Pilot Study of a New Mandibular Advancement Device

This study was conducted to determine the efficacy of a customized mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). Eight patients (M = 3; F = 5; mean age = 56.3 ± 9.4) with a diagnosis of OSA confirmed by polysomnography (PSG) were re-cruited on the basis of the following inclusion criteria: apnea-hypopnea index (AHI) > 5, age between 18 and 75 years, body mass index (BMI) < 25, and PSG data available at baseline (T0). All were treated with the new NOA® MAD by OrthoApnea (NOA® ) for at least 3 months; PSG with NOA in situ was performed after 3 months of treatment (T1). The following parameters were calculated at T0 and T1: AHI, supine AHI, oxygen desaturation index (ODI), percentage of recording time spent with oxygen saturation <90% (SpO2 < 90%), and mean oxygen desaturation (MeanSpO2%). Data were submitted for statistical analysis. The baseline values were AHI = 21.33 ± 14.79, supine AHI = 35.64 ± 12.80, ODI = 17.51 ± 13.5, SpO2 < 90% = 7.82 ± 17.08, and MeanSpO2% = 93.45 ± 1.86. Four patients had mild OSA (5 > AHI < 15), one moderate OSA (15 > AHI < 30), and three severe OSA (AHI > 30). After treatment with NOA®, statistically significant improvements in AHI (8.6 ± 4.21) and supine AHI (11.21 ± 7.26) were recorded. OrthoApnea NOA® could be an effective alternative in the treatment of OSA: the device improved the PSG parameters assessed

Sub-tissue localization of phytochemicals in Cinnamomum camphora (L.) J. Presl. growing in Northern Italy

In the present paper, we focused our attention on Cinnamomum camphora (L.) J. Presl. (Lauraceae), studied at three levels: (i) micromorphological, with the analysis of the secretory structures and a novel in-depth histochemical characterization of the secreted compounds; (ii) phytochemical, with the characterization of the essential oils from young stems, fruits, and leaves, subjected to different conservation procedures (fresh, dried, stored at −20 °C, stored at −80 °C) and collected in two different years; (iii) bioactive, consisting of a study of the potential antibacterial activity of the essential oils. The micromorphological investigation proved the presence of secretory cells characterized by a multi-layered wall in the young stems and leaves. They resulted in two different types: mucilage cells producing muco-polysaccharides and oil cells with an exclusive terpene production. The phytochemical investigations showed a predominance of monoterpenes over sesquiterpene derivatives; among them, the main components retrieved in all samples were 1,8-cineole followed by α-terpineol and sabinene. Conservation procedures seem to only influence the amounts of specific components, i.e., 1,8-cineole and α-terpineol, while analyses on each plant part revealed the presence of some peculiar secondary constituents for each of them. Finally, the evaluation of the antibacterial activity of the essential oil showed a promising activity against various microorganisms, as Listeria monocytogenes, Staphylococcus aureus, Enterococcus faecalis and Pseudomonas aeruginosa. In conclusion, we combined a micromorphological and phytochemical approach of the study on different plant parts of C. camphora, linking the occurrence of secretory cells to the production of essential oils. We compared, for the first time, the composition of essential oils derived from different plant matrices conserved with different procedures, allowing us to highlight a relation between the conservation technique and the main components of the profiles. Moreover, the preliminary antibacterial studies evidenced the potential activity of the essential oils against various microorganisms potentially dangerous for plants and humans

Probing the location of the substrate binding site of ascorbate oxidase near type 1 copper: an investigation through spectroscopic, inhibition and docking studies

The present investigation addresses the problem of the binding mode of phenolic inhibitors and the substrate ascorbate to the active site of ascorbate oxidase. The results from both types of compounds indicate that the binding site is located in a pocket near the type 1 copper center. This information is of general interst for blue multicopper oxidases. Docking calculations performed on the ascorbate oxidase\u2013ascorbate complex show that binding of the substrate occurs in a pocket near type 1 Cu, and is stabilized by at least five hydrogen bonding interactions with protein residues, one of which involves the His512 Cu ligand. Similar docking studies show that the isomeric fluorophenols, which act as competitive inhibitors toward ascorbate, bind to the enzyme in a manner similar to ascorbate. The docking calculations are supported by 19F NMR relaxation measurements performed on fluorophenols in the presence of the enzyme, which show that the bound inhibitors undergo enhanced relaxation by the paramagnetic effect of a nearby Cu center. Unambiguous support to the location of the inhibitor close to type 1 Cu was obtained by comparative relaxation measurements of the fluorophenols in the presence of the ascorbate oxidase derivative where a Zn atom selectively replaces the paramagnetic type 2 Cu. The latter experiments show that contribution to relaxation of the bound inhibitors by the type 2 Cu site is negligible

Nutritional Characterization and Phenolic Profiling of Moringa oleifera Leaves Grown in Chad, Sahrawi Refugee Camps, and Haiti

Moringa oleifera is a plant that grows in tropical and subtropical areas of the world. Its leaves are rich of nutrients and bioactive compounds. However, several differences are reported in the literature. In this article we performed a nutritional characterization and a phenolic profiling of M. oleifera leaves grown in Chad, Sahrawi refugee camps, and Haiti. In addition, we investigated the presence of salicylic and ferulic acids, two phenolic acids with pharmacological activity, whose presence in M. oleifera leaves has been scarcely investigated so far. Several differences were observed among the samples. Nevertheless, the leaves were rich in protein, minerals, and \u3b2-carotene. Quercetin and kaempferol glycosides were the main phenolic compounds identified in the methanolic extracts. Finally, salicylic and ferulic acids were found in a concentration range of 0.14-0.33 and 6.61-9.69 mg/100 g, respectively. In conclusion, we observed some differences in terms of nutrients and phenolic compounds in M. oleifera leaves grown in different countries. Nevertheless, these leaves are a good and economical source of nutrients for tropical and sub-tropical countries. Furthermore, M. oleifera leaves are a source of flavonoids and phenolic acids, among which salicylic and ferulic acids, and therefore they could be used as nutraceutical and functional ingredients

First phase of OSAS treatment: temporary oral appliances for sleep apnea

OBIETTIVI: Scopo di questo lavoro è quello di analizzare la letteratura scientifica in rapporto alla prima fase di trattamento della Sindrome delle apnee ostruttive del sonno (OSAS) con i dispositivi temporanei di avanzamento mandibolare. L’OSAS è una condizione clinica caratterizzata dal verificarsi di ripetuti fenomeni di apnea e ipoapnea durante il sonno, con conseguenti effetti sistemici nella vita dell’individuo. Il gold standard nella terapia dell’OSAS è rappresentato dalla C-PAP, spesso però non ben tollerata dai pazienti. I dispositivi di avanzamento mandibolare rappresentano un’alternativa alla terapia con C-PAP in quanto promuovono la protrusione della mandibola ampliando lo spazio aereo faringeo e riducendo il verificarsi di fenomeni di apnea e ipoapnea. I dispositivi temporanei di avanzamento mandibolare, in particolare, vengono utilizzati per un periodo di tempo limitato, generalmente nelle prime fasi della terapia. MATERIALI E METODI: La revisione della letteratura riguardante i dispositivi temporanei di avanzamento mandibolare è stata svolta attraverso il portale scientifico Medline-PubMed. È stata condotta realizzando una selezione manuale degli articoli e non è stato posto alcun vincolo temporale o linguistico. Sono stati selezionati 13 articoli riguardanti gli effetti clinici indotti dall’utilizzo dei dispositivi MyTAP (Airway Management, Farmers Branch, TX, USA), Silensor (Erkodent GmbH, Tuttlingen, Germania), Somnoguard (Tomed GmbH, Bensheim, Germania) e Blue Pro (BlueSom, Parigi, Francia). RISULTATI: I dispositivi temporanei di avanzamento mandibolare risultano efficaci nel selezionare la popolazione responder al trattamento, migliorando i paramenti polisonnografici dei pazienti con OSAS nella prima fase della terapia. I dispositivi temporanei risultano maggiormente efficaci nei pazienti con età inferiore a 55 anni, in cui la distanza tra l’osso ioide e il piano mandibolare è minore di 20 mm e in cui l’angolo SN^MP è inferiore a 29°. Sono, inoltre, efficaci nel trattare i pazienti con OSAS che presentano anche aterosclerosi carotidea, favorendo una diminuzione dei valori pressorici, lipidici e glicemici. I cambiamenti dentali generati dall’utilizzo di questi dispositivi sono rilevanti dal punto di vista statistico, ma irrilevanti dal punto di vista clinico. I dispositivi temporanei sono efficaci nel migliorare i parametri polisonnografici e nel ridurre gli eventi di apnea e ipoapnea nei pazienti con diagnosi di OSAS. CONCLUSIONI: I dispositivi temporanei rappresentano un’alternativa al trattamento dei pazienti con diagnosi di OSAS, in quanto sono efficaci nel migliorare i valori polisonnografici, in particolare nelle prime fasi della terapia. I dispositivi temporanei oggetto di questa revisione hanno un basso impatto sugli effetti dentali e scheletrici. Tra gli effetti avversi il più frequente è la dolenzia dentale nei primi giorni di utilizzo del dispositivo, probabilmente conseguente alla minor precisione di fabbricazione e di adattamento alle arcate dentarie del singolo paziente rispetto ai MAD definitivi. SIGNIFICATO CLINICO: Questi dispositivi permettono di individuare i pazienti responder e non responder alla terapia con MAD prima che questi procedano con l’acquisto di un apparecchio definitivo più costoso. Il costo contenuto rispetto ad altri dispositivi, inoltre, permette l’accesso alla terapia con i dispositivi di avanzamento mandibolare anche ai pazienti con una ridotta disponibilità economica

Efficacy of a Trial Oral Appliance in OSAS Management: A New Protocol to Recognize Responder/Nonresponder Patients

Oral appliances (OAs) of various types have shown variable success in the treatment of mild-to-moderate obstructive sleep apnoea (OSA). In an OSA sample, this study evaluated the efficacy of a diagnostic trial OA (myTAP™); the efficacy of a definitive custom-fitted mandibular advancement device (MAD) (SomnoDent Flex™); and whether a trial device can be used to distinguish treatment responder from nonresponder patients. Patients underwent overnight home sleep recordings prior to and after fitting of these appliances in order to objectively assess their sleep quality in terms of polysomnographic (PSG) respiratory measures: apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), and minimum oxygen saturation (LowSpO2). 40 patients with symptomatic OSAS were enrolled, 33 males and 7 females, with a mean age of 55.6 ± 12.73 years and an initial (T0) AHI of 26.51 ± 14.79. Trial devices were used in 16 patients (AHI: 29.9 ± 19.97, ODI: 21.06 ± 16.05, and LowSpO2: 82 ± 10.22 at T0) and definitive MADs in 28 (AHI: 23.90 ± 9.19, ODI: 16.27 ± 11.34, and LowSpO2: 82.87 ± 6.04 at T0). Statistically significant decreases in AHI (9.59 ± 8.94, p<0.0023) and ODI (8.20 ± 9.67, p<0.0129) were observed after treatment with the trial device. Only 8 of the patients in the trial device group went on to use the definitive device. Treatment with the definitive MAD produced statistically significant decreases in AHI (11.46 ± 9.65, p<0.0001) and ODI (9.10 ± 8.47, p<0.0016) and a significant improvement in LowSpO2 (85.09 ± 6.86, p<0.0004). Thus, both types of device proved effective in improving the PSG parameters. This study showed that introducing an easy-to-make and low-cost trial device into the therapeutic pathway of OSAS patients can circumvent the problem of individual responses to treatment by allowing effective classification of patients: in short, it allows a first distinction to be drawn between responders and nonresponders to treatment

Efficacy of a Trial Oral Appliance in OSAS Management: A New Protocol to Recognize Responder/Nonresponder Patients

Oral appliances (OAs) of various types have shown variable success in the treatment of mild-to-moderate obstructive sleep apnoea (OSA). In an OSA sample, this study evaluated the efficacy of a diagnostic trial OA (myTAP™); the efficacy of a definitive custom-fitted mandibular advancement device (MAD) (SomnoDent Flex™); and whether a trial device can be used to distinguish treatment responder from nonresponder patients. Patients underwent overnight home sleep recordings prior to and after fitting of these appliances in order to objectively assess their sleep quality in terms of polysomnographic (PSG) respiratory measures: apnoea-hypopnoea index (AHI), oxygen desaturation index (ODI), and minimum oxygen saturation (LowSpO2). 40 patients with symptomatic OSAS were enrolled, 33 males and 7 females, with a mean age of 55.6 ± 12.73 years and an initial (T0) AHI of 26.51 ± 14.79. Trial devices were used in 16 patients (AHI: 29.9 ± 19.97, ODI: 21.06 ± 16.05, and LowSpO2: 82 ± 10.22 at T0) and definitive MADs in 28 (AHI: 23.90 ± 9.19, ODI: 16.27 ± 11.34, and LowSpO2: 82.87 ± 6.04 at T0). Statistically significant decreases in AHI (9.59 ± 8.94, ) and ODI (8.20 ± 9.67, ) were observed after treatment with the trial device. Only 8 of the patients in the trial device group went on to use the definitive device. Treatment with the definitive MAD produced statistically significant decreases in AHI (11.46 ± 9.65, ) and ODI (9.10 ± 8.47, ) and a significant improvement in LowSpO2 (85.09 ± 6.86, ). Thus, both types of device proved effective in improving the PSG parameters. This study showed that introducing an easy-to-make and low-cost trial device into the therapeutic pathway of OSAS patients can circumvent the problem of individual responses to treatment by allowing effective classification of patients: in short, it allows a first distinction to be drawn between responders and nonresponders to treatment

Correlation between periodontal disease and OSAS in diabetic patients

Questo studio si pone l’obiettivo di verificare la correlazione tra la malattia parodontale e le apnee ostruttive del sonno in pazienti che presentano diabete mellito di tipo II. Il protocollo utilizzato prevede: la compilazione di uno screening parodontale clinico visivo; uno screening diabetologico volto a raccogliere tutti i parametri clinici diabetologici; il berlin questionnaire e l’epworth sleepness scale. Il berlin questionnaire è necessario per valutare i pazienti a rischio OSAS, mentre l’epworth test a misurare il grado di sonnolenza. Per tale studio sono stati selezionati 92 pazienti con età media pari a 63 anni. Dai risultati si evince che dei pazienti che presentavano ipertrofia gengivale generalizzata, il 37% mostra un alto rischio di sviluppare OSAS contro il 16% che presenta un basso rischio di sviluppare la patologia. Da questa analisi emerge una significatività statistica pari a 5,404 con P=0,020. Dall’analisi tra la variabile sanguinamento gengivale e alto/basso rischio di sviluppare OSAS emerge che, dei 42 soggetti, il 36% dei casi con alto rischio di sviluppare OSAS non presenta sanguinamento gengivale, mentre il 64% lo presenta. Il medesimo gruppo con alto rischio di sviluppare OSAS presenta anche recessione gengivale nel 67% dei casi, mentre è assente nel restante 33%. In conclusione, tale studio conferma la comorbilità delle tre patologie, con l’emergere di una possibile associazione, non dovuta al caso, tra i parametri parodontali e la variabile rischio di sviluppare OSAS. Tra queste emerge una correlazione tra ipertrofia gengivale e alto rischio di sviluppare OSAS. Si prevede per il futuro una maggior sensibilizzazione alla problematica in pazienti che presentano diabete mellito di tipo II.Aims of the study is to verify the association between the periodontal disease and the obstructive sleep apnea in patients with type 2 diabetes mellitus. The protocol provides the compilation of a visual clinical periodontal screening; a diabetic screening to have information about diabetic parameters; the Berlin Questionnaire and the Epworth Sleepness Scale. The Berlin Questionnaire is useful to evaluate patients at risk of OSAS, while the Epworth Test is used to assess the 'daytime sleepiness'. 92 patients (mean age 63 years) were recruited. Among the patients who suffer of generalized gingival hypertrophy, 37% showed high risk of OSAS, while 16% presents low risk with a statistical significance difference of 5,404 with P=0,020. The analysis of gingival bleeding and high/low risk of OSAS showed that 36% of 42 subjects at high risk of OSAS did not present any gingival bleeding, while 64% had it. The same OSAS high risk group presented gingival recession in 67% of patients, while it was absent in the other 33%. This study confirmed the comorbidity of the three diseases, with a possible association between periodontal parameters and OSAS variable risk. Between these ones emerged a correlation between gingival hypertrophy and OSAS high risk. In the future, a greater awareness of the problem would be desirable in patients with type 2 diabetes mellitus

Efficacy of a testing appliance in osas management

AIM To investigate the efficacy of a diagnostic testing appliance in obstructive sleep apnea syndrome (OSAS) patient management. MATERIALS AND METHODS Sixteen consecutive patients with mild to severe OSA were given a testing appliance (myTAPTM) that maintains the lower jaw in a stable forward position, preventing the soft tissue in the palate and tongue cavity from narrowing the airway in the throat. The appliance is individual fitted and treatable. All patients had polysomnography (PSG) before treatment (T0) and after 6 months (T1) with the appliance in situ. RESULTS At the beginning the patients (13 males and 3 females, mean age 53.88 ± 12.88 showed apnea-hypopnea index AHI base 29.9 ± 19.97, ODI base 21.06 ± 16.05, LowSpO2 base: 82 ± 10.22. AHI and ODI decreased significantly (p value < 0,05) with appliance after six months. CONCLUSIONS myTAPTM is effective in reducing apnea hypopnea index scores and improving oxygen saturation level

Oral appliance treatment for obstructive sleep apnoea in a patient with severe dental condition: case report

Aim. Obstructive sleep apnea (OSA) is a chronic disorder of sleep and breathing characterized by recurrent obstruction of the upper airway. Oral appliances can be recommended to treat moderate-severe OSA when nasal continuous positive airway pressure (nCPAP) treatment is not tolerated. Insufficient number of teeth in maxillary and mandibular jaws is considered a contraindication to oral appliance therapy. The purpose of this case presentation is to report the use and results of a modified mandibular advancement device (MAD) as complete denture in an edentulous upper jaw patient with a severe OSA. Methods. A 77-year-old male patient was referred from the Neurological Institute “C. Mondino” with a history of snoring and excessive daytime sleepness to evaluate the chance of a MAD treatment. An overnight polysomnography revealed an apnea/hypopnea index (AHI) of 30,5 events per hour of sleep always supine with a lowest oxygen saturation of 71%, an average oxygen saturation of 90,9%, an oxygen desaturation index of 29,5 and a time with saturation under 90% of 18.7%. The patient had a severe dental condition: complete edentulous on the upper jaw and 9 teeth remaining on the lower. A SomnoDent® Flex Edentulous was prepared for the patient. Upper Edentulous splint covers the palate in the same way as a full upper denture. The minimum number of teeth required on the lower arch may vary based on the patient’s dentition. Advantages: — Full range of mouth opening — Superior retention and comfort — Easily adjustable. The mandibular part was designed as a removable partial denture. The support and retention of the device relied mainly on its adaptation to the mucous membrane of edentulous parts to avoid overloads on the remaining teeth. The maxillary and mandibular parts were fixed at 70% of the maximum protrusion of the mandible. Results. During treatment, the patient reported a favorable sleeping pattern, but he signaled initially pain caused by sores in the upper anterior region solved with denture adhesive pads. Snoring, wake gasping, and choking were reduced drastically and she also reported improved sleep at night without apneas and his daytime drowsiness had diminished considerably. After a follow up period of 54 months, AHI was decreased from 30,5 to 5,6 with device. Significant decrease of AHI, changing in the oxygen desaturation index (from 29,5 to 5,5) and modification in lowest oxygen saturation (from 71 to 81) were recognized during device use with an overnight polysomnography. Conclusion. This clinical report describes the technique of fabricating and results of oral device for an edentulous patient. The patient was satisfied with the modified device. The significant decrease in the AHI and the increase in minimum pulse oximetric saturation show that the oral appliance described in this case report can be a useful treatment modality in OSA patients with insufficient number of teeth in their dental arches