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Clinical Diagnosis and Management of Obstructive Sleep Apnea Syndrome

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Dentistry, Oral Surgery and Oral Medicine".

Deadline for manuscript submissions: 20 May 2026 | Viewed by 6227

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Special Issue Editors

Prof. Dr. Graziano Montaruli

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Guest Editor

Department of Clinical and Experimental Medicine, Dental School of Foggia, University of Foggia, Foggia, Italy
Interests: orthodontics; obstructive sleep apnea syndrom; osseointegration; implant dentistry; periodontology; oral surgery

Prof. Dr. Domenico Ciavarella

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Guest Editor

Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, FG, Italy
Interests: obstructive sleep apnea; temporomandibular joint disease; orthodontics; craniofacial morphology
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Prof. Dr. Michele Tepedino

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Guest Editor

Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, 67100 L’Aquila, Italy
Interests: osas; impacted canines; craniofacial growth; development; gnathology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

I hope this mail finds you well.

We are pleased to invite esteemed experts to contribute papers to our Special Issue. As a valued researcher, we would be honored to have you as a contributor.

This Special Issue will feature papers on the Journal of Clinical Medicine that aims to present up-to-date and pertinent findings concerning diagnosis, therapy and management of Obstructive Sleep Apnea Syndrome, with particular focus to the multidisciplinary aspects of this widespread pathology.

The prevalence of OSA is approximately 22% in men and 17% in women, it represents a condition with important social implications because of sleep deprivation and daytime sleepiness.

Obstructive Sleep Apnea Syndrome is becoming an increasingly studied disease because of its many comorbidities and consequences, although there’s a high prevalence of undiagnosed and untreated patients.

Nowadays it's clearly recognized as OSA is a risk factor for hypertension, heart failure, coronary artery disease, and so on.

Sleep fragmentation in patients with sleep apnea can also lead to neurocognitive and behavioral consequences.

Given your experience in the field, I do hope you will consider submitting an article. In this Special Issue, original research article and reviews are welcome.

Best wishes.

Prof. Dr. Graziano Montaruli
Prof. Dr. Domenico Ciavarella
Prof. Dr. Michele Tepedino
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

obstructive sleep apnea (OSA)
apnea-hypopnea index (AHI)
oxygen desaturation index (ODI)
mandibular advancement device (MAD)
polysomnography
upper airway
continuous positive airway pressure (C-PAP)

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Published Papers (4 papers)

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Research

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13 pages, 670 KB

Open AccessArticle

Maxillary Arch Expansion and Adenotonsillectomy in Prepubertal Children Diagnosed with Paediatric Obstructive Sleep Apnoea: An Interventional Study

by Derek Mahony, Niroj Bhattarai and Peter Petocz

J. Clin. Med. 2026, 15(8), 2981; https://doi.org/10.3390/jcm15082981 - 14 Apr 2026

Viewed by 1055

Abstract

Background: In many children aged 7–9 years diagnosed with obstructive sleep apnoea (OSA) the decision of which treatment to perform still remains unclear. This is particularly relevant when the children have both a narrow maxilla and enlargement of tonsils and adenoids. Current guidelines recommend adenotonsillectomy (TA) as first-line therapy, but residual OSA is common, prompting interest in adjunctive semi-rapid maxillary expansion (SRME). This study evaluated the effects of TA and SRME on the respiratory disturbance index (RDI) in prepubertal children with OSA, both individually and in combination, regardless of treatment sequence. Materials and Methods: In this retrospective cohort study, 80 children (aged 7–9 years) with polysomnography-confirmed obstructive sleep apnoea, narrow maxillary arches, and adenotonsillar enlargement underwent TA first followed by SRME (n = 39) or SRME first followed by TA (n = 41). Level 1 polysomnography was performed at baseline and 3 months after each intervention. Repeated-measures analyses investigated the RDI profiles of the two groups over time, in each case adjusting for relevant background variables. Results: Baseline mean RDI was 18.99 ± 1.66 events/hour. Adjusted for background variables (including, most importantly, BMI), the initial reduction was significantly greater after SRME than TA (adjusted mean difference 1.49 events/hour, p = 0.002), and this difference persisted until after both treatments were applied (adjusted mean difference 1.42, p = 0.007). Conclusions: Combined TA and SRME produced substantial RDI reductions compared to individual interventions in children with dual soft-tissue and skeletal OSA contributors, with treatment order (as well as BMI) significantly associated with different final outcomes. These findings support a flexible, multidisciplinary approach to optimise airway management and reduce residual disease. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management of Obstructive Sleep Apnea Syndrome)

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19 pages, 2478 KB

Open AccessArticle

Effects of Web-Based Orofacial Myofunctional Therapy on Hyoid Bone Position in Adults with Mild to Moderate Obstructive Sleep Apnea: Evidence from an Estonian Substudy of a Randomized Controlled Trial

by Andres Köster, Anh Dao Hoang, Andrey Dashuk, Heisl Vaher, Katrin Sikk and Triin Jagomägi

J. Clin. Med. 2026, 15(1), 257; https://doi.org/10.3390/jcm15010257 - 29 Dec 2025

Viewed by 1766

Abstract

Background: Orofacial myofunctional therapy (OMT) is an emerging adjunctive treatment for obstructive sleep apnea (OSA), but its effects on upper airway structural support, particularly the hyoid complex, are not well defined. This study assessed the short-term effects of OMT on hyoid bone position and sleep-related indices in adults with mild to moderate OSA. Methods: In this assessor-blinded randomized controlled trial (ClinicalTrials.gov Identifier: NCT06079073), 13 adults with mild to moderate OSA were randomized to a 12-week web-based OMT program (n = 9) or a waitlist control group (n = 4). Cone-beam computed tomography (CBCT) and three-night home sleep testing were performed at baseline and follow-up. The primary outcome was change in axis-based cephalometric hyoid position measures; secondary outcomes included sleep parameters such as the apnea–hypopnea index (AHI). Results: No significant within- or between-group differences were observed in AHI, oxygen desaturation index, or mean nocturnal SpO₂ after 12 weeks (all p > 0.05). However, several cephalometric variables showed significant between-group differences. The waitlist group exhibited greater posterior–inferior hyoid displacement than the OMT group, with large effect sizes across multiple vector measures (all p ≤ 0.045; r = 0.56–0.66). Posterior and inferior hyoid displacement was associated with higher AHI and lower SpO₂, whereas increased lower pharyngeal airway width was associated with lower AHI. Conclusions: Short-term OMT did not improve sleep-disordered breathing indices but was associated with stabilization of hyoid bone position. These findings suggest that structural stabilization may precede functional improvement and highlight the clinical relevance of vector-based hyoid analysis. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management of Obstructive Sleep Apnea Syndrome)

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12 pages, 1123 KB

Open AccessArticle

Impact of Mandibular Advancement Therapy on Occlusal Plane Orientation and Incisor Inclination in Obstructive Sleep Apnea Patients: A Retrospective Observational Study

by Mauro Lorusso, Michele Tepedino, Francesca Papa, Graziano Montaruli, Fariba Esperouz, Rossella Luciano, Giuseppe Burlon, Mario Dioguardi, Lucio Lo Russo and Domenico Ciavarella

J. Clin. Med. 2025, 14(23), 8309; https://doi.org/10.3390/jcm14238309 - 22 Nov 2025

Viewed by 889

Abstract

Objective: This observational study aimed to evaluate occlusal changes in patients with obstructive sleep apnea (OSA) treated with a mandibular advancement device after two years of therapy. Methods: Sixty adult patients with mild to moderate OSA (apnea–hypopnea index 15–30 events/h) were treated with the IMYS MAD for 24 months. Digital dental impressions were analyzed using Autodesk Meshmixer and Fusion 360 to measure sagittal, frontal, and occlusal angles, as well as upper incisor inclination at baseline (T0) and after treatment (T1). In addition, changes in the polysomnographic indices AHI and ODI were evaluated. Statistical analyses were performed using paired t-tests or Wilcoxon signed-rank tests depending on data normality (p < 0.05). Results: No significant differences were found between T0 and T1 in sagittal (IC 95% −2.053,1.433), occlusal (IC 95%, −1.202, 0.722) or frontal angles (IC 95% −1.487, 0.447), or in upper incisor inclination (IC 95%, 0.06,3.04). Polysomnographic parameters improved significantly, with mean AHI decreasing from 27.7 ± 12.3 (IC 95% 24.53–30.87) to 6.2 ± 4.0 events/h (IC 95% 5.17–7.27) and ODI from 19.7 ± 9.4 (IC 95% 17.27–22.13) to 4.7 ± 3.2 (IC 95% 3.82–5.48, p < 0.001). Conclusions: This study found that the IMYS MAD did not induce significant variations in occlusal plane orientation or upper incisors inclination after two years of treatment. These null findings suggest that the IMYS device may provide effective OSA management while minimizing the risk of occlusal or dental side effects. However, the retrospective design and the 24-month follow-up duration should be taken into consideration. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management of Obstructive Sleep Apnea Syndrome)

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Review

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12 pages, 864 KB

Open AccessReview

Western University Protocol for Obstructive Sleep Apnea

by Rehab Simsim and Brian Rotenberg

J. Clin. Med. 2026, 15(6), 2385; https://doi.org/10.3390/jcm15062385 - 20 Mar 2026

Cited by 1 | Viewed by 580

Abstract

Background/Objectives: Obstructive sleep apnea (OSA) is a prevalent disorder in adults, characterized by recurrent upper airway obstruction during sleep, resulting in intermittent hypoxia, sympathetic activation, and sleep fragmentation. It is linked to significant cardiovascular, metabolic, neurocognitive, and psychosocial morbidity. There is increasing evidence that continuous positive airway pressure (CPAP) adherence remains suboptimal in many patients, and in those patients, surgery is often indicated. Methods: This protocol report presents an updated and protocol-driven surgical approach grounded in clinical evidence and experience, highlighting the role of drug-induced sleep endoscopy (DISE) and personalized multi-level interventions for adult patients with OSA. The integration of anatomical phenotyping and DISE-directed planning enables precise surgical targeting. The protocol emphasizes patient selection, individualized treatment based on obstruction patterns, and perioperative optimization. This surgical algorithm improves the success rates and long-term outcomes in patients who are intolerant of CPAP therapy. Results: A DISE-guided and multi-level surgical approach includes uvulopalatoplasty, septoplasty, tongue base reduction, palatoplasty, and maxillomandibular advancement (MMA). Preoperative assessments include BMI and the STOP-BANG and Epworth Sleepiness scales, while postoperative care emphasizes follow-up polysomnography and adjunctive therapies only when necessary. Regional experiences in Saudi Arabia and Canada underscore the importance of standardized evidence-based surgical care. Conclusions: The purpose of this article is to establish a clear protocol for managing patients diagnosed with OSA, drawing on a review of the existing literature and the insights of experienced surgeons in the field of sleep apnea, and to update current protocols with modern evidence. Full article

(This article belongs to the Special Issue Clinical Diagnosis and Management of Obstructive Sleep Apnea Syndrome)

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