The success and failure of using tongue-backing mandible andvancing device in treating obstructive sleep apnea patients
Date Issued
2012
Date
2012
Author(s)
Han, Sung-Ying
Abstract
ABSTRACT
Objectives：
An innovative design of oral appliance, the tongue backing mandible advancing device (t-MAD) has been developed. The aim of this study was to report its treatment efficacy of obstructive sleep apnea (OSA); and to explore potential predictors of this new device.
Materials and Methods:
In this retrospective study (ranged from Jan 2010 to Dec 2011), 62 polysomnogram (PSG)-proved OSA patients (AHI≧5) were recruited. All were treated with t-MAD at the Clinic of Sleep Dentistry of NTUH. Baseline demographic and physiological data and lateral cephalometric images were collected before t-MAD delivery. PSG was used to evaluate its treatment outcomes 3 months after treatment.
Various criteria in defining the so-called “response” by using AHI reduction and residual AHI have been used to evaluate treatment outcomes.
Criterion 1: ≥ 50% reduction of AHI
Criterion 2: ≥ 50% reduction of AHI and the residual AHI less than 15/h
Criterion 3: ≥ 50% reduction of AHI and the residual AHI less than 10/h, and
Criterion 4: ≥ 50% reduction of AHI and the residual AHI less than 5/h .
Results:
The using of t-MAD has resulted in significant improvement in many different aspects of sleep quality parameters, namely N1 percentage, AHI (at REM, NREM, and in total), obstruction apnea, hypopnea, average oxygen saturation, lowest oxygen saturation, saturation<90%, and arousal index (p<0.05).
By using all 4 criteria, t-MAD could bring 83.3% of response rate in treating mild OSA patients. For moderate and OSA patients, the response rates were 73.9％/ 73.9%/ 69.6％/ 47.8％; and 82.6％/ 82.6%/ 65.2％ / 47.8％, according to 4 different criterion, respectively. For some extremely severe OSA patients (AHI ≥ 50), the response rates were 50％/ 20％/ 10％/ 0, respectively.
Age, ∠SNA, overbite, and H-Me distance were found to be significant predictors of tMAD treatment. For the modertate OSA patients, the baseline AHI was an important predictor. The BMI, hyoid bone level(S-H), and oropharyngeal airway space(PNS-AA) were the predictors of severe OSA patients.
Conclusion：
The tMAD is an effective appliance in treating OSA patients. Certain cephalometric measurements and PSG parameters can be used for patient selection.
Subjects
obstructive sleep apnea
oral appliance
tongue backing design
cephalometric analysis
Type
thesis
File(s)![Thumbnail Image]()
Loading...
Name
index.html
Size
23.27 KB
Format
HTML
Checksum
(MD5):b29ed505e5dcabae0d73c61deb35cce0