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OSA. Oral devices have been shown to have a beneficial effect in targeting a number of significant clinical end points. These include the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, blood pressure, aspects of neuropsychological functioning, and quality of life. Elucidation of the mechanism of action of oral devices has provided insight into the factors that predict treatment response and may improve the selection of patients for this
612:
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22:
604:(2008) on the influence of nasal resistance (NAR) on oral device treatment outcome in OSA demonstrates the need for an interdisciplinary approach between ENT surgeons and sleep physicians to treating OSA. The study suggests that higher levels of NAR may negatively affect outcome with MAS and subsequently methods to lower nasal resistance may improve the outcome of oral device treatment.
548:
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for sleep apnea, with a high success rate. Nonetheless, the procedure is often used after other forms of treatment have failed (nasal surgeries, tonsillectomy, uvulopalatopharyngoplasty, tongue reduction surgeries). There is a longer recovery when compared to other sleep apnea surgeries, since the bones of the face have to heal into their new position.
678:
323:(UPPP). This involves removal of the tonsils if still present, and a subsequent palatal procedure. The tonsil pillars are often sutured closed—and the uvula is either trimmed, cut, folded, reshaped, or sutured to the soft palate. Studies have shown that treatment effect of UPPP with tonsillectomy increases with tonsil size.
580:
Over the last decade, there has been a significant expansion in the evidence base supporting the use of oral devices in the treatment of OSA. Robust studies demonstrating their efficacy have been underpinned by increasing recognition of the importance of upper airway anatomy in the pathophysiology of
471:
Currently, surgeons often perform maxillomandibular advancement surgery simultaneously with genioglossus advancement (tongue advancement). The genioglossus advancement pulls the tongue forward to decrease the amount of tongue blockage during sleep. MMA is one of the most effective surgical treatments
205:
of the natural history of obstructive sleep apnea (OSA), found that of a random sample (602 employed men and women, 30–60 years old) the prevalence of OSA (5 or more events/hr) was 9% for women and 24% for men. However, the study found that among sleepy patients in this group, 2% of women and 4% of
179:
is defined as either cessation of breathing (apnea) for 10 seconds, or a decrease in normal breathing (hypopnea) with an associated desaturation in oxygen and arousal during sleep that lasts at least 10 seconds. In adults, it is typical to have up to 4.9 events per hour. In obstructive sleep apnea,
404:
and others) are attached to the lower jaw below the teeth. During a genioglossus advancement procedure, the surgeon cuts a small window or bone cut in the front part of the lower jaw (mandible) at the level of the geniotubercle where the genioglossus muscle attaches. This piece of bone, along with
242:
showed that multilevel sleep surgery achieves a 60.3% apnea hypopnea index (AHI) reduction. This reduction in sleep apnea severity via surgical means compares well against the AHI reduction for best case CPAP patients where an overall AHI reduction of 66% was achieved. Even single level surgical
408:
This procedure is often combined with other surgeries such as uvulopalatopharyngoplasties or maxillomandibular advancement surgeries. It is rare to have this procedure performed as the only surgical treatment for sleep apnea, as obstruction in sleep apnea is most often at multiple levels (nose,
576:
may be used in select patients as treatment for mild or moderate OSA. Where appropriate, they are considered a good therapy choice as they are non-invasive, easily reversible, quiet, and generally well accepted by the patient. The focus of improvement in appliance design is in reducing bulk,
536:(CPAP), which replaced tracheostomy as the gold standard treatment for obstructive sleep apnea. CPAP machines are specially designed to deliver a constant flow or pressure. Some CPAP machines have other features as well, such as heated humidifiers. CPAP is the most effective treatment for
655:
Tongue retaining devices hold the tongue in place by either suction, a fixed bar, or a custom dental impression. Hybrid devices combine mandibular advancement with the tongue restraint. Tongue retaining devices have not been well-received as a therapy choice since they are invasive, and the
377:, is a procedure that pulls the base of the tongue forward, usually to increase airway size due to deformity or a sleep breathing disorder. This procedure is frequently performed with either uvulopalatopharyngoplasty or maxillomandibular advancement surgeries.
626:
327:
1371:
Cartwright, Rosalind; Stefoski, Dusan; Caldarelli, David; Kravitz, Howard; Knight, Sara; Lloyd, Stephen; Samelson, Charles (1988). "Toward a treatment logic for sleep apnea: The place of the tongue retaining device".
1074:
Liu, Stanley Yung-Chuan (2015). "Lateral
Pharyngeal Wall Tension After Maxillomandibular Advancement For Obstructive Sleep Apnea Is A Marker For Surgical Success: Observations From Drug-Induced Sleep Endoscopy".
352:
and its muscle attachments to the tongue and airway are pulled forward in order to increase airway size and improve airway stability behind and below the base of tongue (retrolingual and hypopharyngeal region).
1310:
Lazard DS, Blumen M, Levy P, Chauvin P, Fragny D, Buchet I, Chabolle F. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. Journal of
Clinical Sleep Medicine. 2009 Oct
456:. In the late 1970s, advancement of the lower jaw (mandibular advancement) improved sleepiness in three patients. Subsequently, maxillomandibular advancement was used for patients with obstructive
301:
Some adults with large tonsils may be candidates for having their tonsils and/or adenoids removed either alone or in combination with other procedures, such as uvulopalatopharyngoplasty (UPPP) or
489:
is the only surgical procedure that completely bypasses the upper airway. This procedure was commonly performed in the 1960-1980's for obstructive sleep apnea, until other procedures such as the
644:
Tongue retaining devices are devices that can be placed in a manner such that the tongue is kept in a forward position. These devices have been used for snoring and obstructive sleep apnea.
577:
permitting free jaw movement (i.e., yawning, speaking, and drinking), and allowing the user to breathe through their mouth (early "welded gum shield"-type devices prevented oral breathing).
234:
Most obstructive sleep apnea sufferers have multiple points of obstruction in their airway and therefore require multilevel sleep surgery in order to maximize the efficacy of treatment. A
800:
Stuck, BA; Leitzbach, S; Maurer, JT (Jun 2012). "Effects of continuous positive airway pressure on apnea-hypopnea index in obstructive sleep apnea based on long-term compliance".
405:
the attachment for the tongue (genial tubercle) is pulled forward and subsequently secured to the lower jaw, usually with a single screw or with a plate and screws.
243:
intervention in sleep apnea, which demonstrates a lesser degree of AHI reduction, showed a 31% survival benefit when compared against those using CPAP as therapy.
251:
Children with obstructive sleep apnea typically have enlarged tonsils and adenoid tissue. Surgery on children is over 80% successful by simply performing an
282:) collapses into the airway during sleep. These children may benefit from a supraglottoplasty to help prevent that tissue from collapsing into the airway.
888:"Effect of obesity and medical comorbidities on outcomes after adjunct surgery for obstructive sleep apnea in cases of adenotonsillectomy failure"
1466:
1407:
Lazard, Diane S.; Blumen, Marc; Levy, Pierre; Chauvin, Pierre; Fragny, Dorothee; Buchet, Isabelle; Chabolle, Frederic (15 October 2009).
533:
527:
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Weaver, EM; Maynard, C; Yueh, B (2004). "Survival of veterans with sleep apnea: continuous positive airway pressure versus surgery".
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167:. These surgeries are performed by surgeons trained in otolaryngology, oral maxillofacial surgery, and craniofacial surgery.
43:
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men met criteria for obstructive sleep apnea syndrome (OSAS). Those who snored habitually, were more likely to have an
65:
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performed to treat sleep disordered breathing. Sleep disordered breathing is a spectrum of disorders that includes
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Obstruction in adults is most often multiple level, so the most successful surgeries involve multi-level surgery.
32:
753:"The efficacy of multilevel surgery of the upper airway in adults with obstructive sleep apnea/hypopnea syndrome"
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970:"Clinical Predictors for Successful Uvulopalatopharyngoplasty in the Management of Obstructive Sleep Apnea"
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acclimation period is long. The devices have shown high success rates for therapy in studies published in
54:
1321:
348:, also known as hyoid myotomy and suspension or hyoid advancement, is a surgical procedure in which the
586:
429:
330:
Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.
181:
1021:"Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea"
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452:) forward. The procedure was first used to correct deformities of the facial skeleton, including
260:
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589:< 5) 88% of patients with MAS and proposes optimum patient selection to include AHI < 25,
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1264:"Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea"
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1409:"The Tongue-Retaining Device: Efficacy and Side Effects in Obstructive Sleep Apnea Syndrome"
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A sub-group of children may have occult laryngomalacia, where the tissue directly above the
585:. A further study by Dr. Edmund Rose, University of Freiburg (2004), successfully treated (
540:, in which the pressure from CPAP prevents the airway from collapsing or becoming blocked.
79:
683:
590:
1200:
Chan, A; Lee, R; Cistulli, PA (Aug 2007). "Oral
Appliances for Obstructive Sleep Apnea".
1157:
Chan, A; Lee, R; Cistulli, PA (Aug 2007). "Oral
Appliances for Obstructive Sleep Apnea".
929:"Supraglottoplasty for occult laryngomalacia to improve obstructive sleep apnea syndrome"
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In adults, various surgeries treat specific causes for nasal and soft palate.
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Zeng, B; Ng, AT; Qian, J; Petocz, P; Darendeliler, MAS; Cistulli, PA (2008).
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affected individuals are categorized based on how many apneas or hypopneas (
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704:"The occurrence of sleep-disordered breathing among middle-aged adults"
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Patient using a CPAP machine. There are many models of CPAP face masks.
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surgeries were described as alternative surgical modalities for OSA.
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Rose, E (2004). "Identifying the Ideal Oral
Appliance Candidate".
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are obese children and those with other medical problems, such as
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Tracheostomy, bypassing area of airway obstruction during sleep.
15:
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The procedure most commonly performed for sleep apnea is the
1132:
1133:"SomnoMed - The Leader in Continuous Open Airway Therapy"
751:
Lin, HC; Friedman, M; Chang, HW; Gurpinar, B (May 2008).
1347:"Do Tongue Retaining Devices Work to Decrease Snoring?"
1322:"The Best Dental Snoring Mouthpiece: Types and Option"
702:; Dempsey, J; Skatrud, J; Weber, S; Badr, S (1993).
629:
A different style of mandibular advancement splint.
125:
120:
46:. Unsourced material may be challenged and removed.
933:Archives of Otolaryngology–Head & Neck Surgery
892:Archives of Otolaryngology–Head & Neck Surgery
615:A mandibular advancement splint for treatment of
1111:"General Information about Sleep Apnea Machines"
532:In 1981, Dr. Sullivan and colleagues introduced
8:
444:, is a procedure that moves the upper jaw (
392:Genioglossus advancement after the surgery.
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1077:Journal of Oral and Maxillofacial Surgery
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927:Chan, DK; Truong, MT; Koltai, PJ (2012).
903:
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106:Learn how and when to remove this message
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1019:Tschopp, Samuel; Tschopp, Kurt (2019).
974:International Journal of Otolaryngology
690:
384:Airway before genioglossus advancement.
259:. Those less likely to benefit from an
886:Chan, DK; Jan, TA; Koltai, PJ (2012).
184:or AHI) or events they have per hour.
117:
7:
201:The Wisconsin Sleep Cohort Study, a
44:adding citations to reliable sources
708:The New England Journal of Medicine
572:A mandibular advancement device or
534:continuous positive airway pressure
528:Continuous positive airway pressure
522:Continuous positive airway pressure
217:No airway obstruction during sleep.
134:
1413:Journal of Clinical Sleep Medicine
663:Journal of Clinical Sleep Medicine
297:Tonsillectomy and/or adenoidectomy
194:Moderate: 15 to 30 events per hour
14:
442:maxillomandibular osteotomy (MMO)
375:genial tubercle advancement (GTA)
191:Mild: 5 to <15 events per hour
1245:Journal of Orofacial Orthopedics
676:
309:Uvulopalatopharyngoplasty (UPPP)
225:Airway obstruction during sleep.
161:upper airway resistance syndrome
20:
31:needs additional citations for
1374:Behaviour Research and Therapy
658:Behaviour Research and Therapy
197:Severe: >30 events per hour
1:
574:mandibular advancement splint
568:Mandibular advancement splint
562:Mandibular advancement device
503:maxillomandibular advancement
467:Maxillomadibular advancement.
425:Maxillomandibular advancement
419:Maxillomandibular advancement
413:Maxillomandibular advancement
188:Normal: <5 events per hour
1467:Treatment of sleep disorders
1386:10.1016/0005-7967(88)90111-8
857:10.1016/j.otohns.2003.12.012
770:10.1097/MLG.0b013e31816422ea
721:10.1056/nejm199304293281704
600:Another study published in
175:Obstructive sleep apnea or
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1326:SomnoSure Education Center
1113:. Cpap-machine-reviews.com
1089:10.1016/j.joms.2015.01.028
845:Otolaryngol Head Neck Surg
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491:uvulopalatopharyngoplasty
321:uvulopalatopharyngoplasty
315:Uvulopalatopharyngoplasty
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946:10.1001/archoto.2011.233
905:10.1001/2013.jamaoto.197
499:genioglossus advancement
432:, also sometimes called
369:Genioglossus advancement
363:Genioglossus advancement
357:Genioglossus advancement
651:Tongue Retaining Device
640:Tongue retaining device
538:obstructive sleep apnea
434:bimaxillary advancement
409:palate, tongue, etc.).
165:obstructive sleep apnea
1280:10.1093/sleep/31.4.543
968:Yousuf, Aamir (2013).
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430:orthognathic surgery
182:apnea-hypopnea index
40:improve this article
987:10.1155/2013/290265
286:Surgical procedures
130:sleep apnea surgery
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230:Clinical results
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126:Other names
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