Class II correction improves nocturnal breathing in adolescents

Objective: To examine modifications in sleep pattern and in craniofacial morphology of adolescents with mandibular retrognathism.Materials and Methods: Sixteen subjects at maximum pubertal growth (12.6 years [+/- 11.5 months]) were selected and treated for 12 months with maxillary expansion and mandibular advancement with a Herbst appliance. Cephalometric radiography and magnetic resonance imaging were obtained prior to and after treatment and were compared using the paired Student's t-test or the nonparametric Wilcoxon rank-sum test. Four polysomnographic recordings were obtained with pressurized nasal cannulae and were analyzed by analysis of variance.Results: the length of the mandible was increased, while the antero-posterior position of the maxilla remained stable. the posterior airway space was increased, the length of the tongue was preserved, and the hyoid bone was moved to a more anterior position. After Herbst treatment, sleep efficiency, sleep latency, rapid eye movement (REM) sleep latency, and percentage of REM sleep remained stable. We did observe a reduction (P < .05) in the relative proportions of stage 1 and stage 3-4 (from 4.30 +/- 1.99 to 2.61 +/- 1.83 for stage 1 and from 25.78 +/-. 7.00 to 19.17 +/- 7.58 for stages 3-4) as well as an increase (P < .01) in the percentage of stage 2 after treatment (49.03 +/- 6.25 to 56.90 +/- 6.22). There was a reduction (P < .05) in the number of respiratory effort related arousals (7.06 +/- 5.37 to 1.31 +/- 1.45 per hour of sleep) due to an increase (P < .01) in airway volume.Conclusions: in the short term, the increase in airway space improved nocturnal breathing associated with the correction of mandibular retrognathism. (Angle Orthod. 2011;81:222-228.)Associacao Fundo de Incentivo a Psicofarmacologia (AFIP)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo, Dept Psychobiol, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Orthodont, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychobiol, BR-04024002 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Orthodont, BR-04024002 São Paulo, BrazilFAPESP: CEPID 98/14303-3Web of Scienc

Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome

The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States - POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.Univ Fed Uberlandia, Sch Odontol, Dept Oclusao Protese Fixa & Mat Odontol, Uberlandia, MG, BrazilUniv Fed Sao Paulo Unifesp, Sch Med, Dept Psicobiol, Sao Paulo, SP, BrazilUniv British Columbia, Dept Oral Hlth, Vancouver, BC, CanadaUniv Fed Uberlandia, Sch Med, Dept Pneumol, Uberlandia, MG, BrazilUniversidade Federal de São Paulo – Unifesp, School of Medicine, Department of Psicobiologia, São Paulo, SP, BrazilWeb of Scienc

Comparison of the effects of continuous positive airway pressure, oral appliance and exercise training in obstructive sleep apnea syndrome

OBJECTIVE: There are several treatments for obstructive sleep apnea syndrome, such as weight loss, use of an oral appliance and continuous positive airway pressure, that can be used to reduce the signs and symptoms of obstructive sleep apnea syndrome. Few studies have evaluated the effectiveness of a physical training program compared with other treatments. The aim of this study was to assess the effects of physical exercise on subjective and objective sleep parameters, quality of life and mood in obstructive sleep apnea patients and to compare these effects with the effects of continuous positive airway pressure and oral appliance treatments. METHODS: Male patients with moderate to severe obstructive sleep apnea and body mass indices less than 30 kg/m2 were randomly assigned to three groups: continuous positive airway pressure (n = 9), oral appliance (n = 9) and physical exercise (n = 7). Polysomnographic recordings, blood samples and daytime sleepiness measurements were obtained prior to and after two months of physical exercise or treatment with continuous positive airway pressure or an oral appliance. Clinicaltrials.gov: NCT01289392 RESULTS: After treatment with continuous positive airway pressure or an oral appliance, the patients presented with a significant reduction in the apnea-hypopnea index. We did not observe changes in the sleep parameters studied in the physical exercise group. However, this group presented reductions in the following parameters: T leukocytes, very-low-density lipoprotein and triglycerides. Two months of exercise training also had a positive impact on subjective daytime sleepiness. CONCLUSIONS: Our results suggest that isolated physical exercise training was able to modify only subjective daytime sleepiness and some blood measures. Continuous positive airway pressure and oral appliances modified the apnea-hypopnea index.AFIPCEPECEMSACNPqFAPESPUniversidade Federal de São Paulo (UNIFESP) Departamento de PsicobiologiaUNIFESP, Depto. de Psicobiologia2009/01031-1 e 98/14303-3SciEL