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The effect of mandibular advancement device on pharyngeal airway dimension in patients with congestive heart failure treated for sleep apnoea.

Eskafi, Mahmoud; Cline, Charles LU ; Petersson, Arne; Israelsson, Bo LU and Nilner, Maria (2004) In Swedish Dental Journal1977-01-01+01:00 28(1). p.41283-41283
Abstract
Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyngeal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated.... (More)
Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyngeal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions. (Less)
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author
organization
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Contribution to journal
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published
subject
keywords
Middle Aged, Pharyngeal Diseases: pathology, Matched-Pair Analysis, Mandibular Advancement: instrumentation, Male, Human, Non-U.S. Gov't, Treatment Outcome, Obstructive: pathology, Sleep Apnea, Obstructive: etiology, Congestive: complications, Obstructive: prevention & control, Supine Position, Support, Pharyngeal Diseases: prevention & control, Pharynx: pathology, Pharynx: radiography, Polysomnography, Pulmonary Ventilation: physiology, Aged, Airway Obstruction: pathology, Airway Obstruction: prevention & control, Continuous Positive Airway Pressure, Heart Failure
in
Swedish Dental Journal1977-01-01+01:00
volume
28
issue
1
pages
41283 - 41283
publisher
Sveriges Tandläkarförbund
external identifiers
  • pmid:15129600
  • wos:000222314200001
  • scopus:1842785186
ISSN
0347-9994
language
English
LU publication?
yes
id
52d12872-d0e7-4382-aaa8-bf73978fe357 (old id 123592)
alternative location
http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&list_uids=15129600&dopt=Abstract
date added to LUP
2007-07-19 09:26:10
date last changed
2017-01-01 06:49:44
@article{52d12872-d0e7-4382-aaa8-bf73978fe357,
  abstract     = {Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyngeal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.},
  author       = {Eskafi, Mahmoud and Cline, Charles and Petersson, Arne and Israelsson, Bo and Nilner, Maria},
  issn         = {0347-9994},
  keyword      = {Middle Aged,Pharyngeal Diseases: pathology,Matched-Pair Analysis,Mandibular Advancement: instrumentation,Male,Human,Non-U.S. Gov't,Treatment Outcome,Obstructive: pathology,Sleep Apnea,Obstructive: etiology,Congestive: complications,Obstructive: prevention & control,Supine Position,Support,Pharyngeal Diseases: prevention & control,Pharynx: pathology,Pharynx: radiography,Polysomnography,Pulmonary Ventilation: physiology,Aged,Airway Obstruction: pathology,Airway Obstruction: prevention & control,Continuous Positive Airway Pressure,Heart Failure},
  language     = {eng},
  number       = {1},
  pages        = {41283--41283},
  publisher    = {Sveriges Tandläkarförbund},
  series       = {Swedish Dental Journal1977-01-01+01:00},
  title        = {The effect of mandibular advancement device on pharyngeal airway dimension in patients with congestive heart failure treated for sleep apnoea.},
  volume       = {28},
  year         = {2004},
}