Efficacy of a mandibular advancement intraoral appliance 
(MOA) for the treatment of obstructive sleep apnea syndrome 
(OSAS) in pediatric patients: A pilot-study

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Abstract

Background

To evaluate the treatment efficacy of a mandibular advancement intraoral appliance (MOA) for treatment of obstructive sleep apnea syndrome (OSAS) in pediatric patients.

Material and Methods

Eighteen patients (mean=8.39 years old, women=44.4%) were selected. Sleep disorders, sleep bruxism, and temporomandibular disorders were assessed by the Sleep Disturbance Scale for Children (SDSC), the BiteStrip® (portable SB device), and the Research Diagnostic Criteria for Temporomandibular Disorders, respectively. The clinical diagnosis of OSAS was confirmed with a type 3 portable monitor device (ApneaLinkTM Plus). A silicon-based material MOA was used by patients for 60 days, and the results were compared to baseline.

Results

The median RDI was significantly reduced from 10 to 4.5 events/hour. Nadir SpO2 significantly increased from 82.6% to 88.9%. Total snoring events/hour have also significantly decreased from 205.5 to 91.5. Signs and symptoms of TMD remained unaltered. There was also a reduction from moderate to absence of SB in 12 patients. Similarly, all variables measured by the SDSC have had very significant reductions: disorders of initiating and maintaining sleep, sleep disordered breathing, disorders of arousal, nightmares, sleep wake transition disorders, disorders of excessive somnolence, and sleep hyperhidrosis.

Conclusions

In selected cases, OA maybe considered as an alternative for the OSAS treatment.

Key words:Snoring appliances, sleep apnea, bruxism, sleep disorders, children

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Most cited references 27

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Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine.

Nancy Collop, W Anderson, Brian Boehlecke … (2007)

Based on a review of literature and consensus, the Portable Monitoring Task Force of the American Academy of Sleep Medicine (AASM) makes the following recommendations: unattended portable monitoring (PM) for the diagnosis of obstructive sleep apnea (OSA) should be performed only in conjunction with a comprehensive sleep evaluation. Clinical sleep evaluations using PM must be supervised by a practitioner with board certification in sleep medicine or an individual who fulfills the eligibility criteria for the sleep medicine certification examination. PM may be used as an alternative to polysomnography (PSG) for the diagnosis of OSA in patients with a high pretest probability of moderate to severe OSA. PM is not appropriate for the diagnosis of OSA in patients with significant comorbid medical conditions that may degrade the accuracy of PM. PM is not appropriate for the diagnostic evaluation of patients suspected of having comorbid sleep disorders. PM is not appropriate for general screening of asymptomatic populations. PM may be indicated for the diagnosis of OSA in patients for whom in-laboratory PSG is not possible by virtue of immobility, safety, or critical illness. PM may also be indicated to monitor the response to non-CPAP treatments for sleep apnea. At a minimum, PM must record airflow, respiratory effort, and blood oxygenation. The airflow, effort, and oximetric biosensors conventionally used for in-laboratory PSG should be used in PM. The Task Force recommends that PM testing be performed under the auspices of an AASM-accredited comprehensive sleep medicine program with written policies and procedures. An experienced sleep technologist/technician must apply the sensors or directly educate patients in sensor application. The PM device must allow for display of raw data with the capability of manual scoring or editing of automated scoring by a qualified sleep technician/technologist. A board certified sleep specialist, or an individual who fulfills the eligibility criteria for the sleep medicine certification examination, must review the raw data from PM using scoring criteria consistent with current published AASM standards. Under the conditions specified above, PM may be used for unattended studies in the patient's home. Afollow-up visit to review test results should be performed for all patients undergoing PM. Negative or technically inadequate PM tests in patients with a high pretest probability of moderate to severe OSA should prompt in-laboratory polysomnography.

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Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device.

Daniel Einhorn, Nancy Gordon, Brandon Stewart … (2007)

Screening for sleep apnea may be useful in a number of settings, such as preoperative testing, clinical research, and evaluation for referral to a sleep center. The purpose of the study was to validate the ApneaLink device (ResMed Corporation, Poway, Calif) for use as a screening tool for sleep apnea in clinical practice. The ApneaLink device is a single-channel screening tool for sleep apnea that measures airflow through a nasal cannula connected to a pressure transducer, providing an apnea-hypopnea index (AHI) based on recording time. We compared the AHI from the ApneaLink device to that obtained during simultaneously conducted attended sleep-laboratory polysomnography to assess the sensitivity and specificity of the device in consecutive subjects with type 2 diabetes mellitus referred from a diabetes clinic. We also compared the AHI obtained from the ApneaLink device during a study in the subjects' homes to that obtained during the in-laboratory study. The laboratory study was performed within 2 weeks of the home study. Fifty-nine subjects completed the study. Mean age of subjects was 57 years; mean body mass index was 33 kg/m2. The results demonstrate a high sensitivity and specificity of the at-home ApneaLink AHI compared with the AHI from the simultaneous polysomnographic study at all AHI levels, with the best results at an AHI of > or =15 events per hour (sensitivity 91%, specificity 95%). The AHI comparison from the home and laboratory studies also demonstrates good sensitivity and specificity at AHI levels of > or =15 and > or =20 events per hour (sensitivity 76%, specificity 94%, for both). Given the prevalence of sleep apnea in the adult population and in specific comorbid conditions, a screening tool may be useful in many diagnostic settings. This study demonstrates that the ApneaLink device provides reliable information, is a simple, easy-to-use device, and is highly sensitive and specific in calculating AHI, when compared with the AHI obtained from full polysomnography.

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Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults.

Andrew L. Chesson, Malcolm B Berry, … (2003)

A variety of devices are used to evaluate patients with a potential diagnosis of obstructive sleep apnea (OSA). A committee comprised of members of the American Academy of Sleep Medicine, American Thoracic Society, and American College of Chest Physicians systematically evaluated data on the use of these devices and developed practice parameters. Three categories of portable monitoring (PM) devices were reviewed with regard to assessing the probability of identifying an apnea-hypopnea index (AHI) of greater or less than 15 in attended and unattended settings. Type 2 (minimum of seven channels, including EEG, EOG, chin EMG, ECG or heart rate, airflow, respiratory effort, oxygen saturation), Type 3 (minimum of four channels, including ventilation or airflow (at least two channels of respiratory movement, or respiratory movement and airflow), heart rate or ECG and oxygen saturation) and Type 4 (most monitors of this type measure a single parameter or two parameters) devices were evaluated, and in-laboratory, attended polysomnography was used as a reference. (1) Insufficient evidence is available to recommend the use of Type 2 PM devices in attended or unattended settings. (2) Type 3 PM devices appear to be capable of being used in an attended setting to increase or to decrease the probability that a patient has an apnea-hypopnea index greater than 15. (3) The use of Type 3 PM devices in an unattended setting is not recommended to rule in, rule out, or both rule in and rule out a diagnosis of OSA. (4) There is some evidence that the use of Type 3 PM devices in an attended in-laboratory setting may be acceptable to both rule in and rule out a diagnosis of OSA if certain limitations are in place. These limitations include manually scoring the records, using the devices only in patients without significant comorbid conditions, having an awareness that symptomatic patients with a negative study should have a Type 1 study, and not using these devices for titrating positive airway pressure or conducting split-night studies. (5) The use of Type 4 PM devices in attended or unattended settings is not recommended. Type 3 and 4 PM devices cannot score sleep and, therefore, do not meet some current Medicare guidelines. The use of PM devices is not recommended for general-population screening or in the absence of a pretest probability of the patient having a diagnosis of OSA, for complaints other than those associated with OSA, without review of raw data during interpretation, by physicians without familiarity with their use and limitations, and without trained personnel to perform technical scoring. Future research should address the use of PM devices in patients with comorbid conditions; non-White patients and women; larger, better-controlled studies; studies focused on the use of Type 2 and 3 devices; studies focusing on decision making and outcomes rather than simple classification using arbitrary cutoffs; and studies that seek to elucidate cost-effectiveness data on the use of PM devices.

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Author and article information

Journal

Journal ID (nlm-ta): Med Oral Patol Oral Cir Bucal

Journal ID (iso-abbrev): Med Oral Patol Oral Cir Bucal

Journal ID (publisher-id): Medicina Oral S.L.

Title: Medicina Oral, Patología Oral y Cirugía Bucal

Publisher: Medicina Oral S.L.

ISSN (Print): 1698-4447

ISSN (Electronic): 1698-6946

Publication date (Print): November 2018

Publication date (Electronic): 21 November 2018

Volume: 23

Issue: 6

Pages: e656-e663

Affiliations

[1 ]DDS, MS, PhD, Post-Graduate Program in Dentistry (Prosthodontics), Faculty of Dentistry, Pontifical Catholic University Universidade Católica do Rio Grande do Sul (PUCRS). Av. Ipiranga, 6681, 90619-900, Porto Alegre, RS, Brazil

[2 ]DDS, Faculty of Dentistry, Pontifical Catholic University Universidade Católica do Rio Grande do Sul (PUCRS). Av. Ipiranga, 6681, 90619-900, Porto Alegre, RS, Brazil

[3 ]MD, PhD, Specialist in Sleep Medicine, Pneumology Center, Sleep Laboratory, Clinical Hospital of Porto Alegre (HCPA), Rua Ramiro Barcelos, 2350, sala 2050, 90035-903, Porto Alegre, RS, Brazil

[4 ]DDS, MS, PhD, Professor, Post-Graduate Program in Dentistry (Prosthodontics and Implantology), Araçatuba Faculty of Dentistry, University of the State of São Paulo (UNESP), Brazil

[5 ]DDS, MS, PhD, Professor, Post-Graduate Program in Dentistry (Prosthodontics), Faculty of Dentistry, Pontifical Catholic University of Rio Grande do Sul (PUCRS). Av. Ipiranga, 6681, 90619-900, Porto Alegre, RS, Brazil

Author notes

Av. Ipiranga, 6681, 90619-900 Porto Alegre RS, Brazil , E-mail: mlgrossi@ 123456pucrs.br

Conflict of interest statement:This study has been approved by the Research Ethics Committee of the Clinical Hospital of Porto Alegre - CEP/HCPA#110284 and the Pontifical Catholic University of Rio Grande do Sul - CAAE#08404412.0.1001.5336, Brazil. Federal and State Government research sponsoring agencies (CAPES and FAPERGS) provided financial academic institutional scholarship funding. ResMed LATAM provided the portable ApneaLinkTM Plus device. The sponsors had no role in the design or conduct of this research. All authors certify that they have no conflicts of interest. Informed consent was obtained from all individual participants included in the study.

Article

Publisher ID: 22580

DOI: 10.4317/medoral.22580

PMC ID: 6260994

PubMed ID: 30341264

SO-VID: e42b194a-575b-4e18-9ea3-4d7e70d19061

License:

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

History

Date accepted : 20 September 2018

Date received : 23 May 2018

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Efficacy of a mandibular advancement intraoral appliance (MOA) for the treatment of obstructive sleep apnea syndrome (OSAS) in pediatric patients: A pilot-study

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Abstract

Background

Material and Methods

Results

Conclusions

Related collections

Beyond the Snore: Comprehensive Studies on Sleep Apnea

Most cited references 27

Clinical guidelines for the use of unattended portable monitors in the diagnosis of obstructive sleep apnea in adult patients. Portable Monitoring Task Force of the American Academy of Sleep Medicine.

Validation of the ApneaLink for the screening of sleep apnea: a novel and simple single-channel recording device.

Practice parameters for the use of portable monitoring devices in the investigation of suspected obstructive sleep apnea in adults.

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Cited by 5

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