Sleep Apnea | Sleep Scholar

Gergen’s Orthodontics Lab Releases “Respire” by Gergens

November 2, 2011 by Randy Clare Leave a Comment

FOR IMMEDIATE RELEASE

Gergen’s Orthodontics Lab Releases “Respire” by Gergens

Phoenix, Arizona- 11/2/2011- Gergen’s Orthodonic Lab announced today that it has been awarded accreditation by Respire Medical to fabricate the Respire dental appliance for snoring and sleep apnea. David Gergen C.D.T. and recipient of Arizona small businessman of the year in 2004 declared that “Gergen’s Orthorontic lab is ready and willing to position the Respire as the premier oral appliance for snoring and sleep apnea.”.

Gergen’s Orthodontic lab has extensive experience with sleep apnea appliances. They are the nations largest fabricator of the Herbst sleep appliance, which is widely regarded as the most durable and effective oral appliance for sleep on the market. Gergen’s Orthodontic Lab is FDA registered and is approved by CMS for the fabrication of dental solutions for sleep problems.

David Gergen is considered one of the worlds best orthodontic tech’s since he received the award for The Finest Orthodontic Technician in the United States by Columbus Dental in 1986, he has worked for pioneers in the orthodontic and sleep dentistry fields. He was the personal technician for Dr. Robert Ricketts, Dr. Ronald Roth, Dr. A. Paul Serrano, Dr. Clark Jones, Dr. Joseph R. Cohen, Dr Harold Gelb and Dr. Edward Spiegel.

Obstructive Sleep Apnea (OSA) is a condition that affects 12 million Americans and is characterized by the collapse of the airway during sleep. Co-morbidities associated with sleep apnea are diabetes, high blood pressure and heart disease. Obesity while a contributing factor is not necessarily an indicator of obstructive sleep apnea.

Treatments for OSA include CPAP, Oral appliances and Surgery. The first line of treatment for mild to moderate OSA according to the AASM is the oral appliance when made by a Dentist in a certified and licensed dental Laboratory.

For more information about the “Respire” or Gergen’s Orthodontic Lab please visit www.gergensortho.com.

For additional information contact Nichole Woods at (623) 879-6066

Filed Under: sleep apnea

Home Testing for Sleep Apnea Not Inferior

October 16, 2011 by Randy Clare 1 Comment

BY SUSAN LONDON
Elsevier Global Medical News

VANCOUVER, B.C. – Recent research on the use of home testing for the diagnosis of obstructive sleep apnea and initiation of therapy suggests that “home testing is here to stay,” Dr. Charles W. Atwood Jr., FCCP, said at CHEST 2010, the annual meeting of the American College of Chest Physicians.

For more than 30 years, physicians have relied on the traditional polysomnography performed in the sleep laboratory to diagnose sleep apnea, according to Dr. Atwood. But with growing awareness of the condition and its prevalence, the number of people needing testing could overwhelm capacity.

“If you take the millions and millions and millions of people in the United States alone who have sleep apnea and try to feed them through the relatively small funnel of traditional sleep labs, then you are going to have big bottlenecks,” he said, adding that such bottlenecks already exist in some areas.

However, home-testing devices must meet certain key requirements before they are ready for widespread use. For example, they have to be simpler than those used in the lab. “Perhaps we can get by with fewer [physiological] signals, but we need to understand what the key signals are,” commented Dr. Atwood, a pulmonologist and sleep medicine specialist with the VA Pittsburgh Healthcare System and the University of Pittsburgh Medical Center.

Home testing devices will also need to be accurate, with high sensitivity and specificity, and “there is no single device I would say today that is perfect in both these regards,” he noted. Finally, they must be easy to use and durable, given the demands of in-home use.

Roughly 95 studies conducted between 1990 and 2006 evaluated home testing (also called portable monitoring) for the diagnosis of obstructive sleep apnea. Collectively, they had some limitations, such as their single-site nature, small and usually homogeneous populations, and varying degrees of rigor in design.

“And they frequently focused on the highest-risk subjects: These were middleaged men who were overweight, snored, and were sleepy, so [they were] the very low-hanging fruit for typical sleep apnea,” Dr. Atwood said.

These studies showed some mixed re- Home Testing for Sleep Apnea Not Inferior sults when it came to the diagnostic performance of home testing relative to lab testing. “There is no perfect study, at least so far, in this area, but some have come pretty close,” he commented.

Three more-recent studies suggest that home testing is at least not inferior to lab testing for sleep apnea diagnosis and initiation of continuous positive airway pressure (CPAP) therapy, according to Dr. Atwood.

In the first study, conducted in 68 people with a high likelihood of sleep apnea, the apneahypopnea index on CPAP and Sleep Apnea Quality of Life Index scores at 3 months did not differ significantly between a sleep lab and an ambulatory approach (Ann. Intern. Med. 2007;146:157-66). The rate of adherence to CPAP was better with the latter.

In the second study, which involved 102 patients with sleep apnea symptoms and no major comorbidities, all of a variety of sleep and quality of life outcomes after 4 weeks of CPAP were similar with a standard lab diagnosis and treatment approach vs. a home approach (Chest 2010;138:257-63).

The third study, the Veterans Sleep Apnea Treatment Trial (VSATT), is the largest study of home testing in North America to date, according to Dr. Atwood, one of the principal investigators.

“The VA is ill equipped to manage sleep apnea in a conventional way because we have relatively few numbers of traditional sleep labs,” he noted.

“Our study differed from basically all of the other studies in the literature in that we had very broad inclusion criteria and very nonrestrictive exclusion criteria,” Dr. Atwood noted. For example, patients with comorbidities could participate as long as their condition was stable.

Patients were randomized to lab testing or home testing, followed by initiation of CPAP for those with positive results.

Among the 223 who were started on CPAP, the home and lab groups had similar demographics. The average apnea hypopnea index was 41 for the former and 45 for the latter. The Functional Outcomes of Sleep Questionnaire (FOSQ) total score was about 15 in each group.

Results showed that the mean adjusted improvement in FOSQ total score between baseline and 3 months was identical in the two groups, at 1.79 points. And within each group, patients had significant improvements in the total score as well as its individual components. Both home and lab groups also had significant improvements on the Epworth Sleepiness Scale (–2.6 and –2.9, respectively), the mental health component of the 12-item Short Form Health Survey (+2.5 and +3.0), and the Center for Epidemiologic Studies–Depression scale (–1.4 and –2.2). Neither group improved significantly on the psychovigilance task or the physical health component of the 12-item Short Form Health Survey.

When it came to adherence, which was monitored with smart cards, the mean adjusted number of CPAP hours daily was 3.42 in the home group and 2.99 in the lab group, a difference that was not significant. Cost-effectiveness analyses are still ongoing.

“We concluded that the functional improvement with CPAP for sleep apnea is not worse when treated in the home setting vs. the sleep lab,” Dr. Atwood said. “We believe … home-based sleep apnea diagnosis and initiation of CPAP therapy is an effective way to treat sleep apnea.”

While home testing won’t entirely replace laboratory polysomnography, Dr. Atwood suggested trying to “integrate home sleep testing with full polysomnography in a clinically rational way.”

Dr. Atwood reported that he received research support from Embla, Resmed, and Respironics, and is a consultant to Embla and Itamar Medical, all of which manufacture testing and treatment devices for sleep disorders.

CHEST Physician Article | 01.13.11

Filed Under: sleep apnea

Scottsdale Study Club Announces and Sets Dates for Clinical Workshops and Meetings Focused on Dental Treatments of Sleep Disordered Breathing, Bruxism and TMD/Headache

July 28, 2011 by Randy Clare Leave a Comment

The Scottsdale Study Club announces its 12-month meeting schedule to include monthly club meetings as well as monthly hands-on clinical workshops with patients. The focus of this educational environment is to provide direct one-on-one experience with Dentists who have successfully integrated sleep dentistry into their practices.

About the Workshops and Meetings

General session fees are $1,499 and Workshops are $2,200. Each Dentist is welcome to bring an assistant or auxiliary to the club meeting. For information or to register to attend the meeting, please call 760-633-4162..

Topics and focus of each meeting will be determined by the mentors and may change without notice depending on the number attendees and perceived areas of academic interest. There will be no exhibits at the Study Club meetings.

Background on the Mentors

Dr. Edward Spiegel, DDS: After treating a series of patients in the 1980′s with temporomandibular joint disorder by way of oral appliances, in 1992, he discovered an interesting correlation. As he treated these patients with oral appliances their snoring stopped. Having confirmed this finding after a retrospective case review, he began to evaluate the use of oral appliances to stop patients snoring and in turn the utility of oral appliances in solving a much larger health problem: Sleep Disordered Breathing conditions such as Obstructive Sleep Apnea (OSA).

He designed a rudimentary treatment protocol within his own office based on the dental management of Sleep Disordered Breathing by way of Oral Appliance Therapy. The local success of his clinical program in Erie, PA was mirrored nationally by dental practices emulating his treatment plan. He then created a clinical protocol intended for the dental assessment and treatment of snoring and other airway-related sleep disorders. The result is a turn-key system for the dental management of Sleep Disordered Breathing.

Bradley Eli, DMD, MS: Bradley Eli has a 20 year history of work in the field of Orofacial Pain management (head and neck). Upon completion of his UCLA program there were less than 10 like providers within the United States. In 1995, he began the work in the field of Sleep Medicine and then began the STAR (Sleep Treatment and Research) Institute. This unique early look at the field has assisted him in the development of methods and solutions to assist patients with these life changing pain and sleep disorders.

Location

SleepScholar Study Club General Session

14635 N Kierland Blvd., Ste. 154

Scottsdale, AZ, 85254

Seating is limited and will be assigned on a first come first serve basis

Calendar of Events 2011

September 16- 17, 2011

Where are the patients?

Evaluation of dental patients at each dental appointment for signs and symptoms of untreated sleep disorders
Conversion from dental to medical
Dental insurance vs. Medical Insurance including Medicare
AASM as well as AADSM guidelines for treatment in the dental office
Hands-on workshop for patient evaluation and treatment

Mentor Spotlight

Dr. Rodney Willey, Peoria, IL

Dr. Michael Childres, Bradenton, FL

Dr. Michael Gluhareff, Ocala, FL

Dr. Edward Spiegel, Scottsdale, AZ

Dentists and one staff member will learn proper patient evaluation, examination, jaw registration, and dental and medical records.

October 14-15, 2011

Bruxism, TMD and Sleep

Etiology of Bruxism, use of the Ordinal Scale as well as tie in to TMD and Sleep Disorders
Evaluation of the patient, documentation and medical billing for ABI
Treatment options in the pediatric patient as well as adult patient
Orthodontic evaluation and early treatment
TMD evaluation of patients as well as treatment planning
Sleep patient present with symptoms of pain and pre existing conditions
Hands-on evaluation of patient dentition and treatment planning
Proper medical referral and medical billing

Mentor Spotlight

Dr. Devin Croft, Orthodontist, Peoria, AZ

Dr. Bradley Eli, UCLA 2-year residency, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

November 4-5, 2011

Diagnostic Testing

Diagnostic testing in the dental office for TMD and Oral Appliance
Evaluating diagnostic testing for use id the dental office
Literature support, clinical guidelines for treatment planning as well as follow-up records and documentation to insurance carriers
AAOP as well as AACP Guidelines for treatment and evaluation of patients
Hands-on evaluation for patients as well as discussion on treatment planning

Mentor Spotlight

Dr. Bradley Eli, UCLA 2-year residency, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

December 2-3, 2011

Oral Appliance Selection

Discussion on the most used oral devices for Bruxism, TMD and OSA
Pricing as well as indications and contra indications of oral devices with a 510(k) number
Various jaw registration devices for recording the maxillary/mandibular relationship
Long-term use of Oral Appliances
Trouble-shooting problems associated with oral appliances
Materials for accurate impressions for oral devices

Mentor Spotlight
Mr. Randy Clare, Aliso Viejo, CA

Dr. Edward Spiegel, Scottsdale, AZ

Calendar of Events 2012

February 10-11, 2012

Where are the patients?

Evaluation of dental patients at each dental appointment for signs and symptoms of untreated sleep disorders
Conversion from dental to medical
Dental insurance vs. Medical Insurance including Medicare
AASM as well as AADSM guidelines for treatment in the dental office
Hands-on workshop for patient evaluation and treatment

Mentor Spotlight

Dr. Rodney Willey, Peoria, IL

Dr. Michael Childres, Bradenton, FL

Dr. Michael Gluhareff, Ocala, FL

Dr. Edward Spiegel, Scottsdale, AZ

Dentists and one staff member will learn proper patient evaluation, examination, jaw registration, and dental and medical records.

March 9-10, 2012

Bruxism, TMD and Sleep

Etiology of Bruxism, use of the Ordinal Scale as well as tie in to TMD and Sleep Disorders
Evaluation of the patient, documentation and medical billing for ABI
Treatment options in the pediatric patient as well as adult patient
Orthodontic evaluation and early treatment
TMD evaluation of patients as well as treatment planning
Sleep patient present with symptoms of pain and pre existing conditions
Hands-on evaluation of patient dentition and treatment planning
Proper medical referral and medical billing

Mentor Spotlight

Dr. Devin Croft, Orthodontist, Peoria, AZ

Dr. Bradley Eli, UCLA 2-year residency, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

April 13-14, 2012
Diagnostic Testing

Diagnostic testing in the dental office for TMD and Oral Appliance
Evaluating diagnostic testing for use id the dental office
Literature support, clinical guidelines for treatment planning as well as follow-up records and documentation to insurance carriers
AAOP as well as AACP Guidelines for treatment and evaluation of patients
Hands-on evaluation for patients as well as discussion on treatment planning

Mentor Spotlight

Dr. Bradley Eli, UCLA 2-year residency, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

May 11-12, 2012

Oral Appliance Selection

Discussion on the most used oral devices for Bruxism, TMD and OSA
Pricing as well as indications and contra indications of oral devices with a 510(k) number
Various jaw registration devices for recording the maxillary/mandibular relationship
Long-term use of Oral Appliances
Trouble-shooting problems associated with oral appliances
Materials for accurate impressions for oral devices

Mentor Spotlight
Mr. Randy Clare, Aliso Viejo, CA

Dr. Edward Spiegel, Scottsdale, AZ

June 8-9, 2011

Where are the patients?

Evaluation of dental patients at each dental appointment for signs and symptoms of untreated sleep disorders
Conversion from dental to medical
Dental insurance vs. Medical Insurance including Medicare
AASM as well as AADSM guidelines for treatment in the dental office
Hands-on workshop for patient evaluation and treatment

Mentor Spotlight

Dr. Rodney Willey, Peoria, IL

Dr. Michael Childres, Bradenton, FL

Dr. Michael Gluhareff, Ocala, FL

Dr. Edward Spiegel, Scottsdale, AZ

Dentists and one staff member will learn proper patient evaluation, examination, jaw registration, and dental and medical records.

July 13-14, 2012

Bruxism, TMD and Sleep

Etiology of Bruxism, use of the Ordinal Scale as well as tie in to TMD and Sleep Disorders
Evaluation of the patient, documentation and medical billing for ABI
Treatment options in the pediatric patient as well as adult patient
Orthodontic evaluation and early treatment
TMD evaluation of patients as well as treatment planning
Sleep patient present with symptoms of pain and pre existing conditions
Hands-on evaluation of patient dentition and treatment planning
Proper medical referral and medical billing

Mentor Spotlight

Dr. Devin Croft, Orthodontist, Peoria, AZ

Dr. Bradley Eli, UCLA 2-year residency, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

Clinical Workshops

The intention of the workshop format is to exercise the new skills as learned at the general session in a controlled environment. There will be time provided in this forum for attendee case presentations and the exchange of information that will lead to an excellent educational outcome.

The Apnea and TMJ/Headache workshop will be conducted in small groups with patients in a dental office.

The PSG course will be conducted in a hotel room where a complete sleep diagnostic facility will be re-created for the purpose of demonstrating and teaching the process of collecting sleep study data.

Location for Apnea and TMJ/Headache Workshops

Vistancia Ortho

9772 W. Yearling Rd Suite A-1600

Peoria, AZ 85383

(All materials for the training will be provided onsite)

Location for the Overnight Polysomnography Workshops

Embassy Suites

4415 E. Paradise Village Pkwy South
Phoenix, AZ 85032

Calendar of Events 2011

September 23-25, 2011

Overnight PSG (Limited to 12 Dentists)

Overnight Sleep Polysomnography two-night PSG of patient for diagnosis as well as second night treatment with CPAP and Oral Appliance.
Dentist will see actual examination of patient as well as patient prepared for PSG with evaluation and live data being recorded.
Discussion of PSG results as well as a comparison of CPAP and OA treatment as recorded by the PSG.

Mentor Spotlight
Mr. Jeffory Wyscarver

Mr. Randy Clare

Dr. Edward Spiegel

October 21-22, 2011

Chairside Sleep Apnea

Medical legal aspects involved in treating the Bruxing, TMD and Sleep patient
Health care attorney will review medical insurance guidelines. Medicare guidelines including anti-fraud, anti-kickback and Stark Laws.
Informational seminars for Snoring, TMD as well as Sleep Disorders.
How to organize market and follow-up.
Working with the sleep lab. How to legally refer patients with medical insurance as well as Medicare.

Mentor Spotlight

Dr. Rodney Willey, Peoria, IL

Dr. Bradley Eli, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

November 18-19, 2011

TMD and Headache

Headache classifications relationship between Headache/TMD/Sleep
Diagnostic Process-unique for headache and unique for sleep
Recommended Communication with Physicians
Medications in Headache Management
Oral Appliance Therapy

Headache

Jaw Disorders

Sleep Disorders

Injection uses in Headache Disorders
Injection techniques for Headache
Injection technique for TMD
Review of Tx method of action PAP vs Mandibular advancement

Mentor Spotlight

Dr. Bradley Eli, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

December 16-18, 2011

Overnight PSG (Limited to 12 Dentists)

Overnight Sleep Polysomnography two-night PSG of patient for diagnosis as well as second night treatment with CPAP and Oral Appliance.
Dentist will see actual examination of patient as well as patient prepared for PSG with evaluation and live data being recorded.
Discussion of PSG results as well as a comparison of CPAP and OA treatment as recorded by the PSG.

Mentor Spotlight
Mr. Jeffory Wyscarver

Mr. Randy Clare

Dr. Edward Spiegel

Calendar of Events 2012

February 24-25, 2012

Chairside Sleep Apnea

Medical legal aspects involved in treating the Bruxing, TMD and Sleep patient
Health care attorney will review medical insurance guidelines. Medicare guidelines including anti-fraud, anti-kickback and Stark Laws.
Informational seminars for Snoring, TMD as well as Sleep Disorders.
How to organize market and follow-up.
Working with the sleep lab. How to legally refer patients with medical insurance as well as Medicare.

Mentor Spotlight

Dr. Rodney Willey, Peoria, IL

Dr. Bradley Eli, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

March 23-24, 2012

TMD and Headache

Headache classifications relationship between Headache/TMD/Sleep
Diagnostic Process-unique for headache and unique for sleep
Recommended Communication with Physicians
Medications in Headache Management
Oral Appliance Therapy

Headache

Jaw Disorders

Sleep Disorders

Injection uses in Headache Disorders
Injection techniques for Headache
Injection technique for TMD
Review of Tx method of action PAP vs Mandibular advancement

Mentor Spotlight

Dr. Bradley Eli, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

April 27-29, 2012

Overnight PSG (Limited to 12 Dentists)

Overnight Sleep Polysomnography two-night PSG of patient for diagnosis as well as second night treatment with CPAP and Oral Appliance.
Dentist will see actual examination of patient as well as patient prepared for PSG with evaluation and live data being recorded.
Discussion of PSG results as well as a comparison of CPAP and OA treatment as recorded by the PSG.

Mentor Spotlight
Mr. Jeffory Wyscarver

Mr. Randy Clare

Dr. Edward Spiegel

May 25-26, 2012

Chairside Sleep Apnea

Medical legal aspects involved in treating the Bruxing, TMD and Sleep patient
Health care attorney will review medical insurance guidelines. Medicare guidelines including anti-fraud, anti-kickback and Stark Laws.
Informational seminars for Snoring, TMD as well as Sleep Disorders.
How to organize market and follow-up.
Working with the sleep lab. How to legally refer patients with medical insurance as well as Medicare.

Mentor Spotlight

Dr. Rodney Willey, Peoria, IL

Dr. Bradley Eli, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

June 22-23, 2012

TMD and Headache

Headache classifications relationship between Headache/TMD/Sleep
Diagnostic Process-unique for headache and unique for sleep
Recommended Communication with Physicians
Medications in Headache Management
Oral Appliance Therapy

Headache

Jaw Disorders

Sleep Disorders

Injection uses in Headache Disorders
Injection techniques for Headache
Injection technique for TMD
Review of Tx method of action PAP vs Mandibular advancement

Mentor Spotlight

Dr. Bradley Eli, San Diego, CA

Dr. Edward Spiegel, Scottsdale, AZ

July 27-29, 2012

Overnight PSG (Limited to 12 Dentists)

Overnight Sleep Polysomnography two-night PSG of patient for diagnosis as well as second night treatment with CPAP and Oral Appliance.
Dentist will see actual examination of patient as well as patient prepared for PSG with evaluation and live data being recorded.
Discussion of PSG results as well as a comparison of CPAP and OA treatment as recorded by the PSG.

Mentor Spotlight
Mr. Jeffory Wyscarver

Mr. Randy Clare

Dr. Edward Spiegel

Filed Under: cpap compliance, David Gergen, Dental, dental appliances, dental labs, dental sleep medicine, dentists, Gergens Ortho Lab, glidewell dental lab, obstructive sleep apnea, osa patients, sleep apnea, sleep appliances, sleep disorder Tagged With: Articles, Blog, CPAP compliance, dental, dental appliances, dental labs, dental sleep medicine, dentists, Glidewell Dental Lab, obstructive sleep apnea, OSA Patients

A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnoea

May 8, 2011 by SleepDT Leave a Comment

Ahrens A, McGrath C, Hägg U.

Source

Discipline of Dental Public Health.

Abstract

Oral appliances (OAs) are increasingly advocated as a treatment option for obstructive sleep apnoea (OSA). However, it is unclear how their different design features influence treatment efficacy. The aim of this research was to systematically review the evidence on the efficacy of different OAs on polysomnographic indices of OSA. A MeSH and text word search were developed for Medline, Embase, Cinahl, and the Cochrane library. The initial search identified 1475 references, of which 116 related to studies comparing OAs with control appliances. Among those, 14 were randomized controlled trials (RCTs), which formed the basis of this review. The type of OA investigated in these trials was mandibular advancement devices (MADs), which were compared with either inactive appliances (six studies) or other types of MADs with different design features. Compared with inactive appliances, all MADs improved polysomnographic indices, suggesting that mandibular advancement is a crucial design feature of OA therapy for OSA. The evidence shows that there is no one MAD design that most effectively improves polysomnographic indices, but that efficacy depends on a number of factors including severity of OSA, materials and method of fabrication, type of MAD (monobloc/twin block), and the degree of protrusion (sagittal and vertical). These findings highlight the absence of a universal definition of treatment success. Future trials of MAD designs need to be assessed according to agreed success criteria in order to guide clinical practice as to which design of OAs may be the most effective in the treatment of OSA.

Eur J Orthod. 2011 Jan 13.

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Filed Under: Events, Home Sleep Testing, Home Video List, insomnia, Mynewsletter, Newsletter 0810, Newsletter1, Newsletter2, Newsletter3, Newsletter5, sleep apnea, sleep disorders, sleep labs, Vendors, Videos, Volume 2, Volume 3, Volume 4, Volume 5, Volume 6

Subjective efficacy of oral appliance design features in the management of obstructive sleep apnea: a systematic review

May 8, 2011 by SleepDT Leave a Comment

Ahrens A, McGrath C, Hägg U.

Source

Discipline of Dental Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong SAR.

Abstract

INTRODUCTION:

The purpose of this study was to review available evidence on the efficacy of various oral appliances on subjectively perceived symptoms of obstructive sleep apnea syndrome.

METHODS:

A search of 4 databases was carried out. Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The finally selected articles were methodologically evaluated.

RESULTS:

Of an initial 1475 references, 14 studies were randomized controlled trials, which formed the basis of this review. Mandibular advancement devices (MADs) were compared with either inactive appliances (6 studies) or MADs with different design features (8 studies). In comparison with inactive appliances, the majority of studies showed improved subjective outcomes with MADs, suggesting that mandibular advancement is a crucial design feature of oral appliance therapy for obstructive sleep apnea syndrome.

CONCLUSIONS:

There is no 1 MAD design that most effectively influences subjectively perceived treatment efficacy, but efficacy depends on many factors including materials and method used for fabrication, type of MAD (monoblock or Twin-block), and the degree of protrusion (sagittal and vertical). This review highlights the absence of universally agreed subjective assessment tools and health-related quality of life outcomes in the literature today. Future trials of MAD designs need to assess subjective efficacy with agreed standardized tools and health-related quality of life measures to guide clinical practicitioners about which design might be most effective in the treatment of obstructive sleep apnea syndrome with oral appliances.

Am J Orthod Dentofacial Orthop. 2010 Nov;138(5):559-76.

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Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis – a preliminary study

May 7, 2011 by SleepDT Leave a Comment

Tauman R, Many A, Deutsch V, Arvas S, Ascher-Landsberg J, Greenfeld M, Sivan Y.

Source

Pediatric Sleep Center, Dana Children’s Hospital, Tel Aviv Souraski Medical Center, Tel Aviv University, Israel.

Abstract

OBJECTIVE AND BACKGROUND:

Snoring is common among pregnant women and early reports suggest that it may bear a risk to the fetus. Increased fetal erythropoiesis manifested by elevated circulating nucleated red blood cells (nRBCs) has been found in complicated pregnancies involving fetal hypoxia. Both erythropoietin (EPO) and interleukin-6 (IL-6) mediate elevation of circulating nRBCs. The intermittent hypoxia and systemic inflammation elicited by sleep-disordered breathing (SDB) could affect fetal erythropoiesis during pregnancy. We hypothesized that maternal snoring will result in increased levels of fetal circulating nRBCs via increased concentrations of EPO, IL-6, or both.

METHODS:

Women of singleton uncomplicated full-term pregnancies were recruited during labor and completed a designated questionnaire. Umbilical cord blood was collected immediately after birth and analyzed for nRBCs, plasma EPO and plasma IL-6 concentrations. Newborn data were retrieved from medical records.

RESULTS:

One hundred and twenty-two women were recruited. Thirty-nine percent of women reported habitual snoring during pregnancy. Cord blood levels of circulating nRBCs, EPO and IL-6 were significantly elevated in habitual snorers compared with non-snorers (p=0.03, 0.005 and 0.01; respectively). No differences in maternal characteristics or newborn crude outcomes were found.

CONCLUSIONS:

Maternal snoring during pregnancy is associated with enhanced fetal erythropoiesis manifested by increased cord blood levels of nRBCs, EPO and IL-6. This provides preliminary evidence that maternal snoring is associated with subtle alterations in markers of fetal well being.

Sleep Med. 2011 May;12(5):518-22.

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Aerophagia and Gastroesophageal Reflux Disease in Patients using Continuous Positive Airway Pressure: A Preliminary Observation

April 30, 2011 by SleepDT Leave a Comment

Nathaniel F. Watson, M.D.¹ and Sue K. Mystkowski, M.D.²

¹Department of Neurology, University of Washington, Seattle, WA

²Department of Medicine, Division of Pulmonary and Critical Care, University of Washington, Seattle, WA

Address correspondence to: Nathaniel F. Watson, University of Washington Sleep Disorders Center at Harborview, Box 359803, 325 Ninth Avenue, Seattle, WA 98104-2499Phone: (206) 744-4337Fax: (206) 744-5657,; Email: nwatson@u.washington.edu

Received February 2008; Accepted May 2008.

Abstract

Study Objectives:

Aerophagia is a complication of continuous positive airway pressure (CPAP) therapy for sleep disordered breathing (SDB), whereupon air is forced into the stomach and bowel. Associated discomfort can result in CPAP discontinuation. We hypothesize that aerophagia is associated with gastroesophageal reflux disease (GERD) via mechanisms involving GERD related lower esophageal sphincter (LES) compromise.

Methods:

Twenty-two subjects with aerophagia and 22 controls, matched for age, gender, and body mass index, who were being treated with CPAP for SDB were compared in regard to clinical aspects of GERD, GERD associated habits, SDB severity as measured by polysomnography, and mean CPAP pressure.

Results:

More subjects with aerophagia had symptoms of GERD (77.3% vs. 36.4%; p < 0.01) and were on GERD related medications (45.5% vs. 18.2%, p < 0.05) than controls. Regarding polysomnography, mean oxygen saturation percentages were lower in the aerophagia group than controls (95.0% vs. 96.5%, p < 0.05). No other differences were observed, including mean CPAP pressures. No one in the aerophagia group (vs. 27.3% of the control group) was a current tobacco user (p < 0.01). There was no difference in caffeine or alcohol use between the 2 groups.

Conclusions:

These results imply aerophagia is associated with GERD symptoms and GERD related medication use. This finding suggests a relationship between GERD related LES pathophysiology and the development of aerophagia in patients with SDB treated with CPAP.

Citation:

J Clin Sleep Med 2008;4(5):434–438.

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Filed Under: CPAP, Events, Home Sleep Testing, Home Video List, insomnia, Mynewsletter, Newsletter 0810, Newsletter1, Newsletter2, Newsletter3, Newsletter5, polysomnography, sleep apnea, sleep disorders, sleep labs, sleep therapy, Vendors, Videos, Volume 2, Volume 3, Volume 4, Volume 5, Volume 6 Tagged With: polysomnography

Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea

April 29, 2011 by SleepDT Leave a Comment

Shigeta Y, Ogawa T, Ando E, Clark GT, Enciso R.

Source

Department of Fixed Prosthodontics, School of Dental Medicine, Tsurumi University, Yokohama, Japan

Abstract

OBJECTIVES:

The objective of this study was to investigate the influence on the upper airway of the size ratio of tongue and mandible (T/M ratio) with 3D reconstructed models from computed tomography (CT) data.

STUDY DESIGN:

The subjects were 40 OSA male patients. The age of the patients ranged from 25 to 77 years, with an average age of 52.6 ± 12.5 years. The body mass index (BMI) of the patients ranged from 20.1 to 35.8 kg/m(2), with an average BMI of 25.4 ± 3.4 kg/m(2). All patients underwent a full-night polysomnography. The mean AHI for our subjects was 23.6 ± 18.3 events per hour. CT imaging examinations were carried out in each patient. The mandible and airway volume (between posterior nasal spine [PNS] and the tip of the epiglottis) were segmented based on Hounsfield units, automatically or semi-automatically, and their volume was calculated from the number of voxels. The tongue was carefully outlined, and the inside of the tongue was smeared on each of the axial, frontal, and sagittal planes with a semi-automatic segmentation tool. The tongue/mandible (T/M) ratio was calculated from the volume of the mandible and the tongue. In addition, we investigated simple correlations between our anatomical variables and BMI, age, and AHI.

RESULTS:

In this study, the mean tongue and mandible volume were 79.00 ± 1.06 cm(3) and 87.80 ± 1.21 cm(3), respectively. As BMI increases, tongue volume increases (P = .004) and airway volume decreases (P = .021). However, no significant correlation was found between severity of OSA (AHI) and other variables. On the other hand, there was a negative correlation between airway volume and T/M ratio (P = .046).

CONCLUSION:

As tongue volume increases with BMI, the posterior airway is affected, and thus is likely to be involved in the development of OSA; however, in this study there was no correlation between the severity of sleep apnea (AHI) and other variables in the study.

Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2011 Feb;111(2):239-43.

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Filed Under: Dental, dental appliances, Events, Home Sleep Testing, insomnia, polysomnography, sleep apnea, sleep disorders, sleep labs Tagged With: pharyngometry, polysomnography

Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure

April 25, 2011 by Randy Clare Leave a Comment

Bitter T, Westerheide N, Prinz C, Hossain MS, Vogt J, Langer C, Horstkotte D, Oldenburg O.

Source

Department of Cardiology, Heart and Diabetes Centre North Rhine-Westphalia, Ruhr University Bochum, Georgstasse 11, Bad Oeynhausen, Germany. tbitter@hdz-nrw.de

Abstract

AIMS:

The aim of this first large-scale long-term study was to investigate whether obstructive sleep apnoea (OSA) and/or central sleep apnoea (CSA) are associated with an increased risk of malignant cardiac arrhythmias in patients with congestive heart failure (CHF).

METHODS AND RESULTS:

Of 472 CHF patients who were screened for sleep disordered breathing (SDB) 6 months after implantation of a cardiac resynchronization device with cardioverter-defibrillator, 283 remained untreated [170 with mild or no sleep disordered breathing (mnSDB) and 113 patients declined ventilation therapy] and were included into this study. During follow-up (48 months), data on appropriately monitored ventricular arrhythmias as well as appropriate cardioverter-defibrillator therapies were obtained from 255 of these patients (90.1%). Time period to first monitored ventricular arrhythmias and to first appropriate cardioverter-defibrillator therapy were significantly shorter in patients with either CSA or OSA. Forward stepwise Cox models revealed an independent correlation for CSA and OSA regarding monitored ventricular arrhythmias [apnoea-hypopnoea index (AHI) ≥5 h(-1): CSA HR 2.15, 95% CI 1.40-3.30, P < 0.001; OSA HR 1.69, 95% CI 1.64-1.75, P = 0.001; AHI ≥15 h(-1): CSA HR 2.06, 95% CI 1.40-3.05, P < 0.001; OSA HR 1.69, 95% CI 1.14-2.51, P = 0.02] and appropriate cardioverter-defibrillator therapies (AHI ≥5 h(-1): CSA HR 3.24, 95% CI 1.86-5.64, P < 0.001; OSA HR 2.07, 95% CI 1.14-3.77, P = 0.02; AHI ≥15 h(-1): CSA HR 3.41, 95% CI 2.10-5.54, P < 0.001; OSA HR 2.10, 95% CI 1.17-3.78, P = 0.01).

CONCLUSION:

In patients with CHF, CSA and OSA are independently associated with an increased risk for ventricular arrhythmias and appropriate cardioverter-defibrillator therapies.

Eur Heart J. 2011 Jan;32(1):61-74. Epub 2010 Sep 16.

Filed Under: congestive heart failure, electrocardiography, obstructive sleep apnea, sleep apnea, Uncategorized

Comparative Effects of Two Oral Appliances on Upper Airway Structure in Obstructive Sleep Apnea

April 13, 2011 by SleepDT 2 Comments

“Good article just published in the latest edition of Sleep. It compares a MAS device with a TSD – the results are interesting where both appliances worked, at least in the responders, but the imaging showed some differences. This data reinforces the need for tongue position and management with OAT like The Moses appliance does”

Ashley

Kate Sutherland, PhD¹^,²; Sheryn A. Deane, MDSc³; Andrew S.L. Chan, MD, PhD¹^,²^,⁴; Richard J. Schwab, MD⁵; Andrew T. Ng, MD, PhD⁴; M. Ali Darendeliler, PhD³; Peter A. Cistulli, MD, PhD¹^,²^,⁴

¹Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, NSW, Australia; ²Woolcock Institute of Medical Research, University of Sydney, NSW, Australia; ³Department of Orthodontics, Faculty of Dentistry, University of Sydney, Sydney Dental Hospital, NSW, Australia; ⁴Department of Respiratory and Sleep Medicine, St George Hospital, University of New South Wales, NSW, Australia; ⁵University of Pennsylvania, Philadelphia, PA

Oral appliances are increasingly being used for treatment of obstructive sleep apnea (OSA). Mandibular advancement splint (MAS) mechanically protrudes the mandible, while the tongue stabilizing device (TSD) protrudes and holds the tongue using suction. Although both appliances can significantly improve or ameliorate OSA, their comparative effects on upper airway structure have not been investigated.

Design:

Cohort study.

Setting:

Sleep Investigation Unit.

Patients:

39 patients undergoing oral appliance treatment for OSA.

Interventions:

OSA patients underwent magnetic resonance imaging (MRI) of the upper airway during wakefulness at baseline and with MAS and TSD in randomized order. Treatment efficacy was determined by polysomnography in a subset of 18 patients.

Measurements and Results:

Upper airway lumen and surrounding soft tissue structures were segmented using image analysis software. Upper airway dimensions and soft tissue centroid movements were determined. Both appliances altered upper airway geometry, associated with movement of the parapharyngeal fat pads away from the airway. TSD increased velopharyngeal lateral diameter to a greater extent (+0.35 ± 0.07 vs. +0.18 ± 0.05 cm; P < 0.001) and also increased antero-posterior diameter with anterior displacement of the tongue (0.68 ± 0.04 cm; P < 0.001) and soft palate (0.12 ± 0.03 cm; P < 0.001). MAS resulted in significant anterior displacement of the tongue base muscles (0.35 ± 0.04 cm). TSD responders (AHI reduction ≥ 50%) increased velopharyngeal volume more than non-responders (+2.65 ± 0.9 vs. –0.44 ± 0.8 cm³; P < 0.05). Airway structures did not differ between MAS responders and non-responders.

Conclusions:

These results indicate that the patterns and magnitude of changes in upper airway structure differ between appliances. Further studies are warranted to evaluate the clinical relevance of these changes, and whether they can be used to predict treatment outcome.

SLEEP2011;34(4):469-477.

Full text with images: http://www.journalsleep.org/ViewAbstract.aspx?pid=28089

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Filed Under: Events, Home Sleep Testing, Home Video List, insomnia, Mynewsletter, Newsletter 0810, Newsletter1, Newsletter2, Newsletter3, Newsletter5, polysomnography, sleep apnea, sleep disorders, sleep labs, Vendors, Videos, Volume 2, Volume 3, Volume 4, Volume 5, Volume 6 Tagged With: sleep appliances

	Randy Clare Managing Editor of SleepScholar and RespiratoryScholar
	Dr. Steve Carstensen Pankey Institute for Advanced Dental Education, American Academy of Dental Sleep Medicine.
	Ruchir Patel MD Founder & Medical Director at the Insomnia and Sleep Institute of Arizona.
	Dr. John S. Viviano AADSM Diplomate and member of various sleep organizations. Has lectured internationally on the treatment of Sleep-Disordered Breathing and the use of Acoustic Reflection.
	Jeffroy Wyscarver President, DDME Online, Sleep Lab Technology and Services for the Dental Community.
	Claude Albertario RPSGT, speaker, author and mentor in the field of sleep diagnostics with 25 yrs of management experience in one of New York's premier sleep centers.
	Joseph Anderson Co-Founder and Director of Education for Priority Health Education and Priority Scoring.
	Todd Austin Managed sleep labs and has 15 experience in sleep diagnostics and therapeutic systems. .
	Marietta Bibbs Sleep specialist and manager of Sleep and Neurodiagnostics at Morton Plant Mease Healthcare.
	Bradley Eli DMD, MS Director, San Diego Headache and Facial Pain Center / Sleep Treatment and Research Institute
	Edward Grandi Executive Director of the American Sleep Apnea Association.
	Edward Michaelson MD Board Certified in Pulmonary Medicine, Internal Medicine and Sleep Medicine
	Ashley Truitt Founder & Director of Dental Sleep Medicine Worldwide, Co-Founder of TPT Dental.

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Influence of tongue/mandible volume ratio on oropharyngeal airway in Japanese male patients with obstructive sleep apnea

Source

Abstract

OBJECTIVES:

STUDY DESIGN:

RESULTS:

CONCLUSION:

Cheyne-Stokes respiration and obstructive sleep apnoea are independent risk factors for malignant ventricular arrhythmias requiring appropriate cardioverter-defibrillator therapies in patients with congestive heart failure

Source

Abstract

AIMS:

METHODS AND RESULTS:

CONCLUSION:

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