Satoru Tsuiki

Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity

In a curved tube, the amount of airflow appears to be influenced by the amount of curvature. The purpose of this study was to investigate changes in obstructive sleep apnoea (OSA) severity and awake velopharyngeal curvature in response to an anteriorly titrated mandibular position in 20 male OSA patients. Baseline supine cephalometry was obtained before the initial insertion of a titratable oral appliance and follow-up supine cephalometry was undertaken after titration of the mandibular position with the appliance in place. The mean apnoea/hypopnea index (AHI) before treatment (31.6±13.0u2005events·h−1) was significantly reduced (9.8±7.4u2005events·h−1) after titration of the mandibular position in all 20 patients. There was a significant increase in the anteroposterior calibre and the radius of the curvature of the anterior wall of the velopharynx in 14 good responders who exhibited an AHI reduction to ≤15. Similar observations were not found in six poor responders. To conclude, an anteriorly titrated mandibular position reduced obstructive sleep apnoea severity, enlarged the velopharynx and diminished the curvature of the anterior velopharyngeal wall in good responders. It is proposed that this change in the upper airway curvature associated with mandibular advancement may effect obstructive sleep apnoea severity through its effect on airflow dynamics.

A Pitfall of an Orthodontic Approach to Pubescent Obstructive Sleep Apnea: A Case Report

Orthodontic treatment has potential as a fundamental approach in pubescent obstructive sleep apnea (OSA) patients with a small mandible. However, pitfalls of such treatment have not been documented. We report the case of a 15-year-old OSA patient (apnea hypopnea index [AHI] = 7.6 events/h) with a small mandible in whom we attempted to improve OSA by promoting the growth of the mandible with a mandibular advancement device. The AHI was reduced to 0.8 events/h with the device in place. However, neither notable growth of the mandible nor improvement of OSA without the device in place was observed after a 5-year follow-up (AHI = 7.8 events/h). It was retrospectively concluded that the optimal timing as an orthodontic treatment had already passed when the patient was introduced to our clinic. Hence, an orthodontic approach should be considered as soon as we encounter pubescent OSA so as not to lose an available window for definitive treatment.