Indian Journal of Sleep Medicine

Register      Login

VOLUME 3 , ISSUE 3 ( July-September, 2008 ) > List of Articles

ORIGINAL ARTICLE

Therapeutic efficacy of Thornton adjustable positioner in the management of patients with severe Obstructive sleep apnea : A Pilot study

BNBM Prasad, B Jayan, UR Kamat, OP Kharbanda, D Bhattacharrya

Keywords : Thornton adjustable positioner, severe Obstructive sleep apnea

Citation Information : Prasad B, Jayan B, Kamat U, Kharbanda O, Bhattacharrya D. Therapeutic efficacy of Thornton adjustable positioner in the management of patients with severe Obstructive sleep apnea : A Pilot study. Indian Sleep Med 2008; 3 (3):97-101.

DOI: 10.5005/ijsm-3-3-97

License: CC BY-SA 4.0

Published Online: 01-07-2008

Copyright Statement:  Copyright © 2008; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Mandibular advancement appliances (MAD) have long been used to treat OSA. Most of the international sleep medicine societies recommend MAD in mild and moderate OSA. Most studies with MAD exclude patients with severe OSA and include patients who failed other treatment modalities with significant source of bias. Cephalometric and BMI factors are often not factored while prescribing MAD. So we undertook a pilot study to evaluate the therapeutic efficacy of Thornton adjustable positioner (TAP), a titratable MAD in severe adult OSA cases. We have observed significant (p< .0001) improvement in Apnea-Hypopnea index and Epworth sleepiness scale. We concluded that factoring predictable cephalometric measurements, BMId ≤30 Kg/m2, and mandibular protrusion of 70%; severe OSA can be effectively managed with TAP.


PDF Share
  1. American Academy of Sleep Medicine (1995) Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances. Sleep 18:501-510. (Pub Med)
  2. An American academy of sleep medicine report. Practice parameters for treatment of snoring and obstructive sleep apnea with oral appliances. An update for 2005. Sleep2006. 29.240-243.
  3. Schwarting S, Huebers U, Heise M, Schlieper J, Hanschuld A. Position paper on the use of mandibular advancement devices in adults with sleep related breathing disorders. Sleep breath. 2007; 11(2):125-126.
  4. Lim J, Lasserson TJ, Fleethan J, Wright J. Oral appliances for obstructive sleep apnea. Cochrane database syst Rev. 2006; CD004435.
  5. Ferguson K. Oral appliances therapy for obstructive sleep apnea. Am J Resp. Crit Care Med. 2001;163(6):1294- 1295.
  6. Jayan B, Prasad BNBM, Rajput AK, Bhattacharya R, Dhiman RK, Management of a case of severe obstructive sleep apnea with acrylic herbst splint appliance. Indian Journal of Sleep Medicine 2006;1(2). 157-160.
  7. Jayan B, Prasad BNBM, Rajput AK, Bhattacharya R, Dhiman RK, Thampi PS. Management of obstructive sleep apnea with oral appliances: our experience. Indian Journal of sleep medicine. 2006;1(4):204-207.
  8. Clark WJ. Bite registration in Twin block technique. In Twin block functional appliance therapy: Applications in Dentofacial orthopaedics. Mosby-Wolfe. 1995 ; 25-26.
  9. Cartwright RD, Samelson CF. The effects of non surgical treatment for Obstructive sleep apnea. The tongue retaining device. JAMA.1982;248:705-709.
  10. Meyer-Ewert K, Schafer H, Klob W. Treatment of sleep apnea by mandibular protracting device. 7th European Congress of sleep research. Munchen.217.
  11. Lowe AA. Dental appliances for snoring and obstructive sleep apnea. In Kryger M, Roth T, Dement W (eds): Principles and practice of sleep medicine, ed 3. Philadelphia,WB Saunders, 2000; 929-939.
  12. Schmidt NW. Recent developments in oral appliance therapy of sleep disordered breathing. Sleep and breathing.1999;3.103-106.
  13. Myamoto K, Ozbek MM, Lowe AA et al. Mandibular posture in sleep in patients with obstructive sleep apnea. Arch Oral Biol. 1999; 44: 657-664.
  14. Kuna ST, Remmers JE. Neural and anatomical factors related to upper airway occlusion during sleep. Med Clinc North Am.1985;69:1221-1242.
  15. Schwab RJ, Gefter WB, Hoffman EA, Gupta KB, Pack AI. Dynamic airway imaging during awake respiration in normal subjects and patients with sleep disordered breathing. Am Rev Respir Dis. 1993;148:1385-1400.
  16. Rodenstein DO, Dooms G, Thomas Y, et al. Pharyngeal shape and size in healthy subjects, snorers and patients with obstructive sleep apnea. Thorax 1990; 45 : 722-727.
  17. Pancer J, Al-Faifi S, Al-Faifi M, Hoffstein V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest.1999; 116(6): 1511- 1518.
  18. Rose EC, Germann M, Sorichter S, Jonas IE. Case control study in the treatment of Obstructive sleep disordered breathing with mandibular protrusive appliance. J Orofac Orthop. 2004; 65: 489-500.
  19. Marklund M, Satilin C, Sterlund H, Persson M, Franklin KA. Mandibular advancement device in patients with obstructive sleep apnea : long term effects on apnea and sleep. Chest 2001;120(1):162-9.
  20. Ferguson K. Oral appliance therapy for Obstructive sleep apnea. Am J Resp Crit Care Med. 2001; 163 (6): 1294- 1295.
  21. Johnston CD, Gleadhill IC, Cinnamond MJ, Gabbey J, BurdenDJ. Mandibular advancement appliances and Obstructive sleep apnea: a randomized clinical trial. Eur J Orthod. 2003;.24(3): 251-262.
  22. Henke K, Frantz D, Kuna S. An Oral elastic mandibular advancement device for obstructive sleep apnea. An J Respir Crit Care Med 2000;161:420-425.
  23. Engstrom W, Louise M. Treatment effects with amandibular advancement appliance and Uvulo-pharyngoplasty in Obstructive sleep apnea : randomized control trials. Doctorol thesis. Uppsala university publications. 2003. (publications.uu.se/abstract.xsql?dbid=3376)
  24. Jayan B,Prasad BNBM, Kotwal A, Kharbanda OP, Roy Chowdhury SK, Gupta SH. The role of cephalometric analysis in obese and non obese urban Indian adults with obstructive sleep apnea syndrome: A Pilot study. Indian J Sleep Med. 2007; 2(2): 59-63.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.