Mandibular-Lingual Repositioning Device - MLRD
preliminary results of 8 patients with Obstructive Sleep Apnea Syndrome - OSAS
Keywords:
Obstructive Sleep Apnea, Snoring, Dental deviceAbstract
Dental devices have been employed in the treatment of snoring and obstructive sleep apnea syndrome (OSAS) of mild to moderate degrees. The authors disclose the preliminary results in 8 patients with clinically diagnosed obstructive sleep apnea polisomnographically confirmed and treated with a dental device (Mandibular-Lingual Repositioning Device - MLRD) developed by one of the authors (RCB). Cephalometrics was performed before usage of MLRD, Epworth Sleepiness Scale (ESS) tests were conducted before and after the MLRD and a questionnaire that subjectively qualified the Overall Subjective Improvement of the patient (OSI) was filled out. The tests were repeated 4 weeks after the application of the MLRD. The average subjective overall improvement was 73.75% and the Epworth Sleepiness Scale was 13.88 (pre - MLRD) and 6.63 (post - MLRD) representing a significant statistical variation (p=0.05). The authors discuss probable factors involved in the improvement of the subjective measurements of excessive sleepiness.
Downloads
References
BERNSTEIN, A. & REIDY, R. - The effects of mandibular repositioning on obstructive sleep apnea. J. Craniomandibular Practice 6: 179-181, 1988.
BONHAM, E.; CURRIER, G.; ORR, W.; OTHMAN, J. & NANDA, R. - The effects of a modified functional appliance on OSA. Am. J. Orth Dentofac Orthop 94: 384-392, 1988.
BRADLEY, T.; BROWN, I.G.; GROSSMAN, R.F.; ZAMEL, N.; MARTINEZ, D.; PHILLIPSON, E.A. & HOFFSTEIN, V.- Pharyngeal size in snorers, nonsnoreres, and patients with Obstructive Sleep Apnea. New Engl. J. Med. 315: 1327-1327, 1986.
CARTWRIGHT, R.D. & SAMELSON, C.F. - The effects of a nonsurgical treatment for obstructive sleep apnea. Jama 248: 705-709,1982
CARTWRIGHT, R.D. - Predicting Response to the Tongue Retaining Device for Sleep Apnea Syndrome. Arch Otolaryngol 111: 385-388,1985.
CARTWRIGHT, R.D.; STEFOSKI, D.& CALDARELLI, D. - Toward a treatment logic for sleep apnea: the place for the tongue retaining device. Behav Res Ther 26:121-126.,1988
CARTWRIGHT, R.D.; RISTANOVIC, R.; DIAZ, F.; CALDARELLI, D. & ALDER, G. - A Comparative Study of Treatments for Positional Sleep Apnea. Sleep 14: 546-552, 1991.
CLARK, G.T. & NAKAMO, M. - Dental appliances for the treatment of obstructive sleep apnea. J. Am. Dent Ass 118: 611-619,1989.
CRAMPETTE, L.; CARLANDER, B.; MONDAIN, M.; BILLIARD, M.; GUERRIER, B. & DEJEAM, Y. - Surgical Alternatives to Uvulopalatopharynplasty in Sleep Apnea Syndrome. Sleep 5: S63-S68, 1992
DJUPESLAND, G.; LYBERG, T. & KROSGTAD, O. - Cephalometrics analysis and surgical treatment of patients with obstructive sleep apnea. Acta Otoryngol 103: 551-557, 1987.
FUJITA, S.; CONWAY, W.; ZORICK, F. - Surgical correction of antomical abnormalities in Obstructive Sleep Apnea: Uvulopalatopharingoplasty. Otorynol Head Neck Surg 89: 923 -934, 1981 .
GEORGE, P. - A modified functional appliance for treatment of obstructive sleep apnea. J Clin Ortho 21: 171-175, 1987.
GUILLEMINAULT, C. - Obstructive sleep apnea syndrome. Psych Clin North Am 10: 607-6261, 1987.
HE, J.; KRYEGER, M.H.; ZORICK,.F.J.; CONWAY, W. & ROTH, T. - Mortality and apnea index in obstructive sleep apnea. Chest 94: 9-14, 1988.
HORNER, R.L.; MOHIADDIN, R.H.; LOWELL, D.G.; SHEA, S.A.; BURMAN, E.D.; LONGMORE, D.B & GUZ, A. - Sites and Sizes of fat deposits around the pharynx in obese patients with obstuctive sleep apnea and weight matched controls. Eur Respir J 2: 613-622. 1989.
ISSA, F.G & SULLIVAN, C.E. - Upper airway closure pressures in obstructive sleep apnea. J Appl Physiol 57: 140-146. 1984.
JOHNS, M.W. - A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep 14:540-545, 1991.
KRIEGER, J. - Long - Term Compliance with Nasal Continuos Positive Airway Pressure (CPAP) in Obstrucive Sleep Apnea Patients and Nonapneic Snorers. Sleep 15: 542-S46, 1992.
KRYGER, M.H. - Management of Obstructive Sleep Apnea. In: Principles and Practice of Sleep Medicine, KRYGER, M.; ROTH, T. & DEMENT, W. (eds). Saunders, Toronto, 584-590, 1986.
KUNA, S.T. & SANT'AMBROSIO, G. - Pathophysiology of Upper Airway Closure during Sleep. JAMA 22: 1384-1389, 1991.
LOWE, A.; GURZA, S. & SESSELE, B. - Excitatory and inhibitory influences on tongue muscle activity in cat and monkey. Brain Res 21: 417-422, 1976.
LOWE, A.; SANTAMARIA, J.; FLEETHAM, J.& PRICE, C. - Facial morphology and obstructive sleep apnea. Am J Orthod Dentofac Orthop 90: 364-374, 1986.
LOWE, A. - Effects of a mandibular repositioning appliance used in the treatment of obstructive sleep apnea on tongue muscle activity. In: ISSA, F., SURATT, P. & REMMERS, J. (eds) Sleep and Respiration, New York: Wiley-Liss, Inc. 395-405, 1990.
LOWE, A. - Dental appliances for the treatment of snoring and! or obstructive sleep apnea. In KRYEGER, M.; ROTH, T. & DEMENTW. (eds) Principles and practice of sleep medicine 2 nd edition. W.B. Saunders Co: 722-735, 1993.
MONTPLAISIR, J..; BÊDARD, M.A.; RICHER, F. & ROULEAU, I. - Neurobehavioral Manifestations in Obstructive Sleep Apnea Syndrome Before and After Treatment with Continuous Positive Airway Pressure. Sleep 15: S17-S19, 1992.
NICO-MURCIA, G.; MCCANN, C.C.; BLIWISE, D.L..; GUILLEMINAULTIC, C. & DEMENT, W.C. - Compliance and side effects in sleep apnea patientes treated with nasal continuous positive airway pressure. West J. Med. 150: 165-169, 1989.
PARTINEN, M.; GUILLEMINAULT, C.; QUERA-SALVA, M.A. & JAMIESON, A. - Obstructive Sleep Apnea and cephalometric roentgenograms. The role of anatomic upper airway abnormalities in the definition of abnormal breathing during sleep. Chest 93: 1199-1205, 1988a.
PARTINEN, M.; JAMIESON, A. & GUILLEMINAULT, C. - Long term outcome for obstructive sleep apnea syndrome patients: mortality. Chest 94: 1200-1204, 1988b.
PARTINEN, M. & GUILLEMINAULT, C. - Daytime sleepiness and vascular morbidity at seven-year follow-up in obstructive sleep apnea patients. Chest 97: 27-32, 1990.
PARTINEN, M. & TELAKIVI, T. - Epidemiology of Obstructive Sleep Apnea. Sleep 15: S1-S4, 1992.
POWEL, N.B. & RILEY, R.W. Obstructive sleep apnea, continuous positive airway pressure, and surgery. Otolaryngol Head Neck Surg. 99: 362-369, 1988.
REMMERS, J.E. - Anatomy and physiology of upper airway obstruction. In: Principles and Practice of Sleep Medicine, KRYGER, M.; ROTH, T. & DEMENT, W. (eds). Saunders, Toronto, 525-536, 1989.
RICHARDSON, G.S.; CARSKADON, M.A.; FLAGG, W.; VAN DEN HOED, J.; DEMENT, W.C. & MITTLER M.M. - Excessive daytime sleepiness in man: multiple sleep latency measurements in narcoleptic and control subjects. Electroencephalogr Clin Neurophysiol 45: 621-627, 1978.
ROBIN, P. - Glossoptosis due to atresia and hyportrophy of the mandible. Amer J. Dis. Child. 48: 541-7, 1934.
SANDERS, M.H.; GRUENDL, C. & ROGERS, R.M. - Patient compliance with nasal CPAP therapy for sleep apnea. Chest 90: 330-333, 1986.
SCHIMIDT-NOWARA, W.; MEADDE, T. & HAYS, M. - Treatment of snoring and obstructive sleep apnea with a dental orthosis. Chest 99: 1378-1385, 1991.
SHEPARD, J.W.; GEFTER, W.B.; GUILLEMINAULT, C.; HOFFMAN, E.A.; HOFFSTEIN, V.; HYDGEL, D.W.; SURATT, P.M. & WHITE, D.P. - Evaluation of the Upper Airway in Patients with Obstructive Sleep Apnea. Sleep 14: 361-371, 1992.
SOLL, B. & GEORGE, P. - Treatment of obstructive sleep apnea with a nocturnal airway-patency appliance. N. Engl. J. Med. 313: 386, 1985.
THURROW, R.C. - Functional anatomy of the dental mechanisms. In: Atlas of Orthodontic Principles C. V. Mosby Co., St. Louis, 135, 1970.
WALDHORN, R.E.; HERRICK, T. W.; NGUYEN, M.C.; O'DONNEL, A.E.; SODERO, J. & POTOLICCHIO, S.J. - Long term compliance with nasal continuous positive airway pressure therapy for sleep apnea. Chest 97: 33-38, 1990.
