Although they may have similar pathophysiological mechanisms, because OSA and COPD are common, even by chance alone, a substantial number of patients are afflicted by both OSA and COPD-the overlap syndrome. Nocturnal oxygen desaturation is the most important pathophysiological effect of overlap syndrome. The morbidity and mortality of overlap syndrome is greater than that of either disease alone. During evaluation of patients with either OSA or COPD, a high index of suspicion is crucial to detect the overlap syndrome. The presence of daytime hypercapnia and pulmonary hypertension, in patients having either disease, especially when mild in severity, should prompt assessment for the other disorder. Currently, CPAP with or without oxygen therapy is the treatment of choice for overlap syndrome.
Airway Centric Orthodontics is a philosophy which trumps everything else in contemporary Orthodontics. The philosophy focuses on practice of clinical orthodontics aimed at achieving ideal jaw relationship, establish normal oral function and performance, optimal proximal and occlusal contact of teeth. The central aspect of function and performance is airway and breathing which in fact is hierarchically the most important function for humans. Ideal health and ideal facial development is dependent on correct tongue posture and nasal breathing. Therefore contemporary protocols be it Preventive, interceptive or corrective orthodontics should factor upper airway improvement in addition to improving smile and facial appearance. Today Orthodontic profession is crucial and integral part of the interdisciplinary team in the management of upper airway sleep disorders, thus well poised to become a part of mainstream health profession. The paper would revisit the decision making process in orthodontics and discuss orthodontic strategies to improve the vital human airway which is essential for good health, longevity, and well-being.
Background: Hypothyroidism and obstructive sleep apnea syndrome (OSAS) are common comorbid conditions with overlapping clinical presentation. We decided to study the association of hypothyroidism in our OSAS patients.
Methodology: This observational study included 108 patients with clinical features suggesting OSAS. The clinical details were noted; Polysomnography (PSG) and thyroid function tests (TFT) were done. Qualitative and quantitative data was analyzed with appropriate tests.
Results: Seventy-two (66.7%) men and 36 (33.3%) women were included. PSG confirmed OSAS in 78 (72.2%). The severity of OSAS was mild, moderate, severe in 30 (38%), 28 (36%), 20 (26%) respectively. Thirteen (12%) had hypothyroidism; subclinical in 2 (15%) and clinical in 11 (85%). Only 2 (15%) were on optimal medical treatment. Hypothyroidism was seen in 11(14%) of OSAS, against in 2(7%) of the non-OSAS group. OSAS was found in 11(85%) of hypothyroid, against in 67 (71%) of the Euthyroid group. A statistically significant association between OSAS and hypothyroidism treatment was observed.
Conclusion: The prevalence of hypothyroidism was higher in OSAS; though statistically insignificant. Association between OSAS and hypothyroidism treatment was statistically significant.
Amit Kumar Bansal,
Prasanna Kumar MP,
How to cite this article:
Kumar S, Sharma M, Jayan B, Bansal AK, MP PK, Thapa A. Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea. Indian Sleep Med 2016; 11 (4):151-160.
Background: Medical Dental Sleep Appliance (MDSA) is an adjustable MAD recommended for treatment of snoring and OSA. There are very few studies on Indian population which evaluate the therapeutic efficacy of mandibular advancement devices in the management of OSA.
Material and methods: A prospective clinical study was carried out. 20 Polysomnography diagnosed Obstructive Sleep Apnea patients fulfilling the inclusion and exclusion criteria were treated with MDSA and changes in pre and post treatment sleep parameters (AHI, ESS) were recorded.
Results: Mean differences in Pre-treatment (T1 = 30.7 ± 5.0) and post-treatment (T2 = 17.2 ± 3.9) AHI values and ESS pre-treatment (T1 = 17.2 ± 0.6) and post-treatment (T2 = 10.9 ± 0.9) were highly statistically significant (p < 0.001). Clinically the maximum improvement was observed in mild and moderate OSA cases. Although significant clinical improvement was also observed in severe OSA cases, the post treatment AHI and ESS were still high.
Conclusion: MDSA is a non invasive, low risk and cost-effective treatment option for patients suffering from mild and moderate obstructive sleep apnea and also in cases of severe OSA who are not comfortable with CPAP or not willing for surgery.