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      Acoustic pharyngometry ‐ A new method to facilitate oral appliance therapy

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          Abstract

          Background

          There is lack of reliable and accurate methods to predict treatment outcomes of oral appliance (OA) treatment. Acoustic pharyngometry (AP) is a non‐invasive technique to evaluate the volume and minimal cross‐sectional area of the upper airway, which may prove useful to locate the optimal position of OAs.

          Objective

          This retrospective study aimed to evaluate the effect of applying AP to OA treatment of patients with obstructive sleep apnoea (OSA).

          Methods

          All patients (n = 244) treated with OAs following an AP protocol at two dental clinics between 2013 and 2018 were invited to participate. A total of 129 patients accepted the invitation, and 120 patients (75 men, 45 women) were included in the analyses. Mean baseline age, BMI and apnoea hypopnea index (AHI) were 59.1 ± 0.9 years, 27.8 ± 0.4 and 21.9 ± 1.1, respectively. Mean follow‐up time was 318 ± 24 days.

          Results

          AHI at follow‐up was 6.4 ± 0.7, resulting in a treatment success rate of 86.7% (≥50% reduction of baseline AHI). The number of failures (<50% reduction of baseline AHI) did not differ significantly among patients with mild, moderate and severe OSA. 87.6% of the patients reported OA usage every night, and 95.5% reported > 5 hours usage per night, when worn.

          Conclusion

          The AP protocol applied seems to contribute to the excellent effect of OA treatment in this study. Further research on the application of AP in OA treatment is necessary in order to clarify its possible beneficial contribution to improving OA therapy.

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          Most cited references51

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          Prevalence of sleep-disordered breathing in the general population: the HypnoLaus study.

          Sleep-disordered breathing is associated with major morbidity and mortality. However, its prevalence has mainly been selectively studied in populations at risk for sleep-disordered breathing or cardiovascular diseases. Taking into account improvements in recording techniques and new criteria used to define respiratory events, we aimed to assess the prevalence of sleep-disordered breathing and associated clinical features in a large population-based sample.
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            Adult obstructive sleep apnoea.

            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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              Clinical guideline for the evaluation, management and long-term care of obstructive sleep apnea in adults.

              Obstructive sleep apnea (OSA) is a common chronic disorder that often requires lifelong care. Available practice parameters provide evidence-based recommendations for addressing aspects of care. This guideline is designed to assist primary care providers as well as sleep medicine specialists, surgeons, and dentists who care for patients with OSA by providing a comprehensive strategy for the evaluation, management and long-term care of adult patients with OSA. The Adult OSA Task Force of the American Academy of Sleep Medicine (AASM) was assembled to produce a clinical guideline from a review of existing practice parameters and available literature. All existing evidence-based AASM practice parameters relevant to the evaluation and management of OSA in adults were incorporated into this guideline. For areas not covered by the practice parameters, the task force performed a literature review and made consensus recommendations using a modified nominal group technique. Questions regarding OSA should be incorporated into routine health evaluations. Suspicion of OSA should trigger a comprehensive sleep evaluation. The diagnostic strategy includes a sleep-oriented history and physical examination, objective testing, and education of the patient. The presence or absence and severity of OSA must be determined before initiating treatment in order to identify those patients at risk of developing the complications of sleep apnea, guide selection of appropriate treatment, and to provide a baseline to establish the effectiveness of subsequent treatment. Once the diagnosis is established, the patient should be included in deciding an appropriate treatment strategy that may include positive airway pressure devices, oral appliances, behavioral treatments, surgery, and/or adjunctive treatments. OSA should be approached as a chronic disease requiring long-term, multidisciplinary management. For each treatment option, appropriate outcome measures and long-term follow-up are described.
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                Author and article information

                Contributors
                ulrik.opsahl@uib.no
                Journal
                J Oral Rehabil
                J Oral Rehabil
                10.1111/(ISSN)1365-2842
                JOOR
                Journal of Oral Rehabilitation
                John Wiley and Sons Inc. (Hoboken )
                0305-182X
                1365-2842
                28 December 2020
                May 2021
                : 48
                : 5 ( doiID: 10.1111/joor.v48.5 )
                : 601-613
                Affiliations
                [ 1 ] Department of Clinical Dentistry ‐ Prosthodontics Faculty of Medicine University of Bergen Bergen Norway
                [ 2 ] Norwegian Competence Center for Sleep Disorders Haukeland University Hospital Bergen Norway
                [ 3 ] Tannhelsesenteret Lørenskog og Sogndal Lørenskog Norway
                [ 4 ] Section for Thoracic Medicine Department of Clinical Science Faculty of Medicine University of Bergen Bergen Norway
                Author notes
                [*] [* ] Correspondence

                Ulrik L. Opsahl, Department of Clinical Dentistry ‐ Prosthodontics, Faculty of Medicine, University of Bergen, Post Box 7800, 5009 Bergen, Norway.

                Email: ulrik.opsahl@ 123456uib.no

                Author information
                https://orcid.org/0000-0003-4312-4137
                Article
                JOOR13134
                10.1111/joor.13134
                8246767
                33314265
                00165d02-051a-42ca-8f77-70157403d53f
                © 2020 The Authors. Journal of Oral Rehabilitation published by John Wiley & Sons Ltd

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 14 July 2020
                : 04 December 2020
                Page count
                Figures: 6, Tables: 3, Pages: 13, Words: 9517
                Funding
                Funded by: Universitetet i Bergen , open-funder-registry 10.13039/501100005036;
                Categories
                Original Article
                Original Articles
                Custom metadata
                2.0
                May 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.2 mode:remove_FC converted:01.07.2021

                Dentistry
                acoustic pharyngometry,oral appliance,sleep apnoea
                Dentistry
                acoustic pharyngometry, oral appliance, sleep apnoea

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