This Article Full Text Full Text (PDF) All Versions of this Article: 200211-1275OCv1 168/2/238    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ng, A. T Articles by Cistulli, P. A Search for Related Content PubMed PubMed Citation Articles by Ng, A. T Articles by Cistulli, P. A

Effect of Oral Appliance Therapy on Upper Airway Collapsibility in Obstructive Sleep Apnea

Department of Respiratory and Sleep Medicine, St. George Hospital, University of New South Wales, Sydney, Australia

Correspondence and requests for reprints should be addressed to Peter Cistulli, M.D., Ph.D., Department of Respiratory Medicine, St. George Hospital, Belgrave Street, Kogarah, NSW 2217, Australia. E-mail: p.cistulli{at}unsw.edu.au

Oral appliance therapy is emerging as an alternative to continuous positive airway pressure for the treatment of obstructive sleep apnea (OSA). However, its precise mechanisms of action are yet to be defined. We examined the effect of a mandibular advancement splint (MAS) on upper airway collapsibility during sleep in OSA. Ten patients with proven OSA had a custom-made MAS incrementally adjusted during an acclimatization period until the maximum comfortable limit of mandibular advancement was reached. Polysomnography with the splint was then performed. After a 1-week washout period, upper airway closing pressures during sleep (with and without MAS) were determined. Significant improvements with MAS therapy were seen in the apnea/hypopnea index (25.0 ± 3.1 vs. 13.2 ± 4.5/hour, p < 0.03) and upper airway closing pressure in Stage 2 sleep (–1.6 ± 0.4 vs. –3.9 ± 0.6 cm H₂O, p < 0.01) and in slow wave sleep (–2.5 ± 0.7 vs. –4.7 ± 0.6 cm H₂O, p < 0.02) compared with no therapy. These preliminary data indicate that MAS therapy is associated with improved upper airway collapsibility during sleep. The mediators of this effect remain to be determined.

Key Words: mandibular advancement splint • obstructive sleep apnea • upper airway collapsibility

This article has been cited by other articles:

				N. Tanoue, K. Nagano, S. Yanamoto, and A. Mizuno Comparative evaluation of the breaking strength of a simple mobile mandibular advancement splint Eur J Orthod, December 1, 2009; 31(6): 620 - 624. [Abstract] [Full Text] [PDF]

				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. R. Schwartz, J. Kirkness, and P. Smith Extraluminal tissue pressure: what does it mean? J Appl Physiol, January 1, 2006; 100(1): 5 - 6. [Full Text] [PDF]

				K. Kairaitis, R. Stavrinou, R. Parikh, J. R. Wheatley, and T. C. Amis Mandibular advancement decreases pressures in the tissues surrounding the upper airway in rabbits J Appl Physiol, January 1, 2006; 100(1): 349 - 356. [Abstract] [Full Text] [PDF]

				A. Johal, J. M. Battagel, and B. T. Kotecha Sleep nasendoscopy: a diagnostic tool for predicting treatment success with mandibular advancement splints in obstructive sleep apnoea Eur J Orthod, December 1, 2005; 27(6): 607 - 614. [Abstract] [Full Text] [PDF]

				Y. Huang, D. P. White, and A. Malhotra The Impact of Anatomic Manipulations on Pharyngeal Collapse: Results From a Computational Model of the Normal Human Upper Airway Chest, September 1, 2005; 128(3): 1324 - 1330. [Abstract] [Full Text] [PDF]

				T. Inazawa, T. Ayuse, S. Kurata, I. Okayasu, E. Sakamoto, K. Oi, H. Schneider, and A.R. Schwartz Effect of Mandibular Position on Upper Airway Collapsibility and Resistance Journal of Dental Research, June 1, 2005; 84(6): 554 - 558. [Abstract] [Full Text] [PDF]

				M. Barnes, R. D. McEvoy, S. Banks, N. Tarquinio, C. G. Murray, N. Vowles, and R. J. Pierce Efficacy of Positive Airway Pressure and Oral Appliance in Mild to Moderate Obstructive Sleep Apnea Am. J. Respir. Crit. Care Med., September 15, 2004; 170(6): 656 - 664. [Abstract] [Full Text] [PDF]

				B. Fleury, D. Rakotonanahary, B. Petelle, G. Vincent, N. P. Fleury, B. Meyer, and B. Lebeau Mandibular Advancement Titration for Obstructive Sleep Apnea: Optimization of the Procedure by Combining Clinical and Oximetric Parameters Chest, May 1, 2004; 125(5): 1761 - 1767. [Abstract] [Full Text] [PDF]

				M. J. Tobin Sleep-Disordered Breathing, Control of Breathing, Respiratory Muscles, Pulmonary Function Testing in AJRCCM 2003 Am. J. Respir. Crit. Care Med., January 15, 2004; 169(2): 254 - 264. [Full Text] [PDF]