FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W2000482828> ?p ?o ?g. }

• W2000482828 endingPage "677" @default.
• W2000482828 startingPage "674" @default.
• W2000482828 abstract "Obstructive sleep apnea (OSA) has in recent years assumed a somewhat more notorious prominence in the lay press and in the medical literature. With a prevalence of 2 to 4% in the United States,1Young T Palta M Dempsey J et al.The occurrence of sleep disordered breathing among middle-aged adults.N Engl J Med. 1993; 328: 1230-1235Crossref PubMed Scopus (8513) Google Scholar where the predisposing factor of obesity is epidemic,2World Health Organization Obesity: preventing and managing the global epidemic; report of a WHO consultation on obesity. World Health Organization, Geneva, Switzerland1997Google Scholar, 3Kuczmarski RJ Flegal KM Campbell SM et al.Increasing prevalence of overweight among US adults: the National Health and Nutrition Examination Surveys, 1960-1991.JAMA. 1994; 272: 205-211Crossref PubMed Scopus (2417) Google Scholar OSA can no longer be regarded as limited to the overweight hypercapneic or morbidly sleepy patient. Moreover, epidemiologic studies have demonstrated an independent relationship between OSA and cardiovascular disease,4Worsnap CJ Naughton MT Barter CE et al.The prevalence of obstructive sleep apnea in hypertensives.Am J Respir Crit Care. 1998; 157: 111-115Crossref Scopus (183) Google Scholar, 5Weiss JW Remsburg S Garpestad E et al.Hemodynamic consequences of obstructive sleep apnea.Sleep. 1996; 19: 388-397Crossref PubMed Scopus (126) Google Scholar OSA and cerebrovascular disease,6Parra O Arboix A Bechich S et al.Time course of sleep related breathing disorders in first-ever stroke or transient ischemic attack.Am J Respir Crit Care Med. 2000; 161: 375-380Crossref PubMed Scopus (476) Google Scholar, 7Bassetti C Aldrich MS Sleep apnea in acute cerebrovascular disorders: first report on 128 patients.Sleep. 1999; 22: 217-223PubMed Google Scholar and indeed a dose-response relationship with hypertension.8Peppard PE Young T Palta M et al.Prospective study of the association between sleep-disordered breathing and hypertension.N Engl J Med. 2000; 342: 1378-1383Crossref PubMed Scopus (4002) Google Scholar OSA, therefore, is now recognized as having far-reaching implications on cardiovascular health as well as on the quality of life of an increasingly large and diverse population. Perhaps in response to such a growing realization, a substantial amount of research effort has been devoted to extending the ability to diagnose OSA. Limited respiratory monitoring technology,9ASDA Standards of Practice Portable recording in the assessment of obstructive sleep apnea.Sleep. 1996; 17: 378-392Google Scholar simpler oximetry evaluations,10Golpe R Jiminez A Carpizo R et al.Utility of home oximetry as a screening test for patients with moderate to severe symptoms of obstructive sleep apnea.Sleep. 1999; 22: 932-937PubMed Google Scholar and abbreviated split-night studies11Yamashiro Y Kryger MH CPAP titration for sleep apnea using a split-night protocol.Chest. 1995; 107: 62-66Abstract Full Text Full Text PDF PubMed Scopus (101) Google Scholar have been rigorously evaluated and have subsequently made the ability to diagnose sleep-disordered breathing more accessible to patients and more affordable for third-party payers. Consequently, more people with milder disease and more subtle symptoms have been found and have been made aware. Finding more tolerable and successful treatment options for OSA, however, has not kept pace with such diagnostic advances. Well-intentioned physicians may all too often be faced not with the satisfied contentment of having found an answer to vague and puzzling symptoms, but with having to ask themselves, What now? Weight loss is easy to recommend but difficult to comply with. It may have become less relevant as a treatment recommendation, since a greater number of nonobese patients are receiving diagnoses. Compliance with the standard treatment of continuous positive airway pressure (CPAP) falls off as patients with lesser degrees of daytime impairment are fitted. In fact, a recent study12Barbe F Mayoralas LR Duran J et al.Treatment with continuous positive airway pressure is not effective in patients with sleep apnea but no daytime sleepiness.Ann Intern Med. 2001; 134: 1015-1023Crossref PubMed Scopus (485) Google Scholar suggests CPAP may be inappropriate unless daytime sleepiness exists, even as more and more patients with relatively asymptomatic disease, but with a recognized risk factor for future cardiovascular events, are receiving diagnoses. Surgery such as uvulopalatopharyngoplasty (UPPP) has limited long-term efficacy,13Sher AE Schechtman KB Piccerillo JF The efficacy of surgical modifications of the upper airway in adults with obstructive sleep apnea syndrome.Sleep. 1996; 19: 156-177Crossref PubMed Scopus (1032) Google Scholar poses unacceptable risk for the patient with important comorbidities or old age, and may in any case be considered excessive for milder degrees of sleep-disordered breathing or minimal daytime impairment. Medications with purported activity on upper-airway tone, such as the selective serotonin reuptake inhibitors, have been explored but to date also have shown limited efficacy.14Kraiczi H Hedner J Dahlof P et al.Effect of serotonin uptake inhibition on breathing during sleep and daytime symptoms in obstructive sleep apnea.Sleep. 1999; 22: 61-67PubMed Google Scholar Prosthetic mandibular advancement is becoming a more realistic and efficacious alternative in the treatment armamentarium for OSA, not only for milder and/or atypical patients, but for any patient with OSA. In this issue of CHEST (see page 739), Walker-Engstrom et al have supplied important efficacy and compliance information on mandibular advancement through a rigorous and long-term evaluation. Ninety-five male patients with overall mild OSA (mean apnea/hypopnea index [AHI] approximately 20 episodes per hour) were randomized to initial treatment with either UPPP or mandibular advancement, and were followed up for an average of 4 years. The authors used a one-piece device that achieved a fixed mandibular advancement of 50% of each patient's maximum protrusive capacity, a degree of advancement somewhat less than the 66 to 75% movement used in many previous studies.15Clark GT Arand D Chung E et al.Effect of anterior mandibular positioning on obstructive sleep apnea.Am Rev Respir Dis. 1993; 147: 624-629Crossref PubMed Scopus (174) Google Scholar, 16Clark GT Blumenfeld I Yoffe EP et al.A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea.Chest. 1996; 109: 1477-1483Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar, 17Mehta A Qian J Petocz P et al.A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea.Am J Respir Crit Care Med. 2001; 163: 1457-1461Crossref PubMed Scopus (370) Google Scholar Compliance with the dental appliance was 82% at 1-year follow-up and 62% at 4 years, a rate comparable to acceptance rates with CPAP.18Kribbs NB Pack A Kline LR Objective measurement of patterns of nasal CPAP use by patients with obstructive sleep apnea.Am Rev Respir Dis. 1993; 147: 887-895Crossref PubMed Scopus (1103) Google Scholar With respect to efficacy, success (defined by reduction in the AHI by at least 50% of baseline) was 72% at 4 years with the oral appliance. This differed significantly from the 4-year success rate of 35% with UPPP. Data for normalization of OSA (apnea index < 5/h, AHI < 10/h) at 4 years was similar. Sixty-three percent of patients still using the mandibular device attained an AHI < 10/h, while only 33% of patients treated with UPPP achieved such a result. This current study adds further weight to the growing body of evidence supporting prosthetic mandibular advancement as a valid treatment for OSA. Mandibular advancement has been subjected to the same stepwise evaluation as have treatment modalities for other diseases. Initial uncontrolled case series or anecdotal reports establishing feasibility15Clark GT Arand D Chung E et al.Effect of anterior mandibular positioning on obstructive sleep apnea.Am Rev Respir Dis. 1993; 147: 624-629Crossref PubMed Scopus (174) Google Scholar, 19Schmidt-Nowara W Meade T Hays M Treatment of snoring and obstructive sleep apnea with a dental orthosis.Chest. 1991; 99: 1378-1385Abstract Full Text Full Text PDF PubMed Scopus (185) Google Scholar have been followed by studies investigating a mechanistic explanation for success in treatment of OSA.20Eveloff SE Rosenberg CL Carlisle CC et al.Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea.Am J Respir Crit Care Med. 1994; 149: 905-909Crossref PubMed Scopus (184) Google Scholar Randomized controlled trials of mandibular advancement have subsequently followed, providing further scientific credence to the use of mandibular advancement in OSA. Two such randomized crossover investigations, both published in 1996,16Clark GT Blumenfeld I Yoffe EP et al.A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea.Chest. 1996; 109: 1477-1483Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar, 21Ferguson KA Ono T Lowe A et al.A randomized crossover study of an oral appliance vs nasal-continuous positive airway pressure in the treatment of mild-moderate obstructive sleep apnea.Chest. 1996; 109: 1269-1275Abstract Full Text Full Text PDF PubMed Scopus (396) Google Scholar compared oral appliance therapy to the virtual “gold standard” treatment of CPAP and reached similar conclusions. In patients with mild-to-moderate OSA, mandibular advancement and CPAP were both efficacious. CPAP proved more effective in lowering posttreatment AHI, but mandibular advancement was tolerated better and was preferred by a greater number of patients. A more recent placebo-controlled trial17Mehta A Qian J Petocz P et al.A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea.Am J Respir Crit Care Med. 2001; 163: 1457-1461Crossref PubMed Scopus (370) Google Scholar of mandibular advancement against a placebo dental plate in 24 patients confirmed partial or complete response in two of three patients regardless of OSA severity, and demonstrated favorable compliance (87%) and satisfaction (96%) rates among users. Walker-Engstrom et al have extended these findings by confirming a similar degree of efficacy in a larger patient population. The fact that these patients were actually randomized to one of two (non-CPAP) treatments, made possible by the mild-to-moderate severity of their disease, makes the favorable efficacy and side effect profile results especially meaningful. Another important strength of this study was its prolonged duration. The 4-year length of follow-up showed that the relatively low rate of both subjective complaints and objective complications found in previous studies of oral appliances can be maintained despite a much longer period of use. This long-term controlled trial therefore represents a major step forward in catching treatment options for OSA up to the recent progress made in detecting the disease. The answer to “What now?” lies not in relying on any particular “gold standard” of therapy, but on assuring the clinician that several validated and almost complementary options exist, which may be individualized according to particular patient and disease characteristics. CPAP appears to be less tolerated in the very population of patients with mild disease and/or symptoms in which mandibular advancement achieves best results. Previous studies17Mehta A Qian J Petocz P et al.A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea.Am J Respir Crit Care Med. 2001; 163: 1457-1461Crossref PubMed Scopus (370) Google Scholar, 22Pancer J Al-Faifi S Al-Faifi M et al.Evaluation of variable mandibular advancement for treatment of snoring and sleep apnea.Chest. 1999; 116: 1511-1518Abstract Full Text Full Text PDF PubMed Scopus (132) Google Scholar, 23Henke KG Frantz DE Kuna ST An oral elastic mandibular advancement device for obstructive sleep apnea.Am J Respir Crit Care Med. 2000; 161: 420-425Crossref PubMed Scopus (87) Google Scholar do need to be emphasized, however, that demonstrate successful mandibular advancement efficacy can be achieved in patients with more severe degrees of OSA as well. Treatment of OSA has therefore progressed to a state where enough varied therapeutic options exist to allow greater individualization among patients, which hopefully will result in better long-term compliance and satisfaction. Moreover, these expanded treatment options should no longer be regarded in an “either/or” light. Rather, it may now be appropriate to regard upper-airway surgery, pneumatic splinting, and mandibular advancement as independent treatment options for certain patients, but as synergistic stepwise treatments for others. Millman et al,24Millman RP Rosenberg CL Carlisle CC et al.The efficacy of oral appliances in the treatment of persistent sleep apnea after uvulopalatopharyngoplasty.Chest. 1998; 113: 992-996Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar for example, showed that mandibular advancement can accomplish a complete response in certain patients with an unsatisfactory result from UPPP alone. Indeed, the current study by Walker-Engstrom et al demonstrated similar results in a smaller number of patients. Six of 10 patients initially randomized to UPPP normalized sleep-disordered breathing only after “rescue” mandibular advancement. The utility of mandibular advancement as a rescue modality for at least surgical failures becomes even more important in light of evidence that CPAP utility may actually be compromised in patients previously treated with UPPP.25Mortimore IL Bradley PA Murray JAM et al.Uvulopalatopharyngoplasty may compromise nasal CPAP therapy in sleep apnea syndrome.Am J Respir Crit Care Med. 1996; 154: 1759-1762Crossref PubMed Scopus (106) Google Scholar Given that other mechanistic studies20Eveloff SE Rosenberg CL Carlisle CC et al.Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea.Am J Respir Crit Care Med. 1994; 149: 905-909Crossref PubMed Scopus (184) Google Scholar have found that anterior mandibular advancement may impact on velopharyngeal (soft palate, uvula) tissues as well as on the posterior airway space, adjunctive orthodontic manipulation of pharyngeal tissues is supported by physiologic as well as epidemiologic evidence. Many issues remain unresolved despite such progress. The appropriate patient population for mandibular advancement, at least as monotherapy, may need to be redefined. Patients with only mild-to-moderate OSA, such as the patients in the current study, have generally been considered to offer the best chance of success with oral appliances. As stated above, however, several studies have shown that even more severe cases may respond. Different types of oral devices have been used, making comparison between studies somewhat problematic. One-piece or two-piece construction, as well as adjustable vs fixed advancement capabilities, present opportunities for future investigations, and undoubtedly impact on tolerance, efficacy, and cost considerations. The degree of mandibular movement is also far from resolved, but may be as important a variable as the level of positive pressure delivered by CPAP. A majority of investigators15Clark GT Arand D Chung E et al.Effect of anterior mandibular positioning on obstructive sleep apnea.Am Rev Respir Dis. 1993; 147: 624-629Crossref PubMed Scopus (174) Google Scholar, 16Clark GT Blumenfeld I Yoffe EP et al.A crossover study comparing the efficacy of continuous positive airway pressure with anterior mandibular positioning devices on patients with obstructive sleep apnea.Chest. 1996; 109: 1477-1483Abstract Full Text Full Text PDF PubMed Scopus (217) Google Scholar, 17Mehta A Qian J Petocz P et al.A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea.Am J Respir Crit Care Med. 2001; 163: 1457-1461Crossref PubMed Scopus (370) Google Scholar, 23Henke KG Frantz DE Kuna ST An oral elastic mandibular advancement device for obstructive sleep apnea.Am J Respir Crit Care Med. 2000; 161: 420-425Crossref PubMed Scopus (87) Google Scholar, 26O'sullivan RA Hillman DR Mateljan R et al.Mandubular advancement splint: an appliance to treat snoring and obstructive sleep apnea.Am J Respir Crit Care Med. 1995; 151: 194-198Crossref PubMed Scopus (186) Google Scholar have recommended at least 75% of maximal protrusion, a value representing absolute mandibular advancement of between 5 mm and 11 mm. One such study23Henke KG Frantz DE Kuna ST An oral elastic mandibular advancement device for obstructive sleep apnea.Am J Respir Crit Care Med. 2000; 161: 420-425Crossref PubMed Scopus (87) Google Scholar with an adjustable oral device even used an average movement of 88% of maximal protrusion (8.8- to 16.5-mm absolute advancement). Importantly, a substantial number of patients in that study achieved improvement despite severe OSA (mean AHI 52 ± 28/h for all patients), perhaps as a result of such profound advancement. Although the incidence of side effects was not detailed, another recent 2.5-year study27Fritsch KM Iseli A Russi EW et al.Side effects of mandibular advancement devices for sleep apnea treatment.Am J Respir Crit Care Med. 2001; 164: 813-818Crossref PubMed Scopus (137) Google Scholar specifically focusing on side effects instead of efficacy found only minor orthodontic and occlusive side effects despite initial anterior mandibular movement of 75% of maximal protrusion. Subjective discomfort was prevalent but relatively minor, and was outweighed by overall subjective improvement in daytime symptoms. It is possible, therefore, that the relatively lower degree of advancement achieved by the authors of this current study could be exceeded in future clinical trials. In so doing, an even better risk benefit ratio could be achieved, even with long-term use. It may be that lessons learned from years of CPAP therapy may provide the answer to at least the last issue. Future studies should emphasize adjustable mandibular advancement devices, with objective titration trials similar to CPAP titration. Initial advancement may depend more on objective reduction of AHI, while long-term compliance may rely more on subsequent patient-driven adjustment. However these issues are resolved, responsible use of oral appliances depends on factors that should not be open to discussion. Success of mandibular advancement needs to be confirmed by objective follow-up polysomnographic verification, as some studies have reported subjective daytime improvement without corresponding resolution of OSA. Perhaps as important if not more so, fitting and manufacture of oral appliances should be conducted by dentists with particular interest and experience in sleep disorders. In fact, the particular device probably does not have as much bearing on eventual clinical effectiveness as does the dentist and associated sleep center prescribing it. The variable compliance and success rates seen up to now in the treatment of OSA would not be found acceptable with other prevalent diseases such as hypertension, coronary artery disease, or diabetes. This rigorous and ambitious study will hopefully lead to expanding treatment options by building greater confidence in the orthodontic treatment of OSA. Utilization of both monotherapy and combined therapies have become standard in the treatment of these other diseases. The growing number of patients with OSA may benefit from such a philosophy as well, even if such treatment options and combinations are sutured, worn, and inserted instead of swallowed." @default.
• W2000482828 created "2016-06-24" @default.
• W2000482828 creator A5085769161 @default.
• W2000482828 date "2002-03-01" @default.
• W2000482828 modified "2023-09-25" @default.
• W2000482828 title "Treatment of Obstructive Sleep Apnea" @default.
• W2000482828 cites W113566499 @default.
• W2000482828 cites W119190672 @default.
• W2000482828 cites W1981417640 @default.
• W2000482828 cites W2025248470 @default.
• W2000482828 cites W2033893565 @default.
• W2000482828 cites W2039634178 @default.
• W2000482828 cites W205664854 @default.
• W2000482828 cites W2056722705 @default.
• W2000482828 cites W2059602766 @default.
• W2000482828 cites W2066409119 @default.
• W2000482828 cites W2067338371 @default.
• W2000482828 cites W2080403422 @default.
• W2000482828 cites W2096308766 @default.
• W2000482828 cites W2103637155 @default.
• W2000482828 cites W2106189167 @default.
• W2000482828 cites W2136654722 @default.
• W2000482828 cites W2151609530 @default.
• W2000482828 cites W2152796920 @default.
• W2000482828 cites W2154497093 @default.
• W2000482828 cites W2162856105 @default.
• W2000482828 cites W2333343699 @default.
• W2000482828 cites W2335449614 @default.
• W2000482828 cites W4240225536 @default.
• W2000482828 doi "https://doi.org/10.1378/chest.121.3.674" @default.
• W2000482828 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/11888940" @default.
• W2000482828 hasPublicationYear "2002" @default.
• W2000482828 type Work @default.
• W2000482828 sameAs 2000482828 @default.
• W2000482828 citedByCount "17" @default.
• W2000482828 countsByYear W20004828282012 @default.
• W2000482828 countsByYear W20004828282013 @default.
• W2000482828 countsByYear W20004828282014 @default.
• W2000482828 countsByYear W20004828282015 @default.
• W2000482828 countsByYear W20004828282016 @default.
• W2000482828 countsByYear W20004828282022 @default.
• W2000482828 crossrefType "journal-article" @default.
• W2000482828 hasAuthorship W2000482828A5085769161 @default.
• W2000482828 hasBestOaLocation W20004828281 @default.
• W2000482828 hasConcept C111919701 @default.
• W2000482828 hasConcept C164705383 @default.
• W2000482828 hasConcept C177713679 @default.
• W2000482828 hasConcept C2775841894 @default.
• W2000482828 hasConcept C2776006263 @default.
• W2000482828 hasConcept C2777935920 @default.
• W2000482828 hasConcept C2781326671 @default.
• W2000482828 hasConcept C41008148 @default.
• W2000482828 hasConcept C42219234 @default.
• W2000482828 hasConcept C71924100 @default.
• W2000482828 hasConceptScore W2000482828C111919701 @default.
• W2000482828 hasConceptScore W2000482828C164705383 @default.
• W2000482828 hasConceptScore W2000482828C177713679 @default.
• W2000482828 hasConceptScore W2000482828C2775841894 @default.
• W2000482828 hasConceptScore W2000482828C2776006263 @default.
• W2000482828 hasConceptScore W2000482828C2777935920 @default.
• W2000482828 hasConceptScore W2000482828C2781326671 @default.
• W2000482828 hasConceptScore W2000482828C41008148 @default.
• W2000482828 hasConceptScore W2000482828C42219234 @default.
• W2000482828 hasConceptScore W2000482828C71924100 @default.
• W2000482828 hasIssue "3" @default.
• W2000482828 hasLocation W20004828281 @default.
• W2000482828 hasLocation W20004828282 @default.
• W2000482828 hasOpenAccess W2000482828 @default.
• W2000482828 hasPrimaryLocation W20004828281 @default.
• W2000482828 hasRelatedWork W1969950653 @default.
• W2000482828 hasRelatedWork W1995527129 @default.
• W2000482828 hasRelatedWork W2085796976 @default.
• W2000482828 hasRelatedWork W2089884582 @default.
• W2000482828 hasRelatedWork W2141772508 @default.
• W2000482828 hasRelatedWork W2319103027 @default.
• W2000482828 hasRelatedWork W2413774094 @default.
• W2000482828 hasRelatedWork W3036540864 @default.
• W2000482828 hasRelatedWork W3092127899 @default.
• W2000482828 hasRelatedWork W4295775062 @default.
• W2000482828 hasVolume "121" @default.
• W2000482828 isParatext "false" @default.
• W2000482828 isRetracted "false" @default.
• W2000482828 magId "2000482828" @default.
• W2000482828 workType "article" @default.