Facteurs associés à l’efficacité des orthèses d’avancée mandibulaire chez des patients AOSby Francesca Milano, Maria Celeste Billi, Francesca Marra, Giovanni Sorrenti, Antonio Gracco, Giulio A. Bonetti

International Orthodontics

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Year
2013
DOI
10.1016/j.ortho.2013.05.007
Subject
Orthodontics

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Summary

The aim of this study was to evaluate the anthropometric, demographic, occlusal and cephalometric characteristics of a group of adult obstructive sleep apnea (OSA) patients treated with mandibular advancement devices (MADs) and to determine the factors associated with treatment efficacy. Twentythree consecutive patients with mild to severe OSA (polysomnographically diagnosed [T0]) were recruited for this prospective study; they were treated with a Silensor appliance, and a polysomnographic exam with the MAD in situ was performed 2 to 3 months later (T1) to evaluate MAD’s efficacy. Based on apnea-hypopnea index (AHI) differences between the T0 and T1 values, patients were classified into two groups: completely recovered and not completely recovered patients. The differences in anthropometric, demographic, occlusal and cephalometric parameters between the two groups were analyzed, and significant parameters verified. The sample showed these prevalent characteristics: deep bite, crossbite, tooth wear, dental and skeletal Class II, mesofacial mandibular vertical growth pattern, low position of the hyoid bone, longer soft palate length. The transverse diameters of upper maxilla had the greatest impact

Resume

L’objectif de cette etude etait d’evaluer les caracteristiques anthropometriques, demographiques, occlusales et cephalometriques d’un groupe d’adultes souffrant d’apnee obstructive du sommeil (AOS) et traites avec des ortheses d’avancee mandibulaire (OAM). Il s’agissait aussi de determiner les facteurs associes a` l’efficacite de ce type de traitement. Vingt-trois patients consecutifs souffrant d’une

OAS legere a` severe (diagnostiquee par polysomnographie [T0]) ont ete recrutes dans cette etude prospective. Les patients ont ete traites avec une gouttiere Silensor et ils ont ete examines avec l’OAM en place deux a` trois mois plus tard [T1] afin d’evaluer l’efficacite de l’appareil. En utilisant les differences entre les valeurs T0 et T1 sur l’index d’apnee hypopnee (IAH), les patients ont ete classes en deux groupes : retablissement complet et retablissement incomplet.

Les differences entre les parametres anthropometriques, demographiques, occlusaux et cephalometriques des deux groupes ont ete analysees et les parametres significatifs ont ete verifies. L’echantillon a montre les caracteristiques predominantes suivantes : supraclusion, articule croise,

Original article

Article original  2013 CEO

Published by / E´dite´ par Elsevier Masson SAS

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Factors associated with the efficacy of mandibular advancing device treatment in adult OSA patients

Facteurs associes a` l’efficacite des ortheses d’avancee mandibulaire chez des patients AOS

Francesca MILANOa,*, Maria Celeste BILLIb, Francesca MARRAc, Giovanni SORRENTId,

Antonio GRACCOe, Giulio A. BONETTIf aPrivate Practice, via Clavature 1, 40124 Bologna, Italy bVia Alberto da Giussano 39, 47122 Forlı`, Italy cVia San Domenico Savio 71, 73100 Lecce, Italy dENT Department, S. Orsola-Malpighi Hospital, Alma Mater Studiorum University of

Bologna, via Zamboni 33, 40126 Bologna, Italy eSchool of Dentistry, University of Padova, via 8 Febbraio 2, 35122 Padova, Italy fDepartment of Orthodontics, Alma Mater Studiorum University of Bologna, via Zamboni 33, 40126 Bologna, Italy

Available online: 15 July 2013 / Disponible en ligne : 15 juillet 2013 *Correspondence and reprints / Correspondance et tires a` part. e-mail address / Adresse e-mail : francescamilano@libero.it (Francesca Milano) 278 International Orthodontics 2013 ; 11 : 278-289 http://dx.doi.org/10.1016/j.ortho.2013.05.006 on T0 AHI. The factors associated with MAD efficacy were: age under 55 years, distance between the hyoid bone and the mandibular plane (H-MP) less than 20 mm, divergence of mandibular vertical growth pattern (SN^MP) less than 29.  2013 CEO. Published by Elsevier Masson SAS. All rights reserved

Key-words ·Sleep apnea.·Snoring.·Oral appliance.·Predictability.·Cephalometry.

Introduction

Obstructive sleep apnea (OSA) is a common sleep breathing disorder that affects more than 2% of women and 4% of men, is characterized by snoring and repetitive complete (apnea) or partial (hypopnea) cessations of airflow during sleep, resulting in oxygen desaturation and sleep fragmentation [1]. It is considered a serious public health problem, that can determine an impaired quality of life for its signs and symptoms (excessive daytime sleepiness and impaired cognitive ability) and is also associated to an increased morbidity and mortality because of its potential consequences (increased risk of cardiovascular, cerebrovascular, metabolic diseases and motor vehicle accidents). Mandibular advancing devices (MADs) are nocturnal appliances that induce the mandible protrusion in order to increase the upper airway dimension and reduce or eliminate the respiratory events during sleep [1–4]. They are indicated for several conditions: primary snoring; symptomatic treatment of mild to moderate OSA (5  apnea-hypopnea index [AHI]  30 events per hour [eh]); and severe OSA (AHI > 30 eh) when surgery and ventilatory therapy have been refused by the patient [5,6]. The aim of this study was to evaluate the anthropometric, demographic, occlusal and cephalometric characteristics of a group of adult patients with

OSA who were treated with MADs and to determine the factors that were associated with the treatment outcome. usure dentaire, Classe II dentaire et squelettique, schema de croissance verticale mesofaciale mandibulaire, position basse de l’os hyoı¨de, longueur accrue du voile du palais.

Les diametres transversaux du maxillaire ont eu l’impact le plus important sur le T0 IAH. Les facteurs associes a` l’efficacite des OAM etaient : a^ge superieur a` 55 ans, distance entre l’os hyoı¨de et le plan mandibulaire (H-MP) inferieure a` 20 mm, et divergence du schema de croissance mandibulaire verticale (SN^MP) inferieure a` 29  .  2013 CEO. E´dite´ par Elsevier Masson SAS. Tous droits re´serve´s