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Obstructive sleep apnea affects around 20 million Americans and can lead to hypertension, heart attack, stroke, depression, muscle pain, fibromyalgia, morning headaches, and excessive daytime sleepiness.

Thursday, June 9, 2016

Bite Changes From Somnodent Appliance. Experience with TMJ disorders is important in Sleep Apnea Treatment

The following post was originally from wwwThinkBetterLife.com and was an answer to a patients concern.  Bite changes can and do occur but rarely cause long-term problems.  Dentists treating Sleep Apnea with oral appliances should understand treatment of TMJ disorders (temporomandibular disorders or TMD)

Julie's Question:
I have obstructive sleep apnea and I wear a Somnomed appliance at night. As a result, my bottom teeth and top teeth are meeting on top of each other and the bottom teeth are off to the side. I would to be able to straighten my bite and wear the sleep appliance at night. Is this possible? Please let me know if you have additional questions. I have consulted a prosthodontist who told me he needs to confer with my dentist and sleep appliance doctor. But they are busy and I want to know if my situation is something I must accept.

Dr Shapira's Response:
Dear Julie

There are many ways to "make you whole" and possibly offer long term cure to sleep apnea. A side effect of wearing a Somnomed Appliance or other sleep appliance is bite changes. These are usually mild but can be more severe. These are discussed at the start of treatment. The bite changes can be favorable or unfavorable. The are he result of the jaw heling to a position with a better airway.

I have been utilizing sleep appliances since 1982 and bite changes are common. Ideally aggressive morning exercise prevents most changes but after they occur they are hard to reverse. I have followed some patients for approximately 30 years and many never have issues.

Sometimes the bite changes can be reversed if you use CPAP instead of an oral appliance to treat your sleep apnea. The changes actually are healing of the retrodiscal ligaments and muscles. They improve your daytime and night-time breathing, posture and actually make your face look younger and healthier but when everything is healed your bite looks wrong.

I teach all my patients how to prevent changes before giving them an appliance. I often have patients who want permanent orthopedic change and this is accomplished with a plan rather than as an accident.

The changes you see in essence explain why you originally had seep apnea. It is possible to orthodontically or prosthetically correct the bite but my preferred method is the RNA version of the DNA Appliance that orthopedically grows your maxilla to a proper size. Additional work may be required to finish case after the DNA Appliance.

I frequently see long distance patients with difficult problems and the DNA Appliance lends itself to long distance treatment.

The beauty of the DNA Appliance is that it has been shown in clinical studies to cure sleep apnea in some patients. Long term prospective studies are underway.

The first video is a physician who is using DNA Appliance to grow larger airway.
https://www.youtube.com/watch?v=iGjYCuYARuA

 This patient is a young girl whose DNA Appliance is growing a larger airway after orthodontics constricted her airway
https://www.youtube.com/watch?v=j9Y7EPf9tiM

This is a month by month explanation of a long term patient utilizing DNA Appliance.
http://sleepandhealth.websiteexpert.ca/category/blog-keywords/highland-park-epigenetic-orthodontics/

It is also possible to do a full mouth reconstruction to a neuromuscular position.

Julie's response:
I currently wear the Summoned sleep appliance which I believe the only appliance my doctor makes. I would like to continue to wear this appliance because it helps my OSA without tearing up the inside of my mouth. I would like to correct my bite as my jaw pops and it is difficult to chew. Is my situation futile or can I do the bite correction and keep my current appliance?

Dr Shapira's response:
Dear Julie,
I see many patients who we treat for both TMJ and bite issues who also wear sleep appliances. I will usually make a daytime orthotic to treat the jaw issues that is worn when the sleep appliance is out.

Treatment is usually divided into phases, the first phase is a diagnostic that can be adjusted over time during initial treatment. A second phase of long term stabilization is then done. This can be done with long term removable orthotic that would allow you to use your current Somnomed appliance.

There are other options for long time stabilization but they would require replacement of Somnomed appliance.


Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMO
Chair, Alliance of TMD Organizations
Diplomat, American Academy of Pain Management
Diplomat, American Board of Dental Sleep Medicine
Regent & Fellow, International College of CranioMandibular Orthopedics
Board Eligible, American Academy of CranioFacial Pain
Dental Section Editor, Sleep & Health Journal
Member, American Equilibration Society
Member, Academy of Applied Myofunctional Sciences
www.ThinkBetterLife.com
www.DelanyDentalCare.com
www.IHateCPAP.com
www.iHateHeadaches.org

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posted by Dr Shapira at 7:19 AM

Wednesday, April 13, 2016

WALL STREET NEWS.... Sleep Apnea Treatment: CPAP and Oral Appliances are Equivalent

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Sleep Apnea Treatment: CPAP and Oral Appliances are Equivalent According to Outcome Studies. Patients Prefer Comfortable Oral Appliance to CPAP Chicago Dentist Leader in Oral Appliance Therapy
Oral Appliances are preferred over by 95% of patients with Sleep Apnea yet CPAP is usually prescribed even in mild and moderate sleep apnea when outcomes are equal. Patient Testimonials say it all! Do CPAP Companies Pay Kickbacks to promote CPAP?

CHICAGO, IL, April 09, 2016 /24-7PressRelease/ -- Treatment of sleep apnea is essential. CPAP was once considered the Gold Standard of Care but today Oral Appliances are considered a First Line Approach equal to CPAP for mild to moderate Sleep Apnea and an alternative for severe apnea when the patient does not tolerate or prefers oral appliance therapy. 

Patients generally don't like CPAP, in fact only 25% use CPAP as recommended but 60% abandon it completely. The number one reason patients give why they discontinue CPAP use "I Hate CPAP!"

Millions of patients have visited www.IHateCPAP.com looking for comfortable alternatives to CPAP. Marketing of this site at AASM and AADSM meetings was banned even though it was acknowledged it would save lives of non-compliant CPAP patients. 

Dr Ira Shapira is a Chicago area dentist who has been treating sleep apnea with oral appliances since 1982. The American Academy of Dental Sleep Medicine is celebrating it's 25th Anniversary in June in Denver. Dr Shapira was one of 20 dentists worldwide who started the Sleep Disorder Dental Society 25 years ago that became today's American Academy of Sleep Medicine. Dr Shapira created the I Hate CPAP website that brought oral appliances into the mainstream and was featured on numerous Television and Radio news stations as well as publications like Bottomline.

The Science of Sleep Medicine has given it's verdict: Oral Appliances are safe and effective for mild, moderate and severe sleep apnea.

Outcome studies for cardiac, blood pressure and cognitive measures are equal and sometimes oral appliances rate higher than CPAP.

A new article in JAMA states that outcome studies of CPAP and Oral Appliances are similar. Another article in Sleep and Breathing Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime. This article concluded that "that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure." 

Oral Appliances continually prove to be equal to CPAP in OUTCOME STUDIES. This is in spite of the fact that the majority of research money funds studies to show value of CPAP and that CPAP companies expect a return on their investment.

The conclusions of this study are enormous, Among patients with obstructive sleep apnea, both CPAP and MADs (mandibular advancement devices) were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.

Another article in Respirology, "Cardiovascular mortality in obstructive sleep apnoea treated with continuous positive airway pressure or oral appliance: an observational study" concluded "Both CPAP and MAD may be equally effective therapy in reducing the risk of fatal cardiovascular events in patients with severe OSA."

The Sleep and Breathing article also stated that "CPAP is more effective than MAD in eliminating respiratory events." While this is true other studies have shown that the frequency and length of use of oral appliances actually makes total effectiveness higher. Most CPAP users only utilize CPAP 30-40% of the time. 

A 2-year mean follow-up of oral appliance therapy for severe obstructive sleep apnea: a cohort study. (Oral Dis. 2015 Apr;21(3):386-92.) concluded that "Oral appliances were found to be successful for treating for severe OSA after first-line treatment had failed."

The DNA Appliance (an oral appliance) has been shown to orthopedically grow the airway in a process called Pneumopedics and has been shown in clinical cases to "Cure" Sleep Apnea. Long term prospective studies are beginning.

CPAP continues to be prescribed far more than oral appliances. Much of this is due to doctors who are ignorant of newest studies or who like CPAP and ignore the research. There is also a problem with billions of dollars in Revenue allowing CPAP companies to push their product, often using unethical practices.

A recent lawsuit found " Philips Respironics has agreed to pay $34.8 million to resolve alleged False Claims Act violations for paying kickbacks to DME providers that bought its CPAP masks, the Department of Justice has announced."

There are many in the field of sleep medicine who feel this is only the tip of the iceberg and that illegal or unethical marketing may be widespread.

"The payment of illegal remuneration in any form to induce patient referrals threatens public confidence in the healthcare system," said Principal Deputy Assistant Attorney General Benjamin Mizer, head of the Justice Departments' Civil Division. "Americans deserve to know that when they are prescribed a device to treat a serious healthcare problem, they supplier's judgment has not been compromised by illegal payments from equipment manufacturers." 

The Anti-Kickback Statute prohibits the knowing and willful payment of any remuneration to induce the referral of services or items that are paid for by a federal healthcare program, such as Medicare, Medicaid or Tricare. Claims submitted to these programs in violation of the Anti-Kickback Statute are also false claims under the False Claims Act.

Respironics will pay roughly $34.14 million to the federal government and roughly $660,00 to various state governments based on their participation in the Medicare program.

The field of Dental Sleep Medicine grew based on patient referrals and testimonials not by illegal kickbacks. In the following youtube testimonials patients clearly explain why they prefer oral appliances to other treatments.

Think Better Life - Dr. Ira Shapira
35 YEARS OF SLEEP APNEA TREATMENT. VIEW THIS VIDEO OF A PATIENT WEARING AN ORAL APPLIANCE FOR 9 YEARS.
https://www.youtube.com/watch?v=1WsNhOE0wvw

ANOTHER PATIENT WITH 9 YEARS EXPERIENCE
https://www.youtube.com/watch?v=Cub9IROYoYY

A FEMALE PATIENT USING ORAL APPLIANCE
https://www.youtube.com/watch?v=0BxuX9Yso1I

USED TO FALL ASLEEP DRIVING
https://www.youtube.com/watch?v=d4R4xYs_tAE

ORAL APPLIANCE FOR INTERNATIONAL TRAVEL
https://www.youtube.com/watch?v=6VNsb6n8mXw

PHYSICIAN REVIEWS SLEEP APNEA APPLIANCE.
https://www.youtube.com/watch?v=aMp64bXi9bI

RESPIRATORY THERAPIST REVIEWS APPLIANCE
https://www.youtube.com/watch?v=f9w9L1miIN4

Dentist helps with sleep apnea, snoring, and fibromyalgia
https://www.youtube.com/watch?v=kMEhJemCwm8

ADNA Appliance Testimonial...Life Changing results!!!
https://www.youtube.com/watch?v=j9Y7EPf9tiM

ADDITIONAL VIDEOS ON SLEEP, TMJ TREATMENT, MIGRAINE TREATMENT , CHRONIC DAILY HEADACHES AND MORE
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos

Learn More at www.IHateCPAP.com

In Highland Park and surrounding suburbs Visit:
www.ThinkBetterLife.com

In Gurnee and Far North Suburbs:
www.DelanyDentalCare.com

North Shore visit:
www.NorthShoreSleepDentist.com

#sleepapneadentist, #snoringcure, #Oralappliance, #oralappliancetherapy, #sleeptreatment, #snoringtreatment, #apneatreatment, #sleeptestimonial, #snoringtestimonial, #guneesnoring, #gurneesleepapnea, #Dentalsleepmedicine, #academyofdentalsleepmedicine

Dr Ira L Shapira created the I HATE CPAP (www.ihatecpap.com) and I HATE HEADACHE (www.ihateheadaches.org) websites to help patients find help with these difficult medical disorders that medicine can frequently not treat adequately without a dental collaboration. Dr Shapira did research in the 1980's as a visiting assistant professor at Rush Medical School where he worked with Rosalind Cartwright PhD who is primarily responsible for the entire field of Dental Sleep Medicine. He also studied with Dr Barney Jankelson who created the initial concepts that neuromuscular dentistry still uses today and created a company Myotronics that is the leading manufacturer of instrumentation used by Neuromuscular Dentistry.

Dr Shapira is a Diplomate of The American Board of Dental Sleep Medicine, a Diplomate of the American Academy of Pain Management, and a Fellow of the International College of CranioMandibular Orthopedics (ICCMO). He is a former national and International Regent of ICCMO, its current Secretary and the representative to the Alliance of TMD organizations or the TMD ALLIANCE has a general dental practice (http://www.delanydentalcare.com) in Gurnee, Il and has recently started Chicagoland Dental Sleep Medicine Associates with offices in Vernon Hills and Highland Park. Patients in Northern Illinois or southern Wisconsin can contact Dr Shapira thru his office websites or thru http://www.ihateheadaches.org or http://www.chicagoland.ihatecpap.comwww.ThinkBetterLife.com, NorthShoreSleepDentist.com SleepandHealth.com

Dr Ira L Shapira is President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice, Delany Dental Care with his partner Dr Mark Amidei. He has recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative and the current Chair of the American Alliance of TMD Organizatins (www.TMDAlliance.com), He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School's Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of the fields of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and http://www.ihatecpap.com

Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. He is currently working with Dr Tom Diekwisch at the Baylor in Texas to prove these stem cells can change peoples lives for the better. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.

Dr Shapira is currently working on patents he hope will drastically improve the field of pain management.

---

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posted by Dr Shapira at 3:15 PM

Thursday, April 7, 2016

North Shore Sleep Apnea Treatment: Oral Appliances are The Comfortable CPAP Alternative!

Chicago Sleep Apnea Treatment:  Patient Testimonials Praise Oral Appliance Therapy


Sleep Apnea is Dangerous with a host of serious medical problems associated .

Live a longer healthier life by treating your sleep disordered breathing.

Sleep Apnea treatment is life changing when it is successful.  only one in four patients wear CPAP as recommended and 60% abandon it completely.  The Most common complaint is I Hate CPAP due to: Mask. Hose Noise, Claustrophobia, Bronchitis, Acne, Dry eyes and the list is almost endless.

95% OF PATIENTS PREFER ORAL APPLIANCES OVER CPAP IF OFFERED A CHOICE! 

It has been reported that Colin Sullivan the Australian who invented CPAP utilizes an oral appliance for himself.  50-70 million Americans don't get enough sleep according to Dr Oz

According to May Clinic spouses of snorers lose 50% of their Sleep.

ResMed a major make of CPAP and CPAP masks was recently fin

Treatment of sleep apnea is essential. CPAP was once considered the Gold Standard of Care but today Oral Appliances are considered a First Line Approach equal to CPAP for mild to moderate Sleep Apnea and an alternative for severe apnea when the patient does not tolerate or prefers oral appliance therapy.
Outcome studies for cardiac, blood pressure and cognitive measures are equal and sometimes oral appliances rate higher than CPAP.
Think Better Life - Dr. Ira Shapira PIONEER OF DENTAL SLEEP MEDICINE!
35 YEARS PROVIDING  SLEEP APNEA TREATMENT.
This video describes how patient was lining in a fog prior to treatment.  

https://www.youtube.com/watch?v=lxRtjXJMJ1k


 VIEW THIS VIDEO OF A PATIENT WEARING AN ORAL APPLIANCE FOR 9 YEARS.
https://www.youtube.com/watch?v=1WsNhOE0wvw
ANOTHER PATIENT WITH 9 YEARS EXPERIENCE
https://www.youtube.com/watch?v=Cub9IROYoYY
A FEMALE PATIENT USING ORAL APPLIANCE
https://www.youtube.com/watch?v=0BxuX9Yso1I
Oral appliance more convenient the CPAP for travel....Amazing Results!
https://www.youtube.com/watch?v=xYjNUxwwIOY
ORAL APPLIANCE FOR INTERNATIONAL TRAVEL
https://www.youtube.com/watch?v=6VNsb6n8mXw
PHYSICIAN REVIEWS SLEEP APNEA APPLIANCE.
https://www.youtube.com/watch?v=aMp64bXi9bI
RESPIRATORY THERAPIST REVIEWS APPLIANCE
https://www.youtube.com/watch?v=f9w9L1miIN4
Dentist helps with sleep apnea, snoring, and fibromyalgia
https://www.youtube.com/watch?v=kMEhJemCwm8
ADDITIONAL VIDEOS ON SLEEP, TMJ TREATMENT, MIGRAINE TREATMENT , CHRONIC DAILY HEADACHES AND MORE
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos
Learn More at www.IHateCPAP.com

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posted by Dr Shapira at 8:54 AM

Wednesday, March 23, 2016

Sleep Problems and Chronic Migraines. New Study At Rush Medical School Looking For Participants

I received this message from a researcher at Rush,where I did research at Rush Sleep Center under Dr Cartwright as a Visiting Assistant Professor starting in 1985-1991 on jaw position and sleep apnea and found that Female TMJ (migraine/headache) patients had similar neuromuscular bite relations as male sleep apnea patients.

"Dr Shapira,

 My name is Megan Crawford and I am a researcher at the sleep center at Rush University Medical Center. It is with great enthusiasm that I read about your practice, and how you emphasize the importance of good sleep. We here in the Rush Sleep Center have become interested in understanding the relationship between sleep and migraine, and whether treating sleep problems would be beneficial for migraineurs with insomnia. I am a principal investigator of a clinical trial testing an online sleep intervention for women with chronic migraines. The online sleep intervention is called SLEEPIO (https://www.youtube.com/watch?v=zv-nn0KTwnw) and has been shown to be effective for individuals with insomnia in a clinical trial (http://www.ncbi.nlm.nih.gov/pubmed/22654196). We are looking for females over 18 who have sleep problems and chronic migraines.
Recruitment can sometimes be challenging, and so I am trying to reach out to local headache/pain clinics that might be interested in spreading the word about this study. It is helpful to have someone that individuals know and trust advertise for the research you are doing on their social media websites (blogs, facebook, twitter etc.), or in monthly pamphlets.
If you would like to speak to me on the phone/via email for more information about the study, please do not hesitate to contact me. I would be very happy to send a few fliers to distribute in your office. I look forward to hearing from you.
Kind regards,
Megan"

e-mail for Megan Crawford is megan_crawford@rush.edu 

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posted by Dr Shapira at 2:44 PM

Sunday, March 20, 2016

Chicago Sleep Apnea Treatment: Oral Appliances, A Better Alternative. Patient Testimonials Tell All!!!

Sleep Apnea treatment is life changing when it is successful.  only one in four patients wear CPAP as recommended and 60% abandon it completely.  The Most common complaint is I Hate CPAP due to: Mask. Hose Noise, Claustrophobia, Bronchitis, Acne, Dry eyes and the list is almost endless.

95% OF PATIENTS PREFER ORAL APPLIANCES OVER CPAP IF OFFERED A CHOICE!

Treatment of sleep apnea is essential. CPAP was once considered the Gold Standard of Care but today Oral Appliances are considered a First Line Approach equal to CPAP for mild to moderate Sleep Apnea and an alternative for severe apnea when the patient does not tolerate or prefers oral appliance therapy.
Outcome studies for cardiac, blood pressure and cognitive measures are equal and sometimes oral appliances rate higher than CPAP.
Think Better Life - Dr. Ira Shapira PIONEER OF DENTAL SLEEP MEDICINE!
35 YEARS PROVIDING  SLEEP APNEA TREATMENT. VIEW THIS VIDEO OF A PATIENT WEARING AN ORAL APPLIANCE FOR 9 YEARS.
https://www.youtube.com/watch?v=1WsNhOE0wvw
ANOTHER PATIENT WITH 9 YEARS EXPERIENCE
https://www.youtube.com/watch?v=Cub9IROYoYY
A FEMALE PATIENT USING ORAL APPLIANCE
https://www.youtube.com/watch?v=0BxuX9Yso1I
USED TO FALL ASLEEP DRIVING
https://www.youtube.com/watch?v=d4R4xYs_tAE
ORAL APPLIANCE FOR INTERNATIONAL TRAVEL
https://www.youtube.com/watch?v=6VNsb6n8mXw
PHYSICIAN REVIEWS SLEEP APNEA APPLIANCE.
https://www.youtube.com/watch?v=aMp64bXi9bI
RESPIRATORY THERAPIST REVIEWS APPLIANCE
https://www.youtube.com/watch?v=f9w9L1miIN4
Dentist helps with sleep apnea, snoring, and fibromyalgia
https://www.youtube.com/watch?v=kMEhJemCwm8
ADDITIONAL VIDEOS ON SLEEP, TMJ TREATMENT, MIGRAINE TREATMENT , CHRONIC DAILY HEADACHES AND MORE
https://www.youtube.com/channel/UCk9Bfz6pklC7_UluWFHzLrg/videos
Learn More at www.IHateCpaP.com

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posted by Dr Shapira at 12:30 PM

Tuesday, March 15, 2016

Oral Appliance Therapy in Sleep Apnea Patients Improve Cognitive and Psychomotor Performance

This new study in the Journal of Clinical Sleep Medicine shows improvement in cognitive function in patients with sleep apnea.

Other recent outcome studies have shown improvement in Blood Pressure and Cardiac Function.

Review these abstracts and you will understand why more and more sleep physicians consider oral appliances to be a first line treatment for moderate obstructive sleep apnea and an alternative for severe sleep apnea.

Find oral Appliance Therapy in Chicago:

www.IHateCPAP.com   find a dentist section

www.ThinkBetterLife.com

www.DelanyDentalCare.com

www.NorthShoreSleepDentist


 2015 Feb 15;12(2):177-86. doi: 10.5664/jcsm.5480.

Improvement of Cognitive and Psychomotor Performance in Patients with Mild to Moderate Obstructive Sleep Apnea Treated with Mandibular Advancement Device: A Prospective 1-Year Study.

Abstract

STUDY OBJECTIVES:

This study aimed to provide the evidence on effect of mandibular advancement device (MADtherapy on long-term cognitive and psychomotor performance, excessive daytime sleepiness, and quality of life in patients with mild to moderate obstructive sleep apnea (OSA).

METHODS:

A total of 15 patients with mild to moderate OSA were treated with MAD therapy and they were followed up after 3 mo and 1 y oftherapy. The patients were tested on three different tests of cognitive and psychomotor performance using the computer-based system Complex Reactionmeter Drenovac (CRD-series) at baseline and at the time of follow-up, and the 36-Item Short Form Health Survey (SF-36) questionnaire and Epworth Sleepiness Scale were used to assess their quality of life and excessive daytime sleepiness, respectively.

RESULTS:

The mean apnea-hypopnea index (AHI) decreased significantly from 22.9 ± 5.9 events/h at baseline, to 9.7 ± 4.5 events/h after 1 y ofMAD therapy (p < 0.001). There was significant improvement on all three CRD-series tests used after 1 y of MAD therapy, considering total test solving time (TTST) and minimal single task solving time (MinT), whereas total number of errors committed during the tests (TE) remained unchanged. Self-reported measures, excessive daytime sleepiness, and three domains of quality of life, social functioning, general health perception, and health change following MAD therapy showed significant improvements after 1 y of MAD therapy.

CONCLUSIONS:

This study demonstrates significant improvements in cognitive and psychomotor performance, particularly in the domain of perceptive abilities, convergent thinking (constructing and solving simple mathematical tasks) and psychomotor reaction times, excessive daytime sleepiness, and quality of life in patients with mild to moderate OSA following MAD therapy.


 2015 Dec 1;314(21):2280-93. doi: 10.1001/jama.2015.16303.

CPAP vs Mandibular Advancement Devices and Blood Pressure in Patients With Obstructive Sleep Apnea: A Systematic Review and Meta-analysis.

Abstract

IMPORTANCE:

Obstructive sleep apnea is associated with higher levels of blood pressure (BP), which can lead to increased cardiovascular risk.

OBJECTIVE:

To compare the association of continuous positive airway pressure (CPAP), mandibular advancement devices (MADs), and inactive control groups (placebo or no treatment) with changes in systolic BP (SBP) and diastolic BP (DBP) in patients with obstructive sleep apnea.

DATA SOURCES:

The databases of MEDLINE, EMBASE, and the Cochrane Library were searched up to the end of August 2015 and study bibliographies were reviewed.

STUDY SELECTION:

Randomized clinical trials comparing the effect of CPAP or MADs (vs each other or an inactive control) on BP in patients with obstructive sleep apnea were selected by consensus. Of 872 studies initially identified, 51 were selected for analysis.

DATA EXTRACTION AND SYNTHESIS:

Data were extracted by one reviewer and checked by another reviewer. A network meta-analysis using multivariate random-effects meta-regression was used to estimate pooled differences between each intervention. Meta-regression was used to assess the association between trial characteristics and the reported effects of CPAP vs inactive control.

MAIN OUTCOMES AND MEASURES:

Absolute change in SBP and DBP from baseline to follow-up.

RESULTS:

Of the 51 studies included in the analysis (4888 patients), 44 compared CPAP with an inactive control, 3 compared MADs with an inactive control, 1 compared CPAP with an MAD, and 3 compared CPAP, MADs, and an inactive control. Compared with an inactive control, CPAP was associated with a reduction in SBP of 2.5 mm Hg (95% CI, 1.5 to 3.5 mm Hg; P < .001) and in DBP of 2.0 mm Hg (95% CI, 1.3 to 2.7 mm Hg; P < .001). A 1-hour-per-night increase in mean CPAP use was associated with an additional reduction in SBP of 1.5 mm Hg (95% CI, 0.8 to 2.3 mm Hg; P < .001) and an additional reduction in DBP of 0.9 mm Hg (95% CI, 0.3 to 1.4 mm Hg; P = .001). Compared with an inactive control, MADs were associated with a reduction in SBP of 2.1 mm Hg (95% CI, 0.8 to 3.4 mm Hg; P = .002) and in DBP of 1.9 mm Hg (95% CI, 0.5 to 3.2 mm Hg; P = .008). There was no significant difference between CPAP and MADs in their association with change in SBP (-0.5 mm Hg [95% CI, -2.0 to 1.0 mm Hg]; P = .55) or in DBP (-0.2 mm Hg [95% CI, -1.6 to 1.3 mm Hg]; P = .82).

CONCLUSIONS AND RELEVANCE:

Among patients with obstructive sleep apnea, both CPAP and MADs were associated with reductions in BP. Network meta-analysis did not identify a statistically significant difference between the BP outcomes associated with these therapies.
 2015 Oct 13. [Epub ahead of print]

Comparison of effects of OSA treatment by MAD and by CPAP on cardiac autonomic function during daytime.

Abstract

PURPOSE:

The present study compared the effects of mandibular advancement therapy (MAD) with continuous positive airway pressure therapy(CPAP) on daytime cardiac autonomic modulation in a wide range of obstructive sleep apnea (OSA) patients under controlled conditions in a randomized, two-period crossover trial.

METHODS:

Forty OSA patients underwent treatment with MAD and with CPAP for 12 weeks each. At baseline and after each treatment period, patients were assessed by polysomnography as well as by a daytime cardiac autonomic function test that measured heart rate variability (HRV), continuous blood pressure (BP), and baroreceptor sensitivity (BRS) under conditions of spontaneous breathing, with breathing at 6, 12, and 15/min.

RESULTS:

Both CPAP and MAD therapy substantially eliminated apneas and hypopneas. CPAP had a greater effect. During daytime with all four conditions of controlled breathing, three-minute mean values of continuous diastolic BP were significantly reduced for both MAD and CPAP therapy. At the same time, selective increases due to therapy with MAD were found for HRV high frequency (HF) values. No changes were observed for BRS in either therapy mode.

CONCLUSIONS:

These findings indicate that both MAD and CPAP result in similar beneficial changes in cardiac autonomic function during daytime, especially in blood pressure. CPAP is more effective than MAD in eliminating respiratory events.

KEYWORDS:

Baroreceptor sensitivity; Blood pressure; Cardiac autonomic function; Continuous positive airway pressure; Heart rate variability; Mandibular advancement device; Obstructive sleep apnea
PMID:
 
26463420
 
[PubMed - as supplied by publisher]


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posted by Dr Shapira at 11:07 AM