Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea : A randomized, placebo-controlled trial on temporomandibular side-effects

Purpose To assess the differences in the frequency of clinical signs of temporomandibular disorder (TMD) pain and mandibular function impairment between mandibular advancement device (MAD) and nasal continuous positive airway pressure (nCPAP) therapies in obstructive sleep apnea (OSA) patients at baseline and after 6 month of treatment. Methods This study concerns a secondary analysis of a randomized placebo-controlled trial in which different treatment effects of an objectively titrated MAD were compared with those of nCPAP and an intra-oral placebo appliance in a parallel design. Sixty-four mild to severe OSA patients (52.0 +/- 9.6 years) were randomly assigned to these three groups. All patients underwent a shortened functional examination of their masticatory system at baseline and after 6 months to establish the presence of clinical signs of TMD pain. Mandibular function impairment was assessed with a questionnaire. Results Clinical signs of TMD pain were only rarely present at baseline and therapy evaluation. No significant differences were found between the three groups in the (low) frequency of clinical signs of TMD pain at both time points (p = .401-.176). In addition, the (low) scores of mandibular function impairment did not differ between the three groups either, neither at baseline (p = .744) nor after 6 months (p = .359). Conclusions A low frequency of clinical signs of TMD pain in mild to severe OSA patients was found after 6 months, regardless of treatment with MAD or nCPAP. In addition, no difference in mandibular function impairment was observed between the different treatment modalities.Peer reviewe

Prevalence of oral behaviours in general dental patients attending a university clinic in Italy

Background: Oral behaviors represent a diverse array of habits beyond the physiological behaviors of the stomatognathic system. Objective: To describe the prevalence of different oral behaviors, as reported with the Oral Behavior Checklist (OBC-21), in a convenience sample of patients attending an Italian university clinic for routine dental cares. Methods: In this study, charts of adult patients presenting to the dental department of a regional hospital in Trieste, Italy, from January 2018 and January 2019 were reviewed. Patients with complete files were retrieved, and those with orofacial pain complaints were excluded. OBC-21 scores and grades (score of 0 corresponding to no risk, 1-24 to low risk, and higher than 24 to high risk) were analyzed and stratified according to age and sex. Results: Data from a total of 1424 patients were reported. The overall mean OBC score was 13.3 ± 9.9, with 6.7% no-risk grade, 79.6% low-risk grade, and 13.7% high-risk grade. In general, mean OBC scores decreased with increasing age. Females showed a higher frequency of high-risk grade than males. Most frequent prevalent habits included yawning (73.1%), eating between meals (66.9%) and chewing food on one side only (63.3%). Other behaviors were also highly prevalent, including pressing, touching, or holding teeth together other than while eating (52.7%) and awake clenching (47.5%). Conclusion: A low-risk grade of oral behaviors has been found to be frequent in our sample. Future studies are warranted to confirm these findings in larger, representative general populations and to assess if any of these habits are linked to negative effects on the stomatognathic system

Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea : a randomized, placebo-controlled trial on psychological distress

The aim of this randomized placebo-controlled trail was to compare the effects of an objectively titrated mandibular advancement device (MAD) with those of nasal continuous positive airway pressure (nCPAP) and an intraoral placebo device on symptoms of psychological distress in OSA patients. In a parallel design, 64 mild/moderate OSA patients (52.0 +/- 9.6 years) were randomly assigned to an objectively titrated MAD, nCPAP, or an intraoral placebo appliance. All patients filled out the Symptom Checklist-90-Revised twice: one before treatment and one after 6 months of treatment. The Symptom Checklist-90-Revised is a multidimensional symptom inventory designed to measure symptomatic psychological distress over the past week. Linear mixed model analyses were performed to study differences between the therapy groups for the different dimensions of the Symptom Checklist-90-Revised over time. The MAD group showed significant improvements over time in the dimensions "somatization," "insufficiency of thinking and acting," "agoraphobia," "anxiety," "sleeping problems," and "global severity index" (F = 4.14-16.73, P = 0.048-0.000). These improvements in symptoms of psychological distress were, however, not significantly different from those observed in the nCPAP and placebo groups (P = 0.374-0.953). There is no significant difference between MAD, nCPAP, and an intraoral placebo appliance in their beneficial effects on symptoms of psychological distress. The improvement in psychological distress symptoms in mild/moderate OSA patients under MAD or nCPAP treatment may be explained by a placebo effect.Peer reviewe

Impact of climate change on forest resources: Case of Quercus rotundifolia, Tetraclinis articulata, Juniperus phoenicea, J. oxycedrus, J. thurifera and Pinus halepensis

Forest resources in the Ourika watershed are subject to several anthropogenic and climatic degradation factors. As for the human factor, this degradation of forest resources is explained by the bad practices exercised by the local population expressed by the cutting of live wood, carbonization, and overgrazing. In terms of the climatic factor, the decrease in the amount of rainfall and the increase in temperature contribute to the exacerbation of the degradation of these resources. In order to better understand the evolution of plant cover in a changing climate context, this study highlights an assessment of the impact of climate change on forest dynamics based on a process-based model at the forest landscape scale which makes it possible to simulate the changes according to growth, succession, disturbances (fire, wind, insects, etc), forest management, and land use change. This analysis is based on the use of the LANDIS-II model and the PnET-succession extension. Projections of the dynamics of forest communities are made using climate projections from the Japanese global circulation model adopted by Morocco (model for interdisciplinary research on climate – earth system models) and this by adopting the two climate scenarios , representative concentration pathways 4.5 and 8.5. The results obtained highlight the spatial distribution of the ecosystems studied after 100 years with a quantitative evaluation of the total average biomass of these resources as a function of climatic disturbances. In general, the estimated total biomass will decline over the coming years under the joint effect of the climate change and the aging of forest stands, while on the other hand, the distribution of potential areas for species settlement remains independent of the effect of these climate changes

Signal acquisition and analysis of ambulatory electromyographic recordings for the assessment of sleep bruxism: A scoping review

Background: Ambulatory electromyographic (EMG) devices are increasingly being used in sleep bruxism studies. EMG signal acquisition, analysis and scoring methods vary between studies. This may impact comparability of studies and the assessment of sleep bruxism in patients. Objectives: (a) To provide an overview of EMG signal acquisition and analysis methods of recordings from limited-channel ambulatory EMG devices for the assessment of sleep bruxism; and (b) to provide an overview of outcome measures used in sleep bruxism literature utilising such devices. Method: A scoping review of the literature was performed. Online databases PubMed and Semantics Scholar were searched for studies published in English until 7 October 2020. Data on five categories were extracted: recording hardware, recording logistics, signal acquisition, signal analysis and sleep bruxism outcomes. Results: Seventy-eight studies were included, published between 1977 and 2020. Recording hardware was generally well described. Reports of participant instructions in device handling and of dealing with failed recordings were often lacking. Basic elements of signal acquisition, for example amplifications factors, impedance and bandpass settings, and signal analysis, for example rectification, signal processing and additional filtering, were underreported. Extensive variability was found for thresholds used to characterise sleep bruxism events. Sleep bruxism outcomes varied, but typically represented frequency, duration and/or intensity of masticatory muscle activity (MMA). Conclusion: Adequate and standardised reporting of recording procedures is highly recommended. In future studies utilising ambulatory EMG devices, the focus may need to shift from the concept of scoring sleep bruxism events to that of scoring the whole spectrum of MMA

A crossover randomised controlled trial of oral mandibular advancement devices for obstructive sleep apnoea-hypopnoea (TOMADO)

Rationale Mandibular advancement devices (MADs) are used to treat obstructive sleep apnoea-hypopnoea syndrome (OSAHS) but evidence is lacking regarding their clinical and cost-effectiveness in less severe disease. Objectives To compare clinical- and cost-effectiveness of a range of MADs against no treatment in mild to moderate OSAHS. Measurements and methods This open-label, randomised, controlled, crossover trial was undertaken at a UK sleep centre. Adults with Apnoea-Hypopnoea Index (AHI) 5–<30/h and Epworth Sleepiness Scale (ESS) score ≥9 underwent 6 weeks of treatment with three nonadjustable MADs: self-moulded (SleepPro 1; SP1); semi-bespoke (SleepPro 2; SP2); fully-bespoke MAD (bMAD); and 4 weeks no treatment. Primary outcome was AHI scored by a polysomnographer blinded to treatment. Secondary outcomes included ESS, quality of life, resource use and cost. Main results 90 patients were randomised and 83 were analysed. All devices reduced AHI compared with no treatment by 26% (95% CI 11% to 38%, p=0.001) for SP1, 33% (95% CI 24% to 41%) for SP2 and 36% (95% CI 24% to 45%, p<0.001) for bMAD. ESS was 1.51 (95% CI 0.73 to 2.29, p<0.001, SP1) to 2.37 (95% CI 1.53 to 3.22, p<0.001, bMAD) lower than no treatment (p<0.001 for all). Compliance was lower for SP1, which was the least preferred treatment at trial exit. All devices were cost-effective compared with no treatment at a £20 000/quality-adjusted life year (QALY) threshold. SP2 was the most cost-effective up to £39 800/QALY. Conclusions Non-adjustable MADs achieve clinically important improvements in mild to moderate OSAHS and are cost-effective