| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
|
|
|
|
|||||||||||||
|
|
|||||||||||||||
Departments of
Medicine and Clinical Dental Sciences, University of British Columbia,
Vancouver, British Columbia, Canada
Correspondence to: Dr CF Ryan, Division of Respiratory Medicine, Vancouver Hospital and Health Sciences Centre, 2775 Heather Street, Vancouver, British Columbia V5Z 3J5, Canada
Received 10 December 1998; Returned to authors 25 February 1999; Revised version received 14 June 1999; Accepted for publication 13 July 1999
BACKGROUND
The
mechanisms of action of oral appliance therapy in obstructive sleep
apnoea are poorly understood. Videoendoscopy of the upper airway
was used during wakefulness to examine whether the changes in
pharyngeal dimensions produced by a mandibular advancement oral
appliance are related to the improvement in the severity of obstructive
sleep apnoea.
METHODSFifteen
patients with mild to moderate obstructive sleep apnoea (median (range)
apnoea index (AI) 4(0-38)/h, apnoea-hypopnoea index (AHI) 28(9-45)/h)
underwent overnight polysomnography and imaging of the upper airway
before and after insertion of the oral appliance. Images were obtained
in the hypopharynx, oropharynx, and velopharynx at end tidal expiration
during quiet nasal breathing in the supine position. The cross
sectional area and diameters of the upper airway were measured using
image processing software with an intraluminal catheter as a linear calibration.
RESULTSAI decreased
to a median (range) value of 0 (0-6)/h (p<0.01) and AHI to 8 (1-28)/h (p<0.001) following insertion of the oral appliance. The
median (95% confidence interval) cross sectional area of the upper
airway increased by 18% (3 to 35) (p<0.02) in the hypopharynx and by
25% (11 to 69) (p<0.005) in the velopharynx, but not significantly in
the oropharynx. Although in general the shape of the pharynx did not
change following insertion of the oral appliance, the lateral diameter
of the velopharynx increased to a greater extent than the
anteroposterior diameter. Following insertion of the oral appliance the
reduction in AHI was related to the increase in cross sectional area of
the velopharynx (p = 0.01).
CONCLUSIONSA
mandibular advancement oral appliance increases the cross sectional
area of the upper airway during wakefulness, particularly in the
velopharynx. Assuming this effect on upper airway calibre is not
eliminated by sleep, mandibular advancement oral appliances may reduce
the severity of obstructive sleep apnoea by maintaining patency of the
velopharynx, particularly in its lateral dimension.
This article has been cited by other articles:
|
|
 |
|
  O. M. Vanderveken, A. Devolder, M. Marklund, A. N. Boudewyns, M. J. Braem, W. Okkerse, J. A. Verbraecken, K. A. Franklin, W. A. De Backer, and P. H. Van de Heyning Comparison of a Custom-made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea Am. J. Respir. Crit. Care Med., July 15, 2008; 178(2): 197 - 202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. L. Chan, R. W. W. Lee, and P. A. Cistulli Non-Positive Airway Pressure Modalities: Mandibular Advancement Devices/Positional Therapy Proceedings of the ATS, February 15, 2008; 5(2): 179 - 184. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Boudewyns, M. Marklund, and W. Hochban Alternatives for OSAHS treatment: selection of patients for upper airway surgery and oral appliances Eur. Respir. Rev., December 1, 2007; 16(106): 132 - 145. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. S. L. Chan, R. W. W. Lee, and P. A. Cistulli Dental Appliance Treatment for Obstructive Sleep Apnea Chest, August 1, 2007; 132(2): 693 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Smith and J. M. Battagel Non-apneic snoring and the orthodontist: radiographic pharyngeal dimension changes with supine posture and mandibular protrusion J. Orthod., June 1, 2004; 31(2): 124 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Hoekema, B. Stegenga, and L.G.M. de Bont EFFICACY AND CO-MORBIDITY OF ORAL APPLIANCES IN THE TREATMENT OF OBSTRUCTIVE SLEEP APNEA-HYPOPNEA: A SYSTEMATIC REVIEW Crit. Rev. Oral. Biol. Med., May 1, 2004; 15(3): 137 - 155. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Tsuiki, A.A. Lowe, F.R. Almeida, N. Kawahata, and J.A. Fleetham Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity Eur. Respir. J., February 1, 2004; 23(2): 263 - 268. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. T Ng, H. Gotsopoulos, J. Qian, and P. A Cistulli Effect of Oral Appliance Therapy on Upper Airway Collapsibility in Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., July 15, 2003; 168(2): 238 - 241. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J. Pitsis, M. A. Darendeliler, H. Gotsopoulos, P. Petocz, and P. A. Cistulli Effect of Vertical Dimension on Efficacy of Oral Appliance Therapy in Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., September 15, 2002; 166(6): 860 - 864. [Abstract] [Full Text]
|
|
|
|
|
|
E. C. Rose, R. Staats, C. Virchow Jr, and I. E. Jonas Occlusal and Skeletal Effects of an Oral Appliance in the Treatment of Obstructive Sleep Apnea* Chest, September 1, 2002; 122(3): 871 - 877. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D M Smith and J R Stradling Can mandibular advancement devices be a satisfactory substitute for short term use in patients on nasal continuous positive airway pressure? Thorax, April 1, 2002; 57(4): 305 - 308. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. FRITSCH, A. ISELI, E. W. RUSSI, and K. E. BLOCH Side Effects of Mandibular Advancement Devices for Sleep Apnea Treatment Am. J. Respir. Crit. Care Med., September 1, 2001; 164(5): 813 - 818. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.D. McGown, H.K. Makker, J.M. Battagel, P.R. L'Estrange, H.R. Grant, and S.G. Spiro Long-term use of mandibular advancement splints for snoring and obstructive sleep apnoea: a questionnaire survey Eur. Respir. J., March 1, 2001; 17(3): 462 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. T. GEORGE Selecting sleep-disordered-breathing appliances: Biomechanical considerations J Am Dent Assoc, March 1, 2001; 132(3): 339 - 347. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. E. BLOCH, A. ISELI, J. N. ZHANG, X. XIE, V. KAPLAN, P. W. STOECKLI, and E. W. RUSSI A Randomized, Controlled Crossover Trial of Two Oral Appliances for Sleep Apnea Treatment Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 246 - 251. [Abstract] [Full Text]
|
|
|
|
|
|
C F Ryan and L L Love Unpredictable results of laser assisted uvulopalatoplasty in the treatment of obstructive sleep apnoea Thorax, May 1, 2000; 55(5): 399 - 404. [Abstract] [Full Text]
|
|
Read all eLetters
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS | REGISTER |
