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Drug-Induced Sleep Endoscopy DISE with Target Controlled Infusion TCI and Bispectral Analysis in Obstructive Sleep Apnea
Published on: December 6, 2016
Three-dimensional upper airway changes with mandibular advancement device in patients with obstructive sleep apnea
Chandrakant Shivkumar Shete1, Wasundhara Ashok Bhad2
1Department of Orthodontics and Dentofacial Orthopedics, Government Dental College and Hospital, Aurangabad, Maharashtra, India.
Introduction:
A mandibular advancement device effectively increases upper airway size in patients with obstructive sleep apnea. Three-dimensional volumetric upper airway changes, exact amounts of change in obstructed upper airways (smallest cross-sectional area), and anteroposterior and transverse changes with mandibular advancement devices are not clear.
Methods:
Thirty-seven patients with obstructive sleep apnea diagnosed with polysomnography were evaluated with the subjective Epworth sleepiness scale, percentage of oxygen saturation, and cone-beam computed tomography. Parameters were airway volume, smallest cross-section area, anteroposterior width, and transverse width of the upper airway. Patients received a mandibular advancement device, a Twin-block appliance that could be titrated with a jackscrew; posttreatment data were collected after 6 months.
Results:
A statistically significant improvement in mean oxygen saturation level was observed, from 87.97% ± 4.43% to 94.89% ± 1.54% (P <0.001). A significant mean increase in airway volume of 2360 ± 2050 mm3 (P <0.001) was observed, from 12140 ± 4773 mm3 to 14500 ± 5114.6 mm3. A stastistically significant mean increase in the smallest cross section of 46.55 ± 31.62 mm2, from 81.95 ± 55.23 mm2 to 128.5 ± 54.78 mm2 was observed. Anteroposterior width increased significantly, from 4.99 ± 1.65 mm to 8.01 ± 2.04 mm. Transverse width increased significantly, from 27.67 ± 8.52 mm to 31.94 ± 8.59 mm.
Conclusions:
Mandibular advancement devices increased the mean upper pharyngeal airway volume in this cohort, and this increase in volume appeared to be related to increased oxygen saturation.
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