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Initial Evaluation of a Titration Appliance for Temporary Treatment of Obstructive Sleep Apnea.

Levendowski DJ, Morgan T, Westbrook P - J Sleep Disord Ther (2011)

Bottom Line: The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01).Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy.When set to 70% of maximum protrusion, the titration appliance may provide immediate, temporary therapeutic benefit.

View Article: PubMed Central - PubMed

Affiliation: Advanced Brain Monitoring Inc., Carlsbad, USA.

ABSTRACT

Background: Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances, however, are expensive, must be fitted by a dentist, and the likelihood of successful outcomes are difficult to predict. An inexpensive trial appliance, if proven efficacious, might be used to predict custom appliance outcomes or to provide temporary therapeutic benefit.

Objective: The aim of this initial study was to assess the treatment efficacy of a novel titration oral appliance with that of an optimized custom appliance.

Methods: Seventeen patients, treated with a custom oral appliance for at least one year, successfully completed a three-night home sleep test. The baseline obstructive sleep apnea severity was established on Night 1 with seven patients exhibiting severe, six moderate and four mild apnea/hypopnea indexes. Patients were randomly assigned to wear their custom appliance or the titration appliance on Nights 2 and 3.

Results: Significant reductions in the mean overall and supine apnea indexes (p < 0.05), and the overall (p < 0.01) and supine (p < 0.05) apnea/hypopnea indexes were observed for both the titration and custom appliances. The proportion of patients who exhibited at least a 50% reduction in the overall apnea index and supine apnea/hypopnea were similar for the titration and custom appliance (~60%). The custom appliance reduced the overall apnea/hypopnea index by 50% in a greater proportion of the patients compared to the titration appliance (77% vs. 53%). The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01). Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy.

Conclusion: The titration appliance may be useful in assessing oral appliance treatment efficacy. When set to 70% of maximum protrusion, the titration appliance may provide immediate, temporary therapeutic benefit.

No MeSH data available.


Related in: MedlinePlus

Changes in the SpO2 desaturation across supine events with a 50% reduction in tidal volume in patients with a) severe, and b) mild or moderate OSA.
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Figure 12: Changes in the SpO2 desaturation across supine events with a 50% reduction in tidal volume in patients with a) severe, and b) mild or moderate OSA.

Mentions: Significant reductions in SpO2 reductions across sleep disordered breathing events were obtained with the titration appliance overall and supine (Figure 10) (p=0.014 and 0.006, L-CI = 0.3 and 0.5 % reduction in SpO2). The effect of the custom appliance on the reduction in SpO2 desaturation was close to significant overall and supine (p = 0.058 and 0.055). Individual cases, stratified by OSA severity overall and in the supine position are presented in (Figures 11 and 12).


Initial Evaluation of a Titration Appliance for Temporary Treatment of Obstructive Sleep Apnea.

Levendowski DJ, Morgan T, Westbrook P - J Sleep Disord Ther (2011)

Changes in the SpO2 desaturation across supine events with a 50% reduction in tidal volume in patients with a) severe, and b) mild or moderate OSA.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4626015&req=5

Figure 12: Changes in the SpO2 desaturation across supine events with a 50% reduction in tidal volume in patients with a) severe, and b) mild or moderate OSA.
Mentions: Significant reductions in SpO2 reductions across sleep disordered breathing events were obtained with the titration appliance overall and supine (Figure 10) (p=0.014 and 0.006, L-CI = 0.3 and 0.5 % reduction in SpO2). The effect of the custom appliance on the reduction in SpO2 desaturation was close to significant overall and supine (p = 0.058 and 0.055). Individual cases, stratified by OSA severity overall and in the supine position are presented in (Figures 11 and 12).

Bottom Line: The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01).Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy.When set to 70% of maximum protrusion, the titration appliance may provide immediate, temporary therapeutic benefit.

View Article: PubMed Central - PubMed

Affiliation: Advanced Brain Monitoring Inc., Carlsbad, USA.

ABSTRACT

Background: Custom oral appliances that adjustably advance the mandible provide superior outcomes when treating patients with moderate or severe sleep apnea. Custom appliances, however, are expensive, must be fitted by a dentist, and the likelihood of successful outcomes are difficult to predict. An inexpensive trial appliance, if proven efficacious, might be used to predict custom appliance outcomes or to provide temporary therapeutic benefit.

Objective: The aim of this initial study was to assess the treatment efficacy of a novel titration oral appliance with that of an optimized custom appliance.

Methods: Seventeen patients, treated with a custom oral appliance for at least one year, successfully completed a three-night home sleep test. The baseline obstructive sleep apnea severity was established on Night 1 with seven patients exhibiting severe, six moderate and four mild apnea/hypopnea indexes. Patients were randomly assigned to wear their custom appliance or the titration appliance on Nights 2 and 3.

Results: Significant reductions in the mean overall and supine apnea indexes (p < 0.05), and the overall (p < 0.01) and supine (p < 0.05) apnea/hypopnea indexes were observed for both the titration and custom appliances. The proportion of patients who exhibited at least a 50% reduction in the overall apnea index and supine apnea/hypopnea were similar for the titration and custom appliance (~60%). The custom appliance reduced the overall apnea/hypopnea index by 50% in a greater proportion of the patients compared to the titration appliance (77% vs. 53%). The titration appliance significantly reduced the degree of hypoxic exposure across sleep disordered breathing events overall (p < 0.05) and supine (p < 0.01). Patients found their custom appliance was more comfortable than the titration appliance, but preferred the titration appliance to no therapy.

Conclusion: The titration appliance may be useful in assessing oral appliance treatment efficacy. When set to 70% of maximum protrusion, the titration appliance may provide immediate, temporary therapeutic benefit.

No MeSH data available.


Related in: MedlinePlus