Arch Measurement Changes upon Biomimetic Oral Appliance Therapy for Adults with Obstructive Sleep Apnea

Abstract

Background: Obstructive Sleep Apnea (OSA) is the most common form of sleep disordered breathing. Patients who arrive at the dental office with a diagnosis of OSA are often treated with a mandibular advancement device (MAD). A biomimetic oral appliance therapy (BOAT) offers an alternative nonsurgical method, which can putatively resolve OSA by combining maxilla-mandibular correction and addressing craniofacial deficiencies. Aim: To determine whether maxilla-mandibular correction changes induced by BOAT produce a more favorable upper airway, which might result in a reduction in the severity of OSA. Methods: Patients who were diagnosed with mild to moderate obstructive sleep apnea (OSA, 9 males, 8 females; age, mean (SD): 45.76(10.31), BMI mean (SD): 33.5(13.43), underwent BOAT therapy. Subjects had 2 months of follow-up visits, including examinations for progress and adjustment of the appliances. The mean apnea-hypopnea index (AHI) with no appliance in the mouth prior to BOAT and after treatment was recorded. The mid-palatal screw mechanism of the appliance was advanced once per week. The subjects were asked to wear the appliance for 10-12 hours/day and night. Paired T-Test was used to analyze the results. Results: The BOAT treatment enhanced upper airway function as the total AHI was significantly lower after treatment (P=0.019). Parameters that were significantly improved by the end of the treatment period included total AHI/Per hour of sleep (p=0.019), NREM-AHI (p=0.019), desaturation index (p=0.041), average SpO2 (p=0.088), and average O2 while in non-REM (p=0.043). Measurements of jaw changes were all statistically significant except lower 6-6 and lower 7-7. Additionally, a strong negative correlation between AHI and jaw changes was shown for upper 6-6 (p=-0.52), upper 7-7 (p=-0.48), and lower 3-3 (p=-0.42). Conclusion: The BOAT provides a useful form of therapy for the resolve of OSA. This study suggests that BOATS may be able to reduce the AHI to within normal limits. Still, long-term follow-up is needed to determine whether these subjects need a maintenance program to retain their initial upper airway improvement.