Introduction: Sleep disturbances in children are found to be increasing over the past few years and the knowledge about their risk factors is limited among the medical and dental practitioners. Nutritional status could be one of the contributing factors for sleep problems in children.
Methodology: 500 school going children aged 4 to 10 years were included in the study. The sleep problems were assessed using a validated sleep questionnaire which was filled by the parents of the children and simultaneously the weight of the children was recorded. The data were documented and statistically analyzed.
Results: Sleep problems were found significantly higher in obese children. Also, a significant association was observed between obesity and the following sleep problems, i.e. snoring, observable lapses in breathing sleeps with mouth open and bed wetting.
Conclusion: Obesity can be considered as one of the risk factor for sleep problems in children.
Prasanna Kumar MP
How to cite this article:
Kumar S, Sharma M, Bansal A, Jayan B, Kumar MP P. Evaluation of Therapeutic Efficacy of Adjustable Mandibular Advancement Device in the Management of Obstructive Sleep Apnea. Indian Sleep Med 2018; 13 (1):5-12.
Introduction: Medical dental sleep appliance (MDSA) is an adjustable mandibular advancement device (MAD) recommended for treatment of snoring and obstructive sleep apnea (OSA). There are very few studies on Indian population which evaluate the therapeutic efficacy of mandibular advancement devices in the management of OSA.
Materials and Methods: A prospective clinical study was carried out. Twenty polysomnography diagnosed OSA patients fulfilling the inclusion and exclusion criteria were treated with MDSA and changes in pre and post-treatment sleep para-meters (apneahypopnea index (AHI) and epworth sleepliness scale (ESS)) were recorded.
Results: Mean differences in pre- (T1 = 30.7 ± 5.0) and posttreatment (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.
Sleep-disordered breathing and insomnia are the most common of the sleep disorders. Both these diseases are well defined, diagnosed and managed as per the current guidelines. The initial isolated reports of an overlap of these two diseases were published in the eighties. With newer studies post-2001, the existence of the comorbid obstructive sleep apnea (OSA) and upper airway resistance syndrome (UARS) with insomnia has been increasingly recognized. This disease entity has been referred with diverse unstandardized terminologies. UARS is a variant nomenclature of OSA as per International Classification of Sleep Disorders- third edition (ICSD-3). We hereby address it as the OSA–insomnia overlap syndrome throughout the text and review literature. Alike the ununiform terminology, there is lack of clear textbook/guideline definitions, diagnosis, and management of the OSA–insomnia overlap syndrome. Both have an interlinked pathophysiology. The clinical features and evaluation of the OSA–insomnia overlap syndrome share similarities to the diseases in isolation with exacerbation of overlapping features. An active search for the diagnosis of the overlap syndrome in patients visiting the sleep apnea clinic and insomnia clinic is mandatory as the identification helps in optimizing the management and difficulties in poor responders/ failures. Continuous positive airway pressure (CPAP) therapy with cognitive/behavior therapy for insomnia (CBTi) is the treatment of choice. A lot is yet to surface in the research of the OSA–insomnia overlap syndrome.
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Arora A, Gagnani S, Yadav R. Rapidly Developing Obstructive Sleep Apnea due to Fixation Failure of Atrophic Mandibular Bilateral Body Fractures. Indian Sleep Med 2018; 13 (1):18-20.
Introduction: The aim of this report was to present a case of obstructive sleep apnea (OSA) in a 74-year-old male secondary to 2 mm miniplates fixation failure.
Method: The patient had a preoperative apnea/hypopnea index of 21 and was successfully treated by 2.4 mm reconstruction plate for bifocal mandibular fracture and thus treating OSA.
Results: At two years follow-up, the patient has been doing well with no signs and symptoms of OSA.
Discussion: Treatment of atrophic mandibular fractures can certainly be challenging. Elderly, infirm patients, unopposed muscle pull, diminished blood supply, bone inadequate qualitatively and quantitatively for osteosynthesis, and inadequate ridges for stable splints or prostheses all lead to treatment that is difficult and prone to failure. Bifocal fractures that involve the anterior dentate region of the mandible may cause the lingual displacement of the central proximal fragment. Therefore, they can epitomize an important risk for the upper airways.
Bilateral body fracture in an edentulous mandible as a cause of OSA has never been reported in the literature. Here, we present such a case in a 74-years-old male patient who had a preoperative apnea/hypopnea index of 21 following the failed fixation from the original operation.