorders. The American Academy of Sleep Medicine (AASM) has also acknowledged that OAT should be considered if a patient does not wish to use Continuous Positive Airway Pressure (CPAP) therapy. In their joint clinical practice guideline, the AADSM and the AASM stated that “[p]atient preference for OAs versus CPAP should be considered by the treating sleep physician before therapy is prescribed.” Patient treatment preference and choice can be critical in ensuring that patients experience positive health outcomes. This paper explores evidence regarding patient preference for OAT and how preference may lead to greater adherence and health improvement.","PeriodicalId":91534,"journal":{"name":"Journal of dental sleep medicine","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49385767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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