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Determining the efficacy of temporary mandibular advancement splint in mild to moderate obstructive sleep apnea patients at baseline polysomnography
Abstracts / Sleep Medicine 14S (2013) e165–e238
quency of sleep disorders (SD) and excessive daytime sleepiness (EDS) in patients with epilepsy and to identify the factors that are related to those described. Materials and methods: The factors analyzed included age, sex, type of epilepsy, duration of epilepsy disease, nocturnal seizures, frequency of seizures, electroencephalogram (EEG) interictal pathological, altered brain MRI, antiepileptic drug (AED) used; sleep quality, daytime sleepiness and mood disorders. Results: 58 patients were evaluated by interview and questionnaires on sleep quality (Pittsburgh scale), the degree of EDS (Epworth scale) and anxiety-depression (hospital depression and anxiety (HAD). The rest of the data were obtained from medical history. SD among patients with epilepsy studied had a prevalence of 55%. Significant differences were found between patients with sleep disorders versus (vs) patients with normal sleep in the following variables: frequency of difficulty (1 attacks/month: 8 (25%) vs 1 (4%): p 0.03), EDS (Epworth scale) 8 (25%) vs 1 (4%): p 0.03), presence of anxiety (HAD scale) 11 (22%) vs 3 (6%): p 0.001; presence of depression (HAD scale) 1 (4%) vs 10 (20%): p 0003. No significant differences between epileptic patients with and without sleep disorders when analyzing the rest of the variables. Conclusion: Sleep disorders are common among patients with epilepsy and are associated with a higher frequency of daytime sleepiness, anxiety and depression. It was shown that epileptic patients with sleep disorders showed a significant difference in seizure frequency of 1 time/month. However, this difference was not observed with a lower seizure frequency, possibly due to insufficient sample size. This would also explain the lack of association of other variables such as temporal lobe epilepsy, interictal EEG, AED disease and sleep disorders. While it is known the deleterious effect of epilepsy on sleep architecture, it is important to consider mood disorders predisposing factors of such alterations. Acknowledgements: Laura Zuccolo. http://dx.doi.org/10.1016/j.sleep.2013.11.556
Circadian and homeostatic processes influence daytime nap architecture S. Pereira, F. Beijamini, R. Spada, F. Menon, J. Clementin, F. Louzada Universidade Federal do Paraná, Brazil
Introduction: Besides being a useful tool for coping with sleep deprivation, naps can reduce sleepiness and improve cognitive performance. However, few studies so far have examined what factors regulate its structure. Therefore, we aimed to investigate if circadian preference influences daytime nap architecture. Materials and methods: Following a week of actigraphy monitoring of the sleep/wake cycle, a total of 43 healthy young adults (19 females, 22.16 (3.82) years) filled out the Morningness–Eveningness Questionnaire (MEQ) and took a 90 min polysomnographyrecorded nap. MEQ score, nocturnal sleep data and minutes of prior wakefulness were correlated with nap sleep variables. Results: There is a negative correlation between MEQ Score (47.93 (10.93)) and Slow Wave Sleep% (SWS) (r = .364, p = .044) and a positive correlation with Stage N1% (r = .371, p = .014), meaning that morning preference is associated with increased SWS and decreased N1 in a daytime nap. No correlations were found between MEQ Score and total sleep time (nap or nocturnal, for either the previous night or the mean 5 previous nights), Stage N2%, or REM%. The mean 5 previous nights bedtime (r = .381, p = .038) and wake time (r9 = .362, p = .049) were also negatively correlated with SWS, whereas the previous night bedtime (r = .375, p = .013) and wake time (r = .302, p = .049) were positively correlated with N1, that is, going to bed
e231
and waking up earlier predicted greater SWS% and smaller N1%, supporting MEQ Score correlations. To rule out homeostatic sleep drive as an explanation for increased nap SWS in individuals with a morning preference, minutes of prior wakefulness were correlated with nap sleep data. No association was found between homeostatic sleep drive and SWS (r = 0,244, p > 0.05). However, increasingly amounts of N1 were associated with less time between waking and napping (r = 0.370, p = 0.015). Conclusion: Morningness is associated with increased SWS in a daytime nap and prior wakefulness predicts time spent in N1, in healthy young adults. It is possible that this is because the scheduled nap timing was more suitable for individuals with a morning preference. Both components (circadian and homeostatic) should be taken into account when prescribing naps to ensure maximal restorative effects. Acknowledgements: Supported by grants from CAPES and CNPq. We would like to thank all the subjects that volunteered for this study. http://dx.doi.org/10.1016/j.sleep.2013.11.557
Determining the efficacy of temporary mandibular advancement splint in mild to moderate obstructive sleep apnea patients at baseline polysomnography W. Phuapradit 1, P. Mahakit 2 1 Phramongkutklao Hospital, Dental Department 2 Phramongkutklao Hospital, Otolaryngology Department
Introduction: Mandibular advancement splint (MAS) have become increasingly popular as alternatives to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). However, the acceptance of MAS is limited to the efficacy rate of 50–70% and inability to predict which patients will respond to this treatment. To overcome this limitation, the temporary mandibular advancement titration was performed in mild to moderate OSA patients dsuring baseline polysomnography (PSG) Objective: To determine the efficacy of temporary mandibular advancement splint in mild to moderate OSA patients during baseline polysomnography (PSG). Materials and methods: This pilot study consisted of ten undiagnosed subjects with OSA symptoms. The Temporary mandibular advancement splint, fabricated at 50% and 70% of maximum jaw protrusion, had been delivered to all subjects before each subject underwent baseline PSG. After the first half of the night, five subjects had severe OSA (AHI > 30) and CPAP titration was performed in this group,four subjects had mild to moderate OSA (AHI 5–30) and temporary mandibular advancement splint titration was performed in this group, one subjects was normal (AHI < 5) and no any device was performed on this subject. Results: Mean apnea–hypopnea index (AHI) was significantly reduced from 20.60(SD 8.28) to 5.65(SD 4.49) after treatment with Temporary mandibular advancement splint (p < 0.05). Three patients were considered treatment success and one patient was considered treatment failure as defined by AHI < 5. Conclusion: This pilot study shows that it is possible to utilize temporary mandibular advancement splint titration in mild to moderate OSA patients during baseline PSG and these results suggest that temporary mandibular advancement splint can be used as a tool in predicting treatment response in terms of efficacy piro to oral appliance therapy by means of using mandibular advancement splint in treating OSA. Acknowledgements: This study is granted by dental department,Phramongkutklao hospital, Bangkok, Thailand. http://dx.doi.org/10.1016/j.sleep.2013.11.558
quency of sleep disorders (SD) and excessive daytime sleepiness (EDS) in patients with epilepsy and to identify the factors that are related to those described. Materials and methods: The factors analyzed included age, sex, type of epilepsy, duration of epilepsy disease, nocturnal seizures, frequency of seizures, electroencephalogram (EEG) interictal pathological, altered brain MRI, antiepileptic drug (AED) used; sleep quality, daytime sleepiness and mood disorders. Results: 58 patients were evaluated by interview and questionnaires on sleep quality (Pittsburgh scale), the degree of EDS (Epworth scale) and anxiety-depression (hospital depression and anxiety (HAD). The rest of the data were obtained from medical history. SD among patients with epilepsy studied had a prevalence of 55%. Significant differences were found between patients with sleep disorders versus (vs) patients with normal sleep in the following variables: frequency of difficulty (1 attacks/month: 8 (25%) vs 1 (4%): p 0.03), EDS (Epworth scale) 8 (25%) vs 1 (4%): p 0.03), presence of anxiety (HAD scale) 11 (22%) vs 3 (6%): p 0.001; presence of depression (HAD scale) 1 (4%) vs 10 (20%): p 0003. No significant differences between epileptic patients with and without sleep disorders when analyzing the rest of the variables. Conclusion: Sleep disorders are common among patients with epilepsy and are associated with a higher frequency of daytime sleepiness, anxiety and depression. It was shown that epileptic patients with sleep disorders showed a significant difference in seizure frequency of 1 time/month. However, this difference was not observed with a lower seizure frequency, possibly due to insufficient sample size. This would also explain the lack of association of other variables such as temporal lobe epilepsy, interictal EEG, AED disease and sleep disorders. While it is known the deleterious effect of epilepsy on sleep architecture, it is important to consider mood disorders predisposing factors of such alterations. Acknowledgements: Laura Zuccolo. http://dx.doi.org/10.1016/j.sleep.2013.11.556
Circadian and homeostatic processes influence daytime nap architecture S. Pereira, F. Beijamini, R. Spada, F. Menon, J. Clementin, F. Louzada Universidade Federal do Paraná, Brazil
Introduction: Besides being a useful tool for coping with sleep deprivation, naps can reduce sleepiness and improve cognitive performance. However, few studies so far have examined what factors regulate its structure. Therefore, we aimed to investigate if circadian preference influences daytime nap architecture. Materials and methods: Following a week of actigraphy monitoring of the sleep/wake cycle, a total of 43 healthy young adults (19 females, 22.16 (3.82) years) filled out the Morningness–Eveningness Questionnaire (MEQ) and took a 90 min polysomnographyrecorded nap. MEQ score, nocturnal sleep data and minutes of prior wakefulness were correlated with nap sleep variables. Results: There is a negative correlation between MEQ Score (47.93 (10.93)) and Slow Wave Sleep% (SWS) (r = .364, p = .044) and a positive correlation with Stage N1% (r = .371, p = .014), meaning that morning preference is associated with increased SWS and decreased N1 in a daytime nap. No correlations were found between MEQ Score and total sleep time (nap or nocturnal, for either the previous night or the mean 5 previous nights), Stage N2%, or REM%. The mean 5 previous nights bedtime (r = .381, p = .038) and wake time (r9 = .362, p = .049) were also negatively correlated with SWS, whereas the previous night bedtime (r = .375, p = .013) and wake time (r = .302, p = .049) were positively correlated with N1, that is, going to bed
e231
and waking up earlier predicted greater SWS% and smaller N1%, supporting MEQ Score correlations. To rule out homeostatic sleep drive as an explanation for increased nap SWS in individuals with a morning preference, minutes of prior wakefulness were correlated with nap sleep data. No association was found between homeostatic sleep drive and SWS (r = 0,244, p > 0.05). However, increasingly amounts of N1 were associated with less time between waking and napping (r = 0.370, p = 0.015). Conclusion: Morningness is associated with increased SWS in a daytime nap and prior wakefulness predicts time spent in N1, in healthy young adults. It is possible that this is because the scheduled nap timing was more suitable for individuals with a morning preference. Both components (circadian and homeostatic) should be taken into account when prescribing naps to ensure maximal restorative effects. Acknowledgements: Supported by grants from CAPES and CNPq. We would like to thank all the subjects that volunteered for this study. http://dx.doi.org/10.1016/j.sleep.2013.11.557
Determining the efficacy of temporary mandibular advancement splint in mild to moderate obstructive sleep apnea patients at baseline polysomnography W. Phuapradit 1, P. Mahakit 2 1 Phramongkutklao Hospital, Dental Department 2 Phramongkutklao Hospital, Otolaryngology Department
Introduction: Mandibular advancement splint (MAS) have become increasingly popular as alternatives to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). However, the acceptance of MAS is limited to the efficacy rate of 50–70% and inability to predict which patients will respond to this treatment. To overcome this limitation, the temporary mandibular advancement titration was performed in mild to moderate OSA patients dsuring baseline polysomnography (PSG) Objective: To determine the efficacy of temporary mandibular advancement splint in mild to moderate OSA patients during baseline polysomnography (PSG). Materials and methods: This pilot study consisted of ten undiagnosed subjects with OSA symptoms. The Temporary mandibular advancement splint, fabricated at 50% and 70% of maximum jaw protrusion, had been delivered to all subjects before each subject underwent baseline PSG. After the first half of the night, five subjects had severe OSA (AHI > 30) and CPAP titration was performed in this group,four subjects had mild to moderate OSA (AHI 5–30) and temporary mandibular advancement splint titration was performed in this group, one subjects was normal (AHI < 5) and no any device was performed on this subject. Results: Mean apnea–hypopnea index (AHI) was significantly reduced from 20.60(SD 8.28) to 5.65(SD 4.49) after treatment with Temporary mandibular advancement splint (p < 0.05). Three patients were considered treatment success and one patient was considered treatment failure as defined by AHI < 5. Conclusion: This pilot study shows that it is possible to utilize temporary mandibular advancement splint titration in mild to moderate OSA patients during baseline PSG and these results suggest that temporary mandibular advancement splint can be used as a tool in predicting treatment response in terms of efficacy piro to oral appliance therapy by means of using mandibular advancement splint in treating OSA. Acknowledgements: This study is granted by dental department,Phramongkutklao hospital, Bangkok, Thailand. http://dx.doi.org/10.1016/j.sleep.2013.11.558