Radiographic study on the efficacy of mandibular advancement in patients with obstructive sleep apnea syndrome

Abstract

Abstract: PURPOSE: To investigate the efficacy and mechanism of mandibular advancement device (MAD) treatment on obstructive sleep apnea syndrome (OSAS) patients. METHODS: Eighty OSAS patients treated with a mandibular protraction appliance were included in the study. Three-dimensional reconstruction technique was used as to measure the changes of upper airway structure and volume before and after MAD treatment. The data was analyzed using SPSS 17.0 software package. RESULTS: The anatomic structure and the reinforcement of soft tissue's collapse in the upper airway changed after application of MAD in OSAS patients; velopharyngeal and laryngopharynx configuration was significantly increased (P<0.01), while oropharyngeal configuration was significantly decreased (P<0.05). CONCLUSIONS: This study demonstrated that pathogeny of OSAS based on morphological characteristics may be removed by mandibular advancement device, the mechanism of efficacy of MAD treatment can be the reduction of airway internal fluctuation and vortex of air.

Key words: Obstructive sleep apnea syndrome, Mandibular advancement device, Upper airway, Cross section area

CLC Number:

R783.9

LI De-hong, YANG Xiang-hong, ZHOU Jing, ZHANG Ling-peng, SHU Wen. Radiographic study on the efficacy of mandibular advancement in patients with obstructive sleep apnea syndrome[J]. Shanghai Journal of Stomatology, 2016, 25(2): 208-211.

References

Liu Y, Lowe AA, Fleetham JA, et al. Cephalometric and physiologic predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea . Am J Orthod Dentofacial Orthop, 2001, 120(6): 639-647.
McNicholas WT. Diagnosis of obstructive sleep apnea in adults . Proc Am Thorac Soc, 2008, 5(2): 154-160.
Pataka A, Riha RL. The obstructive sleep apnoea/hypopnoea syndrome-an overview . Respir Med CME, 2009, 2(3): 111-117. Iwamoto T, Takata Y, Kitamura N, et al. Prognostic predictors on the efficacy of oral appliance therapy for obstructive sleep apnea syndrome . Open J Stomatol, 2012, 2(3): 210-221.
Ogawa T, Enciso R, Shintaku WH, et al. Evaluation of cross-section airway configuration of obstructive sleep apnea . Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2007, 103(1): 102-108.
Mello Junior CF, Guimar es Filho HA, Gomes CA, et al. Radiological findings in patients with obstructive sleep apnea . J Bras Pneumol, 2013, 39(1): 98-101.
曹艳, 刘嘉玲, 缪飞, 等. 多层螺旋CT在阻塞性睡眠呼吸暂停低通气综合征中的应用价值 . 临床放射学杂志, 2007, 26(1): 34-38.
Cosentini T, Le Donne R, Mancini D, et al. Magnetic resonance imaging of the upper airway in obstructive sleep apnea . Radiol Med, 2004, 108(2): 404-416.
Paje DT, Kremer MJ. The perioperative implications of obstructive sleep apnea. Orthop Nurs, 2006, 25(5): 291-297. Caballero P, Alvarez-Sala R, García-Río F,et al. CT in the evaluation of the upper airway in healthy subjects and in patients with obstructive sleep apnea syndrome. Chest, 1998, 113(1): 111-116.
Ryan CF, Love LL, Peat D, et al. Mandibular advancement oral appliance therapy for obstructive sleep apnoea: effect on awake calibre of the velopharynx . Thorax, 1999, 54(11): 972-977.
Inoko Y, Morita O. Relationship between mandibular position and oropharyngeal space in obstructive sleep apnea syndrome patients with dental oral appliance . Prosthodont Res Pract, 2007, 6(3): 194-199. Li HY, Engleman H, Hsu CY,et al. Acoustic reflection for nasal airway measurement in patients with obstructive sleep apnea-hypopnea syndrome .. Sleep, 2005, 28(12): 1554-1559.
曾韶华, 刘月华. 口腔矫治器对阻塞性睡眠呼吸暂停低通气综合征患者上气道影响的磁共振研究. 实用口腔医学杂志, 2011, 27(6): 777-781.
Chen NH, Li KK, Li SY, et al. Airway assessment by volumetric computed tomography in snorers and subjects with obstructive sleep apnea in a Far-East Asian population . Laryngoscope, 2002, 112(4): 721-726.

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