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

J Clin Sleep Med. 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.

Galic T1, Bozic J2, Pecotic R3,4, Ivkovic N3, Valic M3,4, Dogas Z3,4.

Author information

Abstract

STUDY OBJECTIVES:

This study aimed to provide the evidence on effect of mandibular advancement device (MAD) therapy 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.

JAMA. 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.

Bratton DJ1, Gaisl T1, Wons AM1, Kohler M2.

Author information

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.

Sleep Breath. 2015 Oct 13. [Epub ahead of print]

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

Glos M1, Penzel T2, Schoebel C2, Nitzsche GR2, Zimmermann S2, Rudolph C2, Blau A2, Baumann G3, Jost-Brinkmann PG4, Rautengarten S5, Meier JC4, Peroz I5, Fietze I2.

Author information

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]

Chicago: Comfortable Alternative to CPAP for Treating Sleep Apnea and Snoring

CPAP is the Gold Standard for Treating Sleep Apnea.  It is a wonderful invention of  Professor Colin Sullivan  PhD, BSc (Med), MB, FRACP in Australia and it has saved thousand of lives and improved the quality of life for millions.

When CPAP treatment is successful it is amazing treatment but unfortunately it fails 60% of the patients who are prescribed CPAP.

The good news is that oral appliances are an excellent alternative to CPAP that are preferred by 95% of patients offered a choice.  It is so successful that even Professor Colin Sullivan who invented CPAP personally utilizes an oral appliance both for comfort and efficacy!

Information on Chicago Providers of Oral Appliance treatment for CPAP is available at the end of this post.  I have opened a Chicago North Shore office dedicated to treating Sleep Apnea, Snoring and TMJ disorders that is conveniently located on the Metra a very short walk from the Fort Sheridan Metra Station.
North Shore Sleep Dentistry
3500 Western Ave #100, Highland Park, IL 60035
847-533-8313

Almost every complaint patients have with CPAP can be improved or eliminated with a professionally fitted well designed appliance that is patient specific.

Failure of CPAP is almost 100% a patient compliance issue.  Patient complaints about CPAP include:

I HATE CPAP!  I Hate the Mask!, I hate the hose!

Claustrophobic feelings from the CPAP  mask and hose.

Dermatologic problems includung facial sores, ulcers and CPAP related acne.

CPAP noise is a complaint from both CPAP users and their bedmates.

Infections in the sinus regions from CPAP use.  (partially Cleaning issue)

Asthma issues from CPAP  (partially Cleaning issue)

Bronchitis from CPAP  (partially Cleaning issue)

Pneumonia from CPAP   (partially Cleaning issue)

Problems with travel related to CPAO

CPAP Mask Discomfort

CPAP Mask leaks

Headache, neckache and backache issues from CPAP related to sleep position,

Dry Mouth

Dry Eyes from CPAP mask leakage

CPAP inconvenience

Don't like cleaning mask and hose

Pain to travel with CPAP

REGARDLESS OF THE ISSUES WITH CPAP AND CPAP MASKS IT IS ESSENTIAL THAT SLEEP APNEA BE TAKEN SERIOUSLY AND TREATED.

UNTREATED SLEEP APNEA CAN BE DEADLY RESULTING IN HEART ATTACKS AND STROKES.  WHEN SUPREME COURT JUSTICE ANTHONY SCALIA DIED IT IS SUSPECTED IT WAS A DIRECT RESULT OF NOT USING HIS CPAP FOR ONE NIGHT!

One study has shown that patients with moderate sleep apnea patients who are not treated have a 36% decrease in 8 year survival compared to those who were treated.

Patients with untreated apnea aresix times more likely to have motor vehicle accidents and often have trouble at work, school and home.  Marital strife is common due to excessive daytime sleepiness and poor cognition in patients with untreated sleep apnea.

I have been treating sleep apnea for over 34 years.  When I first became an Assistant Professor at Rush Medical School back in 1985 the average patient was an older male usually weighing 250-600 pounds and Severely ill.

Over the last 34 years I did research at Rush Medical School in the 1980's until 1991.  I returned in the 1990's and treated patients at Rush Sleep Service until early this century.  I have taught Dental Sleep Medicine to hundreds of dentists in the US and Internationally.  My most recent course was at Advocate Good Samaritan Hospital on February 29, 2016.  Other recent courses were at the International College of CranioMandibular Orthopedics in both the US and Argentina.

Currently, most of the lectures I give are on the common developmental aspects of TMJ, Sleep Apnea, ADD, ADHD, Dyslexia and working to catch children as early as possible prior to permanent changes in physiological development and brain development/ maturation.

It is now possible to decrease and  prevent many of these problems by early epigenetic orthodontic / orthopedic treatment.  It is also sometimes possible to offer permanent cures of sleep apnea in adults by utilizing Epigenetic Orthodontic treatment with the DNA Appliance and the mRNA version of the DNA Appliance.

Today we know that sleep apnea affects old and young, male and female obese and non-obese patients and that it frequently affects children and infants and then carries with them through life.

Short Term memory loss is associated with untreated sleep apnea and when there is a family history of Alzheimers or Dementia it is recognized in can cause more rapid onset of symptoms at a younger age with more profound disease.

Fro Sleep Apnea Treatment in the Chicago Metropolitan area:

I practice in Gurnee, Il at Delany Dental Care.  847-623-5530
310 S Greenleaf, Gurnee 60031    www.DelanyDentalCare.com

In Highland Park   at 3500 Western Ave   847-533-8313

www.NorthShoreSleepDentist.com

www.ThinkBetterLife.com