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      Management of severe obstructive sleep apnea using mandibular advancement devices with auto continuous positive airway pressures

      case-report

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          Abstract

          The use of continuous positive airway pressures (CPAP) is considered standard treatment of moderate to severe obstructive sleep apnea (OSA). Treatment of the disease poses a great challenge not only for its diagnostic purpose but also for its treatment part. In about 29-83% of the patients, treatment is difficult because of non-compliance resulting due to high pressures, air leaks and other related issues. In such situations, alternative methods of treatment need to be looked for so as to ascertain better management. Mandibular advancement devices along with CPAP may show better treatment outcome in specific situations.

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          Most cited references18

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          Adult obstructive sleep apnoea.

          Amy S Jordan, David G McSharry, Atul Malhotra (2014)
          Obstructive sleep apnoea is an increasingly common disorder of repeated upper airway collapse during sleep, leading to oxygen desaturation and disrupted sleep. Features include snoring, witnessed apnoeas, and sleepiness. Pathogenesis varies; predisposing factors include small upper airway lumen, unstable respiratory control, low arousal threshold, small lung volume, and dysfunctional upper airway dilator muscles. Risk factors include obesity, male sex, age, menopause, fluid retention, adenotonsillar hypertrophy, and smoking. Obstructive sleep apnoea causes sleepiness, road traffic accidents, and probably systemic hypertension. It has also been linked to myocardial infarction, congestive heart failure, stroke, and diabetes mellitus though not definitively. Continuous positive airway pressure is the treatment of choice, with adherence of 60-70%. Bi-level positive airway pressure or adaptive servo-ventilation can be used for patients who are intolerant to continuous positive airway pressure. Other treatments include dental devices, surgery, and weight loss.
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            Oral appliances for snoring and obstructive sleep apnea: a review.

            Wolfgang Schmidt, Bethany R. Cartwright, Mark K. Ferguson … (2006)
            We conducted an evidence-based review of literature regarding use of oral appliances (OAs) in the treatment of snoring and obstructive sleep apnea syndrome (OSA) from 1995 until the present. Our structured search revealed 141 articles for systematic scrutiny, of which 87 were suitable for inclusion in the evidence base, including 15 Level I to II randomized controlled trials and 5 of these trials with placebo-controlled treatment. The efficacy of OAs was established for controlling OSA in some but not all patients with success (defined as no more than 10 apneas or hypopneas per hour of sleep) achieved in an average of 52% of treated patients. Effects on sleepiness and quality of life were also demonstrated, but improvements in other neurocognitive outcomes were not consistent. The mechanism of OA therapy is related to opening of the upper airway as demonstrated by imaging and physiologic monitoring. Treatment adherence is variable with patients reporting using the appliance a median of 77% of nights at 1 year. Minor adverse effects were frequent whereas major adverse effects were uncommon. Minor tooth movement and small changes in the occlusion developed in some patients after prolonged use, but the long-term dental significance of this is uncertain. In comparison to continuous positive airway pressure (CPAP), OAs are less efficacious in reducing the apnea hypopnea index (AHI), but OAs appear to be used more (at least by self report), and in many studies were preferred over CPAP when the treatments were compared. OAs have also been compared favorably to surgical modification of the upper airway (uvulopalatopharyngoplasty, UPPP). Comparisons between OAs of different designs have produced variable findings. The literature of OA therapy for OSA now provides better evidence for the efficacy of this treatment modality and considerable guidance regarding the frequency of adverse effects and the indications for use in comparison to CPAP and UPPP.
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              Non-CPAP therapies in obstructive sleep apnoea.

              F Jalbert, B Sanner, A Valipour … (2011)
              In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine. Evidence supports the use of mandibular advancement devices in mild to moderate OSAS. Maxillomandibular osteotomy seems to be as efficient as continuous positive airway pressure (CPAP) in patients who refuse conservative treatment. Distraction osteogenesis is usefully applied in congenital micrognathia or midface hypoplasia. There is a trend towards improvment after weight reduction. Positional therapy is clearly inferior to CPAP and long-term compliance is poor. Drugs, nasal dilators and apnoea triggered muscle stimulation cannot be recommended as effective treatments of OSAS at the moment. Nasal surgery, radiofrequency tonsil reduction, tongue base surgery, uvulopalatal flap, laser midline glossectomy, tongue suspension and genioglossus advancement cannot be recommended as single interventions. Uvulopalatopharyngoplasty, pillar implants and hyoid suspension should only be considered in selected patients and potential benefits should be weighed against the risk of long-term side-effects. Multilevel surgery is only a salvage procedure for OSA patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Lung India
                Journal ID (iso-abbrev): Lung India
                Journal ID (publisher-id): LI
                Title: Lung India : Official Organ of Indian Chest Society
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0970-2113
                ISSN (Electronic): 0974-598X
                Publication date (Print): Mar-Apr 2015
                Volume: 32
                Issue: 2
                Pages: 158-161
                Affiliations
                [1] Department of Pulmonary Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
                [1 ] Department of Prosthodontics, King George's Medical University, Lucknow, Uttar Pradesh, India
                Author notes
                Address for correspondence: Dr. Rasmi Upadhyay, Department of Pulmonary Medicine, King George's Medical University, Lucknow - 226 003, Uttar Pradesh, India. E-mail: rash.georgian@ 123456gmail.com
                Article
                Publisher ID: LI-32-158
                DOI: 10.4103/0970-2113.152632
                PMC ID: 4372871
                SO-VID: fd06ad63-8464-43e6-84f5-bcfe32cd7991
                Copyright © Copyright: © Lung India
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Respiratory medicine
                Keywords: continuous positive airway pressures,mandibular advancement devices,obstructive sleep apnea
                Data availability:
                ScienceOpen disciplines: Respiratory medicine
                Keywords: continuous positive airway pressures, mandibular advancement devices, obstructive sleep apnea

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