Michigan Head & Neck Institute » Sleep Apnea

13 WTHRU.S. Army Sleep Apnea Research Suggests Adjustable Oral Appliances are a Good First-Line Treatment Option

admin — Mon, 28 Nov 2011 16:24:49 +0000

U.S. Army Sleep Apnea Research Suggests Adjustable Oral Appliances are a Good First-Line Treatment Option

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SOURCE U.S. Army Medical Department

FORT KNOX, Ky., Nov. 21, 2011 /PRNewswire/ — Patients with mild to moderate obstructive sleep apnea (OSA), a condition in which the airway collapses and blocks breathing for 10 seconds or more, may consider adjustable oral appliances (OAs), devices that fit within the mouth to prevent upper airway collapse, as an effective first-line treatment, according to two studies conducted by sleep medicine specialists from Walter Reed National Military Medical Center (WRNMMC) in Bethesda, Md.

The retrospective, peer-reviewed studies, published in the December 2011 issue of CHEST, the official journal of the American College of Chest Physicians, and in the current issue of the Journal of Clinical Sleep Medicine (JCSM), the official journal of the American Academy of Sleep Medicine, provide findings on OAs from the largest patient populations studied to date. The studies found that adjustable OAs are nearly as effective as continuous positive airway pressure (CPAP) treatment for patients with a mild form of OSA and are more effective than fixed oral appliances, particularly in patients with moderate to severe OSA.

“Historically, CPAP has been the primary treatment for OSA, but only half of patients tolerate this therapy, which requires wearing a face mask hooked to a machine each night,” said Lt. Col. Christopher Lettieri, M.D., one of the studies’ authors, an Army medical director and the chief of sleep medicine in the pulmonary, critical care and sleep medicine department at WRNMMC. “This new data offers a fresh look at adjustable oral appliances as an initial treatment for OSA in both the military and civilian sectors.” Eighteen million Americans, or 4 percent of men and 2 percent of women, suffer from sleep apnea, which can cause daytime sleepiness and has been linked to high blood pressure, heart attack, and stroke.

The military is interested in the potential of adjustable OAs, also called mandibular advancement devices, as alternatives to CPAP systems since some active duty service members deploy to austere environments where electricity needed to run CPAP machines is not always available. In these cases, reliance on CPAP may result in duty restrictions or separation from service.

“Adjustable OAs would eliminate duty assignment limitations associated with CPAP, allowing Soldiers to travel to remote areas as needed,” said Lettieri.

The study in CHEST, titled “Efficacy of an Adjustable Oral Appliance and Comparison to Continuous Positive Airway Pressure for the Treatment of Obstructive Sleep Apnea Syndrome,” evaluated and compared results of overnight sleep studies in which patients used adjustable OAs or CPAP devices. Results were measured by the apnea-hypopnea index (AHI) score, used to assess the severity of sleep apnea based on the total number of complete cessations (apnea) and partial obstructions (hypoapnea) of breathing that last for at least 10 seconds per hour of sleep. Researchers found that a significantly higher percentage of patients using an adjustable OA experienced successful reduction of their AHI score to below five apneic events per hour in this study compared to past reports (62.3 percent versus 54 percent).

In the JCSM study, “Comparison of Adjustable and Fixed Oral Appliances for the Treatment of Obstructive Sleep Apnea,” patients were treated with either adjustable or fixed OAs and a sleep evaluation was conducted before and during treatment with the devices. Patients using adjustable OAs had a greater reduction in obstructive events (AHI), revealing that adjustable OAs had a greater efficacy than fixed devices (57.2 percent vs. 46.9 percent) among this patient cohort.

A total of 497 patients were prescribed adjustable OAs in the CHEST study and 602 patients in the JCSM study. The studies included patients who participated in an overnight sleep study at the sleep disorders center at Walter Reed National Military Medical Center.

Aaron B. Holley, M.D., Anita A. Shah, D.O., Nathalie Paolino, D.O., and Arn H. Eliasson, M.D., also participated in the studies.

The U.S. Army offers two sleep medicine fellowship programs accredited by the Accreditation Council for Graduate Medical Education at Walter Reed National Military Medical Center and San Antonio Military Medical Center.

WOW! What a great Valentine’s idea!

admin — Thu, 10 Feb 2011 19:53:01 +0000

Sleep Apnea Machine May Cause Facial Changes

admin — Thu, 21 Oct 2010 17:44:24 +0000

October 14, 2010

Sleep Apnea Machine May Cause Facial Changes

Study Shows nCPAP Machine May Cause Temporary Changes in Facial Structure

By Katrina Woznicki
WebMD Health News

Reviewed by Laura J. Martin, MD

Oct. 5, 2010 — Repeated use of nasal continuous positive airway pressure (nCPAP) machines to treat obstructive sleep apnea may have some side effects on facial structure, a study shows.
But researchers did not report any permanent damage to the face from the machines.
Researchers at Kyushu University Hospital in Fukuoka, Japan, and at the University of British Columbia in Vancouver, Canada, studied 46 adults, 89% of them male, with obstructive sleep apnea.
Earlier research had reported craniofacial side effects among children who used nCPAP machines. But the researchers say there had been no documented evidence indicating there was also craniofacial changes in adults.
The researchers took X-rays of the participants’ faces after they had used the airway pressure machines for more than two years. Nasal continuous positive airway pressure involves wearing a mask to bed at night that is connected to a machine that helps patients breathe easier. Patients are typically fitted for their masks.
After evaluating the participants, researchers found that using these airway pressure machines was associated with reduced maxillary and mandibular or front jaw prominence, and altering the two dental arches.
Researchers suspect the air pressure from the machine may contribute to these changes. There were no significant correlations between the participant’s age, body mass index, apnea-hypopnea index (measurement of apnea episodes) and the craniofacial changes.
The concern is that repeated use of these machines could change one’s facial profile, reduce tongue space, and potentially worsen obstructive sleep apnea symptoms over time, particularly if craniofacial changes reduce the patient’s ability to breathe.
The findings are reported in the October issue of Chest, a journal of the American College of Chest Physicians.
The researchers note that these observations raise more questions and require more follow-up.
“The side effects of dental changes obviously have a small impact compared with the beneficial effects of nCPAP, such as reducing the AHI [apnea-hypopnea index] and daytime sleepiness,” the researchers write. “However, because the effects of these dental and skeletal changes have not been fully investigated, further study is required to uncover the factors affecting these changes

October Hour Magazine Article!

admin — Thu, 30 Sep 2010 19:34:57 +0000

Solutions for Doctors: Resolving ‘Unexplainable’ Symptoms NEW!

It’s a common occurrence experienced by many doctors. You’ve run the full gamut of tests, but your patient’s eye, ear, pain, or fatigue symptoms remain “unexplained.” Antibiotics haven’t helped. An ENT exam found no reason for the symptoms.

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REM-Related Obstructive Sleep Apnea: The Effect of Body Position – NEW!

admin — Fri, 10 Sep 2010 14:46:41 +0000

REM sleep related obstructive sleep apnea (OSA), i.e., the sleep breathing abnormality in which apneas and hypopneas are confined mainly to REM sleep periods, has lately attracted several investigations in order to find out if this is a specific clinical entity or just part of the spectrum of sleep disordered breathing.

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New Body Mind Spirit Article

admin — Wed, 14 Apr 2010 10:48:50 +0000

Body Mind Spirit Guide

Articles written by Dr. Richard E. Klein

Good News for Many!!! – NEW!

Good News for Many!!! March can come in like a lion and go out like a lamb. March is the time we begin to think ofhopefitlly putting away snow shovels and bringing out golf clubs.

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TRAUMA PRODUCING TEMPOROMANDIBULAR JOINT DYSFUNCTION PAIN

admin — Tue, 06 Apr 2010 14:10:05 +0000

TRAUMA PRODUCING TEMPOROMANDIBULAR JOINT DYSFUNCTION PAIN

MANDIBULAR HYPER-EXTENSION

In motor vehicle accidents, particularly in a rear end collision, the suddenness of the impact, snapping the head backward, happens so quickly that the anterior neck muscles do not have a chance to relax.

As a result, they act as an anchor on the mandible holding it still and forcing the mouth excessively open, as the head continues to move backward into hyper-extension.

This action, the whipping excessively open of the mouth and its subsequent closure into normal position, results in self-reducing dislocation of the temporomandibular joint. The masticatory and cervical musculature, ligaments, and the synovial tissues of the temporomandibular joint are simultaneously injured. A frequent result of this type of injury is the anterior displacement of the TMJ disc and posteriorization of the mandible as seen in Fig. 19.

This injury is particularly important because it has been well documented that 60% of the people involved in motor vehicle accidents do not fully recover. The same studies also clearly demonstrated that many of the people who do not fully recover continue to suffer from a temporomandibular joint dysfunction that is directly related to the accident, but in fact, HAS GONE UNDIAGNOSED.

The anterior displacement of the TMJ disc has been demonstrated to be the primary etiology of progressive disease, which results in degenerative arthritis.