Made of same material as 2 liter soft drink bottles
Study of 13 pts / 5 had RDI > 15 64% showed improvement / none were worse
Success was not correlated with BMI, NC, age or severity of OSA Only OA to
allow retrusive movement of mandible with effort
Uses buccal elastic straps to attach max. and mandib. portions
Esmarch:
Open VD 15 mm
Protrusive at 7 mm
OA most effective for pts with tendency for retrognathia
OA maintained effect w/o craniomandibular disorders in 20 pts / 55 mo. (Thumm
et al)
AI reduced from 36.8 +/- 18 to 11.6 +/- 9.8 ( note diff. criterion)
EMG amplitudes of gg, masseter, lat'l pterygoid muscles: Normally decrease
during obstructive apneas (no OA) With OA all EMG amplitudes increased
(obstructive OSA)
Normally don't change during central apneas (no OA)
With OA increased in gg and lat'l pterygoid (central apnea) # of obstructive
and mixed apneas decreased, slight increase in central apneas
The coactivation of agonist (gg and lat'l pterygoid muscle) and antagonist (masseter)
after the apnea was postulated to stabilize the mandible to prevent the UA
from collapsing. (Yoshida)
Herbst
(Modified):
60% success rate
Open VD 5-10 mm
Adjustment device on buccal surfaces of appliance
Clark did follow-up PSG at 3 weeks and 7 mo., question'rs at 6,18,36 mo.: 39%
decrease in stage 1 sleep (Clark) up to 50% increase in REM (Clark) 11 of 15
pts showed RDI<9 3 of 24 pts DC'd due to TMJ pain 74% compliant at 18 mo.
52% compliant at 36 mo. (30 % lost to follow-up) (Clark)
Partial return of normal sleep architecture
Sjoholm did study comparing Herbst at 50% protrusion and
Muscle Relaxation Appliance (MR) which increased VDO. Herbst decreased # O2
desats from 44 to 29/hr and frequency of body movements decreased 34 to 20/
hr. The MR had no effect on these parameters. The HR did decrease respiratory
resistance breathing from 14 to 7 % of time in bed.
Pt Selection:
6 teeth in each arch with at least one healthy posterior tooth/quad
All dental care done before fitting (Rosenberg)
No significant perio disease
Pt should be able to protrude 5 mm w/o TMJ discomfort
(A tall narrow vault, long uvula and enlarged tonsils
make OA use more difficult because there is not enough room to comfortably
wear an OA)
Klearway:
55% success by criteria of RDI >10 &
50% decrease fm. baseline
65% tx success if criteria symptom resolution and RDI >15
80% of moderate OSA pts If RDI >15 (Lowe) 61% of severe OSA pts If RDI
>15 (Lowe)
70% of pt decreased RDI by
50% If RDI baseline over >20,
40 % of pts were not successful
5% compliance failure
Advance mandibular portion until complain of pain or
symptoms are resolved
Be aware that advancement device can back off due to retrusive forces from
mandible
Adjustment device in center of palate
Can contain free monomer
Allows pt to drink, cough, and swallow without dislodging OA Complete tooth
coverage may reduce possibility of any occlusal change which may result from
eruption tendency in buccal segments
8% showed INCREASED RDI
Pt selection:
10 stable teeth in each arch with one posterior tooth/
quadrant All dental care done
Be able to protrude >7mm
Able to open > 40 mm
Protrusive position set at 2/3 maximal, or 70% of max,
and advanced until subjective signs and symptoms are reduced or have
disappeared. (Lowe)
Mandible moved to 85 % of protrusive This is a copy of
the letter each patient gets about medical coverage. It will require
editing, but has pertinent info for patients.
