Evidence for dental and dental specialty treatment of obstructive sleep apnoea. Part 1: the adult OSA patient and Part 2: the paediatric and adolescent patient.

Until recently, obstructive sleep apnoea was a largely unknown condition. Because of the well-publicised death of some high-profile people resulting from untreated obstructive sleep apnoea, now mostly everyone has heard of the condition. Following diagnosis, several medical treatment modalities are available to patients. However, the role that dentistry and its various specialties can play in successful treatment for obstructive sleep apnoea should not be overlooked. The common causes for adult and paediatric obstructive sleep apnoea will be presented as well as a review of the more successful forms of dental treatment. Finally, a summary of the current evidence regarding obstructive sleep apnoea treatment will be presented.

[1]  Max Hirshkowitz,et al.  Practice parameters for the treatment of snoring and Obstructive Sleep Apnea with oral appliances: an update for 2005. , 2006, Sleep.

[2]  M. Abeleira,et al.  Prospective evaluation of an oral appliance in the treatment of obstructive sleep apnea syndrome , 2005, Sleep and Breathing.

[3]  A. Krieger,et al.  Current trends in the treatment of obstructive sleep apnea. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[4]  Reyes Enciso,et al.  Evaluation of cross-section airway configuration of obstructive sleep apnea. , 2007, Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics.

[5]  S. Arslan,et al.  Effects on the sagittal pharyngeal dimensions of protraction and rapid palatal expansion in Class III malocclusion subjects. , 2007, European journal of orthodontics.

[6]  S. Higano,et al.  Morphologic analyses of mandible and upper airway soft tissue by MRI of patients with obstructive sleep apnea hypopnea syndrome. , 2006, Sleep.

[7]  P. Mahy,et al.  Modified miniplates for temporary skeletal anchorage in orthodontics: placement and removal surgeries. , 2008, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[8]  T. Young,et al.  Sleep disordered breathing and mortality: eighteen-year follow-up of the Wisconsin sleep cohort. , 2008, Sleep.

[9]  A. Hoekema.  Efficacy and comorbidity of oral appliances in the treatment of obstructive sleep apnea–hypopnea: a systematic review and preliminary results of a randomized trial , 2006, Sleep and Breathing.

[10]  B. Kusnoto,et al.  Relationship between rapid maxillary expansion and nasal cavity size and airway resistance: short- and long-term effects. , 2008, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[11]  D. Timms.  Rapid maxillary expansion in the treatment of nocturnal enuresis. , 2009, The Angle orthodontist.

[12]  P. Cistulli,et al.  Treatment of snoring and obstructive sleep apnoea by rapid maxillary expansion. , 1996, Australian and New Zealand journal of medicine.

[13]  R. Chervin.  Epworth sleepiness scale? , 2003, Sleep medicine.

[14]  P. Cistulli,et al.  Sleep apnea in Marfan's syndrome. Increased upper airway collapsibility during sleep. , 1995, Chest.

[15]  C. Johnston,et al.  Mandibular advancement appliances and obstructive sleep apnoea: a randomized clinical trial. , 2002, European journal of orthodontics.

[16]  F. Campos-Rodriguez,et al.  Mortality in obstructive sleep apnea-hypopnea patients treated with positive airway pressure. , 2005, Chest.

[17]  David M. Eddy,et al.  A Manual for Assessing Health Practices & Designing Practice Policies: The Explicit Approach , 1992 .

[18]  A. Lowe,et al.  A comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea. , 2006, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[19]  Priest Jh,et al.  Sleep apnea syndrome: correction with surgical advancement of the mandible. , 1980, Journal of oral surgery.

[20]  M. Littner,et al.  The indications for polysomnography and related procedures. , 1997, Sleep.

[21]  R. Rogers,et al.  Obstructive sleep apnea. , 1996, The New England journal of medicine.

[22]  J. Peter,et al.  Surgical treatment of obstructive sleep apnea by maxillomandibular advancement. , 1994, Sleep.

[23]  J. Marsh,et al.  Neonatal Distraction Surgery for Micrognathia Reduces Obstructive Apnea and the Need for Tracheotomy , 2004, The Journal of craniofacial surgery.

[24]  Daniel J Buysse,et al.  Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research , 2000 .

[25]  David Hatcher,et al.  Automated 3-dimensional airway analysis from cone-beam computed tomography data. , 2010, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[26]  C. Guilleminault,et al.  Cephalometric analyses and flow-volume loops in obstructive sleep apnea patients. , 1983, Sleep.

[27]  P. Cistulli,et al.  Treatment of obstructive sleep apnea syndrome by rapid maxillary expansion. , 1998, Sleep.

[28]  T. Montemayor,et al.  [Mandibular advancement surgery in patients with severe obstructive sleep apnea uncontrolled by continuous positive airway pressure. A retrospective review of 25 patients between 1998 and 2004]. , 2006, Revue des maladies respiratoires.

[29]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[30]  Scammon.  The measurement of the body in childhood , 1930 .

[31]  P. Lavie,et al.  All-cause mortality in males with sleep apnoea syndrome: declining mortality rates with age , 2005, European Respiratory Journal.

[32]  O. Bruni,et al.  NREM sleep instability changes following rapid maxillary expansion in children with obstructive apnea sleep syndrome. , 2009, Sleep medicine.

[33]  C. Guilleminault,et al.  Rapid maxillary expansion in children with obstructive sleep apnea syndrome. , 2004, Sleep.

[34]  M P Fried,et al.  Assessment of the Airway in Obstructive Sleep Apnea Syndrome with 3-Dimensional Airway Computed Tomography , 2000, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[35]  J. Fleetham,et al.  Facial morphology and obstructive sleep apnea. , 1986, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[36]  H. Legan,et al.  CHAPTER 20 – Role of Orthodontics in Obstructive Sleep Apnea , 2010 .

[37]  S. Malkoç,et al.  Long-term effects of symphyseal distraction and rapid maxillary expansion on pharyngeal airway dimensions, tongue, and hyoid position. , 2007, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[38]  J. A. Harris,et al.  The measurement of man , 1931 .

[39]  M. Sanders,et al.  CPAP via nasal mask: a treatment for occlusive sleep apnea. , 1983, Chest.

[40]  B. Stegenga,et al.  Predictors of Obstructive Sleep Apnea-Hypopnea Treatment Outcome , 2007, Journal of dental research.

[41]  J. Horne,et al.  Sleep related vehicle accidents , 1995, BMJ.

[42]  W H Bell,et al.  Surgical-orthodontic expansion of the maxilla. , 1976, American journal of orthodontics.

[43]  M. Broudy,et al.  Increased severity of obstructive sleep apnea after bedtime alcohol ingestion: diagnostic potential and proposed mechanism of action. , 1982, Sleep.

[44]  H. Barber,et al.  Diagnosis and treatment of transverse maxillary deficiency. , 1995, The International journal of adult orthodontics and orthognathic surgery.

[45]  C. Doruk,et al.  Rapid maxillary expansion and surgically assisted rapid maxillary expansion effects on nasal volume. , 2006, The Angle orthodontist.

[46]  Lucia Cevidanes,et al.  Three-dimensional analysis of maxillary protraction with intermaxillary elastics to miniplates. , 2010, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[47]  J. Coleman.  Laser-Assisted Uvulopalatoplasty: Long-Term Results with a Treatment for Snoring , 1998, Ear, nose, & throat journal.

[48]  C. Guilleminault,et al.  Mandibular osteotomy and hyoid bone advancement for obstructive sleep apnea: a case report. , 1984, Sleep.

[49]  E. Puricelli,et al.  Evaluation of surgically assisted maxillary expansion using acoustic rhinometry and postero-anterior cephalometry. , 2007, International journal of oral and maxillofacial surgery.

[50]  H. Pancherz,et al.  Dentoskeletal effects and facial profile changes in young adults treated with the Herbst appliance. , 2009, The Angle orthodontist.

[51]  K. Sayınsu,et al.  Sagittal airway dimensions following maxillary protraction: a pilot study. , 2006, European journal of orthodontics.

[52]  P. Cistulli,et al.  A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. , 2001, American journal of respiratory and critical care medicine.

[53]  J. Curé,et al.  Three-dimensional changes in upper airways of patients with obstructive sleep apnea following maxillomandibular advancement. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[54]  T. Lyberg,et al.  Obstructive sleep apnoea: a cephalometric study. Part II. Uvulo-glossopharyngeal morphology. , 1995, European journal of orthodontics.

[55]  W. Hochban,et al.  Four-year-old girl with Goldenhar-sequence and severe obstructive sleep apnea, symptoms, diagnosis and therapy. , 1998, International journal of pediatric otorhinolaryngology.

[56]  K Maki,et al.  Computer-assisted simulations in orthodontic diagnosis and the application of a new cone beam X-ray computed tomography. , 2003, Orthodontics & craniofacial research.

[57]  J. Haze,et al.  Obstructive sleep apnea. , 1987, Cranio : the journal of craniomandibular practice.

[58]  H. Legan,et al.  Correction of severe obstructive sleep apnea with bimaxillary transverse distraction osteogenesis and maxillomandibular advancement. , 2006, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[59]  C. Burstone,et al.  Cephalometrics for orthognathic surgery. , 1978, Journal of oral surgery.

[60]  D. Hatcher,et al.  Comparison of airway space with conventional lateral headfilms and 3-dimensional reconstruction from cone-beam computed tomography. , 2009, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[61]  F. Lauwers,et al.  Treatment of obstructive sleep apnea syndrome by mandibular elongation using osseous distraction followed by a Le Fort I advancement osteotomy: case report. , 2001, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[62]  I. Tasca,et al.  Nasal Airway Measurements in Children Treated by Rapid Maxillary Expansion , 2006, American journal of rhinology.

[63]  P. Ngan,et al.  Use of conventional tomography to evaluate changes in the nasal cavity with rapid palatal expansion. , 2005, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[64]  W H Bell,et al.  Mandibular widening by intraoral distraction osteogenesis. , 1997, The British journal of oral & maxillofacial surgery.

[65]  M. Villa,et al.  Randomized controlled study of an oral jaw-positioning appliance for the treatment of obstructive sleep apnea in children with malocclusion. , 2002, American journal of respiratory and critical care medicine.

[66]  Jeffrey R Prinsell,et al.  Maxillomandibular advancement surgery for obstructive sleep apnea syndrome. , 2002, Journal of the American Dental Association.

[67]  J. Prinsell.  Maxillomandibular advancement surgery in a site-specific treatment approach for obstructive sleep apnea in 50 consecutive patients. , 1999, Chest.

[68]  A. Buccheri,et al.  Rapid palatal expansion and pharyngeal space. Cephalometric evaluation. , 2004, Progress in orthodontics.

[69]  John B Ludlow,et al.  Precision of cephalometric landmark identification: cone-beam computed tomography vs conventional cephalometric views. , 2009, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[70]  L. Braitman,et al.  Posterior airway changes associated with mandibular advancement surgery: implications for patients with obstructive sleep apnea. , 1990, The International journal of adult orthodontics and orthognathic surgery.

[71]  G. Jondeau,et al.  Benefits of obstructive sleep apnoea treatment in coronary artery disease: a long-term follow-up study. , 2004, European heart journal.

[72]  P. L. Smith,et al.  Weight loss in mildly to moderately obese patients with obstructive sleep apnea. , 1985, Annals of internal medicine.

[73]  C. N. Vila,et al.  Sleep apnea syndrome in an adult patient with mandibular hypoplasia , 1989 .

[74]  M. Johns,et al.  A new method for measuring daytime sleepiness: the Epworth sleepiness scale. , 1991, Sleep.

[75]  C. Guilleminault,et al.  Obstructive Sleep Apnea Syndrome: A Review of 306 Consecutively Treated Surgical Patients , 1993, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[76]  M. R. Sims,et al.  Maxillary morphology in obstructive sleep apnoea syndrome. , 2001, European journal of orthodontics.

[77]  W. Bell,et al.  Control of the transverse dimension with surgery and orthodontics. , 1980, American journal of orthodontics.

[78]  Daniel J Buysse,et al.  Sleep-related breathing disorders in adults: recommendations for syndrome definition and measurement techniques in clinical research. The Report of an American Academy of Sleep Medicine Task Force. , 1999, Sleep.

[79]  R. Nanda,et al.  Current therapy in orthodontics , 2010 .

[80]  G. Chierici,et al.  Primate experiments on oral respiration. , 1981, American journal of orthodontics.

[81]  M. Koudstaal,et al.  Surgically assisted rapid maxillary expansion (SARME): a review of the literature. , 2005, International journal of oral and maxillofacial surgery.

[82]  E. Avrahami,et al.  Relation between CT axial cross-sectional area of the oropharynx and obstructive sleep apnea syndrome in adults. , 1995, AJNR. American journal of neuroradiology.

[83]  Randy Walld,et al.  What are obstructive sleep apnea patients being treated for prior to this diagnosis? , 2002, Chest.

[84]  P. Cistulli.  Craniofacial abnormalities in obstructive sleep apnoea: Implications for treatment , 1996, Respirology.

[85]  C. Guilleminault,et al.  Rapid maxillary expansion in children with obstructive sleep apnea syndrome: 12-month follow-up. , 2007, Sleep medicine.

[86]  A. Farman,et al.  Effects of Mandibular Advancement Device (MAD) on Airway Dimensions Assessed With Cone-Beam Computed Tomography , 2009 .

[87]  A. Lowe,et al.  Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 1. Cephalometric analysis. , 2006, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[88]  B. Fleury,et al.  Mortality of sleep apnoea patients treated by nasal continuous positive airway pressure registered in the ANTADIR observatory. Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique. , 2000, The European respiratory journal.

[89]  M. Ozbek,et al.  Oropharyngeal airway dimensions and functional-orthopedic treatment in skeletal Class II cases. , 1998, The Angle orthodontist.

[90]  V. Wooten,et al.  Maxillomandibular advancement surgery in 23 patients with obstructive sleep apnea syndrome. , 1989, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[91]  Shoichi Suzuki,et al.  Effects of maxillary protraction on craniofacial structures and upper-airway dimension. , 2009, The Angle orthodontist.

[92]  P. Cistulli,et al.  Oral appliance therapy improves symptoms in obstructive sleep apnea: a randomized, controlled trial. , 2002, American journal of respiratory and critical care medicine.

[93]  P. Winkel,et al.  Mandibular advancement appliance for obstructive sleep apnoea: results of a randomised placebo controlled trial using parallel group design , 2008, Journal of sleep research.

[94]  U. Yilmaz,et al.  Comparison of nasal volume changes during rapid maxillary expansion using acoustic rhinometry and computed tomography. , 2007, European journal of orthodontics.

[95]  J. Fleetham,et al.  Obstructive sleep apnea subtypes by cluster analysis. , 1992, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[96]  Richard Conley,et al.  Mandibular symphyseal distraction osteogenesis: diagnosis and treatment planning considerations. , 2009, The Angle orthodontist.

[97]  Raanan Arens,et al.  Identification of upper airway anatomic risk factors for obstructive sleep apnea with volumetric magnetic resonance imaging. , 2003, American journal of respiratory and critical care medicine.

[98]  H. Oktay,et al.  Maxillary protraction appliance effect on the size of the upper airway passage. , 2008, The Angle orthodontist.

[99]  J. Fleetham,et al.  Oral appliances for obstructive sleep apnoea. , 2006, The Cochrane database of systematic reviews.

[100]  P. Lloberes,et al.  Mortality in severe sleep apnoea/hypopnoea syndrome patients: impact of treatment , 2002, European Respiratory Journal.

[101]  K. Flegal,et al.  Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002. , 2004, JAMA.

[102]  A. Lowe,et al.  Effects of a mandibular repositioner on obstructive sleep apnea. , 2000, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[103]  G. Bettega,et al.  Obstructive sleep apnea syndrome. fifty-one consecutive patients treated by maxillofacial surgery. , 2000, American journal of respiratory and critical care medicine.

[104]  C. George.  Reduction in motor vehicle collisions following treatment of sleep apnoea with nasal CPAP , 2001, Thorax.

[105]  P. Sinclair,et al.  Cephalometric effects of face mask/expansion therapy in Class III children: a comparison of three age groups. , 1998, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.

[106]  B. B. Tuncer,et al.  Effects of maxillary protraction and fixed appliance therapy on the pharyngeal airway. , 2009, The Angle orthodontist.

[107]  T. Montemayor,et al.  Prise en charge par chirurgie d'avancée des maxillaires des patients porteurs d'un syndrome d'apnées du sommeil sévère en échec d'un traitement par pression positive continue : étude rétrospective de 25 patients entre 1998 et 2004 , 2006 .

[108]  D. Caldarelli,et al.  Clinical Predictors of Obstructive Sleep Apnea , 1999, The Laryngoscope.

[109]  W. Bell,et al.  Intraoral mandibular distraction osteogenesis. , 1999, Seminars in orthodontics.

[110]  Mary Farbood,et al.  Long-term sequellae of oral appliance therapy in obstructive sleep apnea patients: Part 2. Study-model analysis. , 2006, American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics.