Objectives:To characterize functional changes of the airway while wearing an appliance simulating severe arch constriction using level 3 polysomnography. Materials and Methods:For this pilot, single-blinded prospective randomized cross-over trial, 34 participants were recruited from the student/staff population of a dental school. Epworth Sleepiness Scale, STOPBANG questionnaire, lateral cephalograms, and digital dental casts were gathered from all patients. Arch constriction was simulated by adding 5 mm thickness to lingual aspects of the dentition using vacuum-formed retainers (VFRs). Each participant completed three at-home sleep studies with a level 3 sleep monitor: the initial baseline test, and after random allocation of 6 days wearing either the control appliance (regular-VFR), or the simulated arch constriction (SAC) appliance, and following crossover of appliances. Oxygen Desaturation Indices (ODIs) and Respiratory Event Index (REI) were compared. Results:Use of the SAC appliance did not affect airway function: No significant difference (P > .05) was found in REI or ODI among the three groups. Five participants had REI values 5.0 or greater on at least one sleep study; however, this was unrelated to appliance use. Conclusion:Simulated extreme dental arch constriction did not result in changes to REI. Constriction of the dental arches does not negatively affect airway function during sleep.

Background Adherence to continuous positive airway pressure (CPAP) for obstructive sleep apnoea (OSA) continues to be low with high termination rates. Alternative therapies to CPAP are needed. Our objective was to compare objective adherence to CPAP and mandibular advancement splints (MAS) and to evaluate their effectiveness, and additionally to identify treatment usage patterns and the clinical effectiveness of having both therapies. Methods This multicentre, double-randomised, three-phase trial (titration/crossover/observation) was conducted at three Canadian universities. Eligible participants were treatment-na & iuml;ve with mild-to-severe OSA. The primary outcome was objectively measured adherence (hours per night) during the crossover phase. Secondary outcomes included efficacy during the crossover phase; adherence during the observational phase; and patient-centred outcomes, blood pressure and side-effects during the crossover and observational phases. Duration of the crossover and observational phase was 2.5 and 6 months, respectively. Results 81 participants were enrolled in the first randomisation. 79 entered the adaptation/titration phase (mean +/- SD age 52.3 +/- 10.8 years; 58 males), 73 entered the crossover phase (included in the intention-to-treat analysis) and 64 completed the observational phase. Mean objective adherence over 1 month: MAS showed higher adherence than CPAP, 6.0 versus 5.3 h night-1 (difference 0.7 (95% CI 0.3-1.2) h night-1; p<0.001). Mean CPAP-MAS difference in efficacy: 10.4 (95% CI 7.8-13.0) events h-1; p<0.001. During the observational phase 55% (35 out of 64) of participants chose to alternate therapies. All treatments led to substantial improvement in patient-centred outcomes. Conclusions Despite the higher efficacy of CPAP and higher adherence to MAS, both demonstrate comparable clinical effectiveness on patient-centred outcomes. Having both CPAP and MAS can improve long-term management of OSA.

Snoring and obstructive sleep apnoea (OSA) affect a significant percentage of children. Recent studies have suggested that altered craniofacial morphology may contribute to the multifactorial pathophysiology of OSA. This study aims to determine the prevalence of craniofacial abnormalities and malocclusion in children referred for polysomnography due to OSA suspicion. This is a multicentre prevalence study completed across four Canadian sites. Otherwise, healthy children (≥ 4 years old) who were seen at the sleep clinic were recruited. Upon arrival for their hospital-based overnight sleep recording, a clinical orthodontic assessment and a series of paediatric sleep questionnaires were completed for each participant. Data from 315 children (age 9.37 ± 3.70) revealed significant risk factors associated with the presence of OSA, including male sex, presence of snoring, endomorph body type, and hypertrophic tonsils. The intra-oral and facial morphologic characteristics were not significantly different between children with (AHI 9.51 ± 10.94) and without (AHI 0.84 ± 0.50) PSG-verified OSA. Factors such as maxillary constriction/posterior crossbite and a retrognathic mandible showed similar (p > 0.05) prevalence between groups. Hierarchical regression analysis showed no statistically significant facial and dental variables in predicting AHI. In conclusion, a multidisciplinary approach involving dental professionals with expertise in growth and development is crucial for the assessment of possible craniofacial abnormalities in children with OSA. Craniofacial morphology may play a limited role in the pathophysiology of OSA in most children, as no differences in the prevalence of these variables in children with and without OSA were found in this large, multicentre study.

Oral appliance (OA) therapy is widely used as an alternative to continuous positive airway pressure (CPAP) therapy for treating obstructive sleep apnea (OSA). Traditionally, OA adherence has been assessed through subjective self-reports before, but the availability of objective adherence sensors now allows for more accurate monitoring. This study aimed to analyze one-year objective adherence data to identify adherence patterns over time and factors influencing adherence to OA therapy. Fifty-five OSA patients were recruited from a cohort study and underwent clinical follow-ups at baseline, 1, 6 and 12 months. Patients were treated with custom-made, titratable OAs, and adherence was objectively collected using embedded sensors. Adherence data were analyzed using both intention-to-treat (ITT) and per-protocol (PP) approaches. Statistical methods, including comparative analyses, logistic regression models, and multivariate linear regression were performed to identify predictors of adherence. Twenty-one patients dropped out before the 12-month follow-up, leaving 34 completed the entire study. At the 1-month follow-up, 80.0% of patients were classified as adherent, with a mean wearing time of 5.98 ± 2.38 hours per night. By 6 months, adherence decreased to 67.3%, with a mean wearing time of 5.69 ± 2.08 hours per night. Several significant predictors of adherence were identified, including larger baseline overjet, younger age, and marital status. OA adherence declined significantly within the first 6 months but stabilized between 6 and 12 months. Key baseline factors, such as larger overjet, younger age, and being married or partnered are predictors of better adherence, while psychological Comorbidities are associated with lower adherence.

INTRODUCTION:This systematic review and meta-analysis aimed to evaluate the efficacy and adherence of different mandibular advancement devices (MADs) designed to treat obstructive sleep apnea, focusing on titratable vs nontitratable and custom-made vs ready-made devices. METHODS:Registered with the International Register of Systematic Review (PROSPERO CRD42024557402), a comprehensive literature search was conducted across Ovid MEDLINE, Ovid Embase, and Web of Science up to June 2024. Randomized controlled trials and nonrandomized studies comparing MAD designs were included. The primary outcome was apnea-hypopnea index (AHI) reduction. Secondary outcomes included improvements in Epworth Sleepiness Scale scores, adherence rates, and patient preference. The risk of bias was assessed using the risk-of-bias tool for randomized trials, and the Risk-Of-Bias In Nonrandomized Studies of Intervention tools. Meta-analyses were performed with weighted mean differences (WMD) and 95% confidence intervals (CI). RESULTS:A total of 22 studies were included, comprising 15 randomized controlled trials and 7 nonrandomized studies. Meta-analysis showed significant AHI reduction with both titratable and nontitratable MADs, with no significant difference between groups (WMD: 1.16; 95% CI, -1.29 to 3.61; P = 0.35). Custom-made MADs demonstrated a marginally significantly greater reduction in AHI compared with ready-made MADs (WMD: 1.51; 95% CI, -0.08 to 3.11; P = 0.06). Custom-made MADs also showed higher adherence rates and longer wearing times (WMD: 1.19; 95% CI, 0.65-1.73; P <0.0001) and higher adherence rates. CONCLUSIONS:Both titratable and nontitratable MADs, as well as custom-made and ready-made MADs, effectively treated obstructive sleep apnea, with no clear preference for one design over another. Custom-made MADs, however, generally had fewer side effects and offered potential adherence advantages. Further high-quality studies with longer follow-ups are recommended.

Obstructive sleep apnea (OSA) represents a prevalent condition impacting over 9% of the general adult population. Various treatment options have been clinically proposed and utilized, with a particular focus on continuous positive airway pressure (CPAP) and oral appliances due to their overall effectiveness and higher adherence rates. CPAP therapy has demonstrated greater effectiveness but lower adherence compared to oral appliances. However, treatment success of oral appliances is not always guaranteed, hence sleep physicians are more cautious in their prescriptions unless they can reasonably estimate the chance of responding to oral appliance therapy. Prior studies often rely on invasive or inconvenient methodologies such as drug-induced sleep endoscopy (DISE), cephalometry, multisensor catheters, or full polysomnography (PSG). In this prospective study, we collected data with a home sleep apnea test (HSAT) device from 50 participants (38 using mandibular advancement devices [MADs] and 12 using tongue stabilizing devices [TSDs]). We used a simple yet informative data source: snoring vibrations extracted from a nasal pressure sensor with a low sampling frequency (125 Hz). Using spectro-temporal analysis of the snoring signal, we successfully predicted therapy efficacy with accuracies of 88% for MAD and 91% for TSD. Our proposed methodology presents a promising approach that can be utilized without further need for PSG or integrated within PSG testing for accurate prediction of oral appliance efficacy.

Obstructive sleep apnea (OSA) is a chronic respiratory disorder characterized by recurrent interruptions in breathing during sleep. The gold standard for clinical OSA diagnosis is the polysomnography test, which is a rather cumbersome and expensive procedure. As a result, other alternatives for screening OSA have gained attention. Speech, an accessible modality, shares similar anatomical structures that contribute to OSA. This study proposes a novel pipeline based on classical acoustic features to estimate the risk of OSA using five vowels and two phonemes recorded in standing and sitting postures. A transfer learning approach that incorporates magnitude and phase-based representations alongside a pre-trained SEResNet-50 was used to compare with our model. Our proposed framework achieved a remarkable F1-score of 0.93 in classifying 35 subjects living in homeless shelters, proving the feasibility of employing acoustic models in accessible speech-based OSA screening.

PURPOSE:This systematic review and meta-analysis aimed to evaluate the dental and skeletal effects of the long-term oral appliance (OA) treatment in patients with obstructive sleep apnea (OSA) and provide insights for clinicians in treatment planning and decision-making for OSA patients undergoing OA treatment. MATERIALS AND METHODS:A comprehensive literature search was conducted in major databases up to April 2024. Studies were included if they assessed long-term OA treatment (≥6 months) in adults with OSA using any type of mandibular advancement device (MADs) or tongue retaining device (TRD). Dental and skeletal changes, measured by dental cast and cephalometric analysis, were the primary outcomes. RESULTS:A total of 42 studies were included in the systematic review, with 23 included in the meta-analysis. Long-term OA treatment was associated with a significant decrease in overbite (0.87 mm, 95% CI: 0.69-1.05) and overjet (0.86 mm, 95% CI: 0.69-1.03). Subgroup analyses showed the decrease of overbite and overjet progressively changed over the years intervals. There was a significant retroclination of the upper incisors (U1-SN, 2.58°, 95% CI: 1.07-4.08) and proclination of the lower incisors (L1-MP, -2.67° (95% CI: -3.78-1.56). Skeletal changes were not significant. CONCLUSION:Overbite and overjet gradually decreased in the long-term OA treatment, which might predominantly result from the retroclination of the upper incisors and the proclination of the lower incisors. The skeletal patterns in the anteroposterior and vertical direction might remain relatively stable over time. There was a tendency for the clockwise rotation of the mandible.

Background: Obstructive sleep apnea (OSA) is the most common sleep-related breathing disorder. Although adenotonsillectomy is first-line management for pediatric OSA, up to 40% of children may have persistent OSA. This document provides an evidence-based clinical practice guideline on the management of children with persistent OSA. The target audience is clinicians, including physicians, dentists, and allied health professionals, caring for children with OSA. Methods: A multidisciplinary international panel of experts was convened to determine key unanswered questions regarding the management of persistent pediatric OSA. We conducted a systematic review of the relevant literature. The Grading of Recommendations, Assessment, Development, and Evaluation approach was used to rate the quality of evidence and the strength of the clinical recommendations. The panel members considered the strength of each recommendation and evaluated the benefits and risks of applying the intervention. In formulating the recommendations, the panel considered patient and caregiver values, the cost of care, and feasibility. Results: Recommendations were developed for six management options for persistent OSA. Conclusions: The panel developed recommendations for the management of persistent pediatric OSA based on limited evidence and expert opinion. Important areas for future research were identified for each recommendation.

Obstructive sleep apnea (OSA) is a chronic respiratory disorder characterized by recurrent interruptions in breathing during sleep. OSA is highly prevalent, affecting 30-70% of people with chronic conditions like hypertension and substance use. The gold standard for clinical OSA diagnosis is the polysomnography (PSG) test, which is a rather cumbersome and expensive procedure, and accordingly can be quite inconvenient for patients. Additionally, patients often have to wait for a long time before they can undergo PSG. As a result, other alternatives for screening OSA have gained attention. For instance, speech is a cheap and accessible modality that shares similar anatomical structures that contribute to OSA. Previous studies have investigated the feasibility of speech recording during wakefulness for assessing the risk of OSA; however, most of the studies have been done in sleep clinics or hospitals in fully- or semi-supervised recording environments. Consequently, the generalizability of the developed algorithms is limited. People experiencing homelessness are specific group of patients who face several challenges accessing healthcare facilities, and due to the existence of OSA comorbidities, have high OSA prevalence. However, this population has never been included in studies related to speech and OSA. Therefore, in this study, for the first time, we demonstrated the difference in spectral speech characteristics of a small cohort (n=18) of people with and without OSA living in homeless shelters, in Toronto, Canada. We also investigated the effect of body posture on such differences and highlighted the potential differences during vowel articulation that can be used for developing an accessible speech-based OSA monitoring tool.

Journal Article Use of facial features to predict obstructive sleep apnea presence and severity Get access Carlos Flores-Mir, Carlos Flores-Mir Professor, Department of Dentistry, University of Alberta, Edmonton, AB, CanadaPart-time Private Practice limited to Orthodontics, Edmonton, AB, Canada Corresponding author. Carlos Flores-Mir, Department of Dentistry, College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, 5-528 Edmonton Clinic Health Academy, Edmonton, AB, Canada, T6G 1C2. Email: cf1@ualberta.ca. https://orcid.org/0000-0002-0887-9385 Search for other works by this author on: Oxford Academic Google Scholar Fernanda R Almeida, Fernanda R Almeida Professor, Faculty of Dentistry, University of British Columbia, Vancouver, BC, CanadaPart-time Private Practice limited to Dental Sleep Disorders, Vancouver, BC, Canada https://orcid.org/0000-0002-8704-9506 Search for other works by this author on: Oxford Academic Google Scholar Rooz Khosravi, Rooz Khosravi Clinical Associate Professor of Orthodontics, Department of Orthodontics, University of Washington, Seattle, WA, USAFull-time Private Practice limited to Orthodontics, Sammamish, WA, USA Search for other works by this author on: Oxford Academic Google Scholar Siddharth Vora Siddharth Vora Associate Professor, Faculty of Dentistry, University of British Columbia, Vancouver, BC, CanadaPart-time Private Practice limited to Orthodontics, Vancouver, BC, Canada Search for other works by this author on: Oxford Academic Google Scholar Sleep, Volume 47, Issue 3, March 2024, zsae017, https://doi.org/10.1093/sleep/zsae017 Published: 19 January 2024 Article history Published: 19 January 2024 Corrected and typeset: 02 February 2024

OBJECTIVE:To evaluate the long-term effectiveness, compliance, and side effects of tongue stabilizing devices (TSDs).METHODS:Thirty-nine patients were followed up after 12 and 30 months. The subjective effectiveness was assessed using the Epworth Sleepiness Scale (ESS), the Functional Outcomes Sleep Questionnaire (FOSQ-10), the Chalder Fatigue Scale (CFQ), and a sleep-related quality of life questionnaire (QoL). Compliance and side effects were assessed.RESULTS:At 12-months, 35.9% of patients confirmed continuing the therapy, compared to only 15.4% of patients at 30 months. At 30 months, a significant average improvement of ESS (2.0 ± 2.8) was observed compared to baseline levels in six patients. Six patients demonstrated an average increase in blood pressure. The most frequently reported side effects were mouth dryness and excessive salivation. The 3D analysis revealed small tooth movements.CONCLUSION:The TSD therapy demonstrated a good long-term subjective effectiveness against OSA but had a relatively low treatment acceptance rate.

Pesticides have been pointed out as hormone disruptors and may significantly affect the prognosis of hormone-dependent diseases such as breast cancer (BC). Here, we investigated the impact of occupational pesticide exposure on systemic cortisol levels in female rural workers diagnosed with BC. Occupational exposure was assessed by interviews with a standardized questionnaire. Plasma samples (112 from pesticide-exposed women and 77 from unexposed women) were collected in the afternoon, outside the physiological cortisol peak, and analyzed by a chemiluminescent paramagnetic immunoassay for the quantitative determination of cortisol levels in serum and plasma. The results from both groups were categorized according to patients' clinicopathological and exposure data. BC pesticide-exposed women presented higher levels of cortisol than the unexposed. Higher cortisol levels were also detected in the exposed group with more aggressive disease (triple-negative BC), with tumors over 2 cm, with lymph node metastases, and with high risk of disease recurrence and death. These findings demonstrated that there is an association between pesticide exposure and BC that affected cortisol levels and correlated to poor disease prognosis.