Search Results (44)

Background: Obstructive sleep apnea (OSA) is a highly prevalent and heterogeneous disorder associated with substantial cardiometabolic morbidity. Although continuous positive airway pressure (CPAP) remains first-line therapy, long-term effectiveness is frequently limited by suboptimal adherence. Advances in airway devices, surgical techniques, neuromodulation, and pharmacologic therapies have expanded the therapeutic landscape and created opportunities for individualized, mechanism-based treatment. Methods: We conducted a selective, narrative review with structured quantitative synthesis of randomized controlled trials, comparative cohorts, long-term follow-up studies, registries, and mechanistic investigations addressing OSA therapies beyond CPAP. Evidence spanning oral appliances, upper-airway and skeletal surgery, hypoglossal nerve stimulation, neuromuscular electrical stimulation, positional therapy, and pharmacologic interventions targeting metabolic and non-anatomical endotypes was integrated. Outcomes of interest included apnea–hypopnea index (AHI), oxygenation, blood pressure, patient-reported symptoms, durability, safety, and real-world adherence. Results: Mandibular advancement devices (MADs) consistently reduced AHI relative to placebo and produced symptom relief comparable to CPAP in mild-to-moderate OSA, largely due to superior adherence. Palatal surgery yielded meaningful short-term improvement in selected patients but demonstrated limited long-term durability. In contrast, maxillomandibular advancement (MMA) achieved the largest and most durable reductions in OSA severity, with efficacy comparable to CPAP and superior to other surgical modalities in appropriate skeletal phenotypes. Hypoglossal nerve stimulation (HNS) produced substantial, durable improvements in AHI and symptoms with high adherence, supported by randomized trials, long-term follow-up, and real-world registry data; newer bilateral and proximal stimulation systems may further broaden candidacy. Neuromuscular electrical stimulation and positional therapy provided modest, phenotype-dependent benefits, primarily as adjunctive or early-stage interventions. A major advance is the emergence of metabolic and endotype-targeted pharmacotherapy: longitudinal data demonstrate a dose-dependent relationship between weight change and OSA progression or regression, while randomized trials show that GLP-1-based therapies—particularly dual GLP-1/GIP agonism with tirzepatide—produce large, clinically meaningful reductions in AHI and cardiometabolic risk in obesity-associated OSA. Additional pharmacologic strategies targeting ventilatory loop gain and arousal threshold further support an endotype-driven treatment paradigm. Conclusions: Contemporary OSA management is shifting from a CPAP-centric model toward a precision-guided, multimodal framework that aligns therapy with dominant anatomic and physiological contributors to airway collapse. Integrating metabolic, neuromodulatory, and structural interventions—often in combination—offers the potential for durable disease control and improved patient-centered outcomes. Future priorities include head-to-head and combination trials, long-term cardiovascular outcomes, cost-effectiveness analyses, and pragmatic tools to operationalize personalized OSA therapy in routine clinical practice. Full article

Background: Obstructive sleep apnea is characterized by recurrent upper airway obstruction during sleep, leading to intermittent hypoxemia, sleep fragmentation, and excessive daytime sleepiness. Affecting up to 11% of the adult Polish population and more commonly diagnosed in men, OSA poses a major public health concern due to its association with cardiovascular, metabolic, and neurocognitive complications. This review summarizes the current evidence on diagnostic methods, risk factors, and therapeutic approaches, with particular emphasis on oral appliance therapy using mandibular advancement devices (MADs). Methods: A systematic literature review was conducted using the PubMed and Scopus databases, covering publications from 2020 to 2025, including clinical trials, meta-analyses, and systematic reviews evaluating the efficacy and safety of MAD therapy. Results: Findings demonstrate that MAD effectively reduces apnea–hypopnea index (AHI) values, improves oxygen saturation, and alleviates snoring and daytime fatigue, offering a patient-tolerable alternative for those intolerant to continuous positive airway pressure (CPAP). However, long-term use may cause occlusal or dental changes. Novel techniques, such as Er:YAG laser therapy, show potential in treating mild OSA. Moreover, epidemiological data suggest a correlation between tooth loss and an increased risk of OSA, particularly among men over 65. Conclusions: Dentists play a pivotal role in early detection, screening, and interdisciplinary management of OSA, underscoring the importance of collaboration between dental professionals and sleep medicine specialists for comprehensive care. Full article

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

Background: Mandibular advancement device (MAD) therapy is a non-invasive treatment for obstructive sleep apnea (OSA). Although the effect of MAD on OSA outcomes is widely known, its effect on the upper airway collapse degree remains poorly understood. This study aimed to assess the impact of MAD therapy on site-specific airway collapse degree during drug-induced sleep endoscopy (DISE). Methods: One hundred participants were recruited and underwent a baseline polysomnography. Overall, 69 participants with OSA (AHI 5–50 events/h) underwent DISE at baseline and with MAD set to 75% of maximal mandibular protrusion. Collapse degree (none, partial, complete) was evaluated at the palate, oropharynx, tongue base, hypopharynx, and epiglottis without and with MAD. Ordinal logistic regression was used to analyze changes in degree of collapse. Results: MAD therapy reduced collapse degree at the palate (OR = 5.92 [3.28; 10.66], p < 0.001), oropharynx (OR = 2.70 [1.48; 4.92], p = 0.001), tongue base (OR = 1.83 [1.32; 2.53], p < 0.001), and hypopharynx (OR = 2.90 [1.53; 5.48, p = 0.001), with no effect at the epiglottis (OR = 0.65 [0.42; 1.02], p = 0.058). Conclusions: MAD therapy reduces upper airway collapse at most anatomical levels, except at the level of the epiglottis. These findings confirm its therapeutic efficacy while underscoring the importance of identifying patients with residual or worsening collapse who may benefit from combined or alternative treatments. Full article

Obstructive sleep apnoea (OSA) is a complex health condition associated with significant health risks and diminished quality of life. Despite continuous positive airway pressure (CPAP) being the gold standard treatment for years, its poor adherence is well documented. With the emergence of drug-induced sleep endoscopy (DISE) and phenotypic approach to OSA, traditional surgical and non-surgical treatment pathways have been improved to allow personalised treatment and minimising suboptimal treatment to patients demonstrating various upper airway obstruction of OSA endotypes. Sedation protocol propofol, midazolam and dexmedetomidine have been suggested. The VOTE classification for documenting DISE findings have been proposed to unify results across studies. DISE plays an invaluable role in offering insights on treatment successes for positive airway pressure (PAP) therapy, mandibular advancement device (MAD) therapy, positional therapy, and surgical interventions including palatal surgeries, tongue base surgeries, upper airway stimulation (UAS) surgery and maxillomandibular advancement (MMA). This review aims at consolidating current evidence on DISE protocols, indications, and treatment implications to improve therapeutic success in OSA management. Full article

Background: Mandibular advancement devices (MADs) are widely used for mild-to-moderate obstructive sleep apnea (OSA). We aimed to synthesize recent evidence on their clinical effectiveness and tolerability. Methods: A systematic review was conducted. Ten studies were included, evaluating MAD therapy in adults with mild-to-moderate OSA. The review reported on standard outcomes, including the apnea-hypopnea index (AHI), oxygenation, daytime sleepiness (Epworth Sleepiness Scale, ESS), quality of life, adherence, and adverse events. Risk of bias was also assessed. Results: Across the included studies, MADs consistently reduced AHI from baseline and improved ESS and/or snoring. In head-to-head comparisons, MADs generally yielded smaller reductions in AHI than CPAP but achieved comparable improvements in symptoms and quality of life, with higher nightly adherence. Reported adverse effects were mostly mild and transient. Conclusions: MAD therapy is an effective and generally well-tolerated option for adults with mild-to-moderate OSA and for the patients intolerant to CPAP, although average AHI reduction is smaller than with CPAP. Given the low certainty and heterogeneity of current evidence, high-quality randomized trials with objective adherence tracking and standardized titration are needed. Full article

Background: Mandibular advancement devices (MADs) are considered an effective therapeutic option for managing obstructive sleep apnea syndrome (OSAS) in adults. Obstructive sleep apnea (OSA) is associated with a range of comorbidities, notably cardiovascular disease. The aim of the present retrospective study is to evaluate respiratory and cardiovascular parameters in OSA patients treated with a MAD. Methods: A total of 64 adults with OSA from moderate-to-severe OSAS underwent split-night polysomnography (SN-PSG) at baseline (T0) and after three months of treatment with a MAD (T1) and were subsequently analyzed using statistical methods for a comparative evaluation. Results: After 3 months of treatment, patients showed a significant decrease in mean heart rate (p < 0.05), maximum heart rate (p < 0.01) and in both the AHI and ODI (p < 0.01), along with a significant increase in minimum heart rate (p < 0.05).Conclusions: These findings indicate that MAD therapy may contribute to improvements in both respiratory efficiency and cardiovascular function in individuals with OSAS, offering a valuable integrated treatment strategy for patients with coexisting cardiovascular conditions. Full article

Background: Obstructive sleep apnea (OSA) is a prevalent disorder in both pediatric and adult populations, characterized by substantial morbidity encompassing cardiovascular, neurocognitive, and metabolic impairments. Management strategies vary by age group and underlying etiology, with orthodontic and non-orthodontic interventions playing key roles. This narrative review synthesizes the current evidence on orthodontic and non-orthodontic therapies for OSA in pediatric and adult populations, emphasizing individualized, multidisciplinary care approaches and highlighting future research directions. Methods: A narrative review was conducted using PubMed, Scopus, and Google Scholar to identify studies on diagnosis and management of OSA in children and adults from 2000 to 2025. Results: In pediatric patients, treatments such as rapid maxillary expansion (RME), mandibular advancement devices (MADs), and adenotonsillectomy have shown promising outcomes in improving airway dimensions and reducing apnea–hypopnea index (AHI). For adults, comprehensive management includes positive airway pressure (PAP) therapy, oral appliances, maxillomandibular advancement (MMA) surgery, and emerging modalities such as hypoglossal nerve stimulation. Special attention is given to long-term treatment outcomes, adherence challenges, and multidisciplinary approaches. Conclusions: The findings highlight the need for individualized therapy based on anatomical, functional, and compliance-related factors. As the understanding of OSA pathophysiology evolves, orthodontic and adjunctive therapies continue to expand their role in achieving durable and patient-centered outcomes in sleep apnea management. Full article

Background/Objectives: Mandibular advancing devices (MADs) are removable intraoral apparatuses to use during sleep that modify the spatial position of the mandible, increasing airway patency and improving respiratory function at night in patients with obstructive sleep apnea syndrome (OSAS). Methods: In this work, a new mandibular advancement device useful for mild-to-moderate OSAS patients is presented. It is developed through a CAD–CAM process and involves a passive propulsion of the mandible thanks to the attraction of rare-earth magnets positioned in the thickness of two thermally molded PET-G devices. The use of a PET-G device compared to traditional resin ones offers several clinical advantages related to the innovative characteristics of this polymer, which allows the fabrication of thinner devices, with high resistance to fluid corrosion, resulting in less bulk inside the oral cavity. Results: The innovative feature of the device proposed by the authors is that mandibular propulsion induced by the attraction of the magnetic jigs is not affected by a patient’s mandibular posture during sleep. Conclusions: The original apparatus proposed by the authors determines a mesializing movement of the jaw through a different mechanism to traditional MADs and presents the great advantage of a digital and CAD–CAD workflow that can be developed directly by the clinicians in the practice. Full article

Background/Objectives: One prior study revealed that a newly developed auto-titrating mandibular advancement device (AMAD) could potentially enhance polysomnographic outcomes in individuals with obstructive sleep apnea (OSA). However, evidence regarding its impact on autonomic nervous system dysregulation in OSA remains limited. In this study, we aimed to compare the effects of conventional mandibular advancement devices (MADs) and AMDA on autonomic function. Methods: We retrospectively reviewed data from patients who visited a sleep center with complaints of snoring and sleep apnea (30 and 15 patients in the conventional MAD and AMAD groups, respectively). We assessed heart rate variability (HRV) frequency-domain metrics such as total power (TP), very low frequency (VLF), low frequency (LF), and high frequency (HF) using ultra-short-term and short-term modalities, assessing sympathetic and parasympathetic activity changes across treatment groups. Results: Conventional MAD treatment was associated with reductions in LF and LF/HF ratios, whereas AMAD treatment was linked to decreases in TP, VLF, LF, and LF/HF ratios. Notably, in patients with moderate OSA, LF values were significantly lower in the AMAD group than in the conventional MAD group. Conclusions: These findings suggest that both devices could reduce sympathetic over-activity in patients with OSA, with AMAD demonstrating greater efficacy, particularly in those with moderate OSA. Full article

Background: The widespread prevalence of obstructive sleep apnea (OSA) underscores the necessity for effective therapies. Mandibular advancement devices (MADs) have emerged as valid treatment for mild to moderate cases, despite the associated dental side effects. Methods: This study evaluates the nature, onset, and long-term manifestation of these side effects. In the prospective group (n = 12), dental impressions were taken pre-MAD-insertion and at intervals of three, six, nine, and twelve months post-insertion to monitor occlusal alterations. In the retrospective group, participants (n = 8) wearing MADs for 7 years at average underwent lateral cephalogram assessments to compare with pre-treatment X-rays. All participants completed a specific questionnaire. Statistical analysis was performed via t-test and with p < 0.05 as the significance level. Results: The majority of participants in both groups consistently used MADs and reported significant sleep quality improvements, rating common symptoms like jaw tension as negligible. In both the prospective group and the retrospective group, significant reductions in overjet were observed at multiple time points, with the prospective group showing reductions at six months (p = 0.001), nine months (p > 0.001), and twelve months (p = 0.019), while the retrospective group indicated a notable decrease between baseline and follow-up assessments after a mean of seven years of device wear (p = 0.004). A slight overbite increase of 0.2 mm was prospectively observed after one year, whereas a trend towards a minimal decrease over the long term was observed in the retrospective sample (p = 0.003). Noteworthy changes in angle class or lower incisor inclination were absent. Cephalograms revealed significant IOK-NL angle alterations with a mean of 98.2° before and 95.2° upon long-term treatment (p = 0.020). Conclusions: These findings suggest that MADs are effective in treating OSA with minor adverse effects. This study advocates for moderate mandibular protrusion to balance therapeutic efficacy with dental health considerations, crucial for optimizing treatment outcomes. Nonetheless, the limited sample size warrants caution when generalizing these results to the broader population. Full article

Background: Obstructive sleep apnea syndrome (OSA) is a chronic inflammatory disease characterized by endothelial dysfunction and cardiovascular complications. Continuous positive airway pressure (CPAP) is the standard treatment, hence poor adherence has prompted interest in mandibular advancement devices (MAD) as an alternative. This comprehensive review aimed to explore the effects of MAD therapy on oxidative stress, inflammation, endothelial function, and its impact on the cardiovascular risk in OSA patients. Results: MAD therapy significantly reduces the apnea-hypopnea index (AHI), improves serum nitric oxide (NOx) concentrations, reduces oxidative stress markers, and enhances endothelial function. Animal studies indicated that MAD reduces myocardial fibrosis and attenuates inflammatory markers. While both CPAP and MADs improve endothelial function and heart rate variability, CPAP is more effective in reducing OSA severity. Nevertheless, MAD has higher compliance, contributing to its positive impact on cardiovascular function. Moreover, CPAP and MADs have similar effectiveness in reducing cardiovascular risk. Conclusions: MAD therapy is an effective alternative to CPAP, particularly for patients with mild to moderate OSA as well as those intolerant to CPAP. It offers significant improvements in endothelial function and oxidative stress. Further studies are needed to assess MAD therapy in comprehensive OSA management. Full article

Obstructive sleep apnea (OSA) is a heterogenous disease process that cannot be adequately categorized by AHI alone. There is a significant prevalence of OSA in the general population with ongoing efforts to evaluate the risk factors contributing to OSA and its associated clinical implications. Only by improving our understanding of OSA can we advance our methods in the diagnosis and treatment of OSA. For this article, the authors reviewed keywords of obstructive sleep apnea diagnosis and therapy in the databases of Embase, Medline, and Medline ePub over the past 3 years, excluding any articles that only addressed sleep apnea in children under age 17 years. This review article is divided into three main sections. First, we will investigate the use of novel screening tools, biomarkers, anthropometric measurements, and novel wearable technologies that show promise in improving the diagnosis of OSA. There is mention of comorbid conditions seen in OSA patients since certain disease combinations can significantly worsen health and should raise our awareness to diagnose and manage those concomitant disorders. The second section will look at the current and developing treatment options for OSA. These include positive airway therapy (PAP), mandibular advancement device (MAD), exciting new findings in certain medications, orofacial myofunctional therapy (OMT), hypoglossal nerve stimulation therapy (HGNS), and other surgical options. We will conclude with a section reviewing the current Clinical Practice Guidelines for Diagnostic Testing in Adults with Obstructive Sleep Apnea from 2017, which strongly advises polysomnography (PSG) or home sleep apnea testing (HSAT), along with comprehensive sleep evaluation for uncomplicated patients with a clinical presentation of OSA. Full article

Background: Mandibular advancement devices (MADs) are considered a primary alternative treatment for adults with moderate to severe obstructive sleep apnea (OSA) who are unable to tolerate or do not respond to continuous positive airway pressure (CPAP) therapy, supported by substantial scientific evidence. While a range of designs and materials for MADs are commercially available, there is a lack of clear diagnostic guidelines to assist clinicians in selecting the most appropriate device based on a multidisciplinary evaluation of OSA patients. This narrative review seeks to outline the key characteristics of MADs that clinicians should evaluate during both the diagnostic and treatment phases for patients with OSA. Methods: An extensive search of academic databases was conducted to gather relevant studies that address therapeutic and diagnostic recommendations for the design and titration of MADs. The search was carried out across EMBASE, Scopus, PubMed, and Web of Science up to May 2024. From a total of 1445 identified citations, 1103 remained after duplicate removal. Based on the inclusion criteria, the full text of 202 articles was retrieved, and 70 studies were ultimately included in this review. The extracted data were organized to generate clinical insights, aimed at guiding orthodontists in optimizing diagnostic and decision-making processes for treating OSA patients with MADs. Results: The analysis led to the identification of key clinical questions that can assist orthodontists in enhancing their approach and choosing the appropriate appliance basing on the diagnosis and clinical dento-orofacial characteristics. Conclusions: Bibloc appliances could be preferred over mono-bloc devices due to the possibility of arranging the mandibular advancement according to the patient’s clinical condition and orofacial symptoms. Provisional devices could be used as screening tools to verify the patient’s adherence to the therapy. Regardless of the MAD design, type and programmed advancement, it must be under-lined that the rule of the orthodontist/dental specialist is secondary to the other sleep-medicine specialists (ORL, pulmonologist) and must be related to (1) a preliminary assessment of MAD usage (dental anatomical conditions), (2) testing a diagnostic MAD usable during a sleep examination (PSG or DISE), (3) final treatment with a definitive MAD. Full article

Obstructive sleep apnea (OSA) is a sleep disorder characterized by repetitive episodes of partial or complete obstruction of the upper airway during sleep. Continuous positive airway pressure (CPAP) is a method used as a first-line treatment for obstructive sleep apnea (OSA). However, intolerance and resistance to CPAP can limit its long-term effectiveness. Alternative treatments are available, such as Mandibular Advancement Devices (MADs), positional therapy, upper airway surgery, and maxillomandibular osteotomy. However, often less efficient in reducing the apnea-hypopnea index, the higher tolerance of and compliance to alternative treatment has resulted in the adequate treatment of OSA in CPAP-intolerant patients. This paper describes the protocol of a prospective single-center cohort study including adult patients with moderate to severe OSA (15 events/h ≤ apnea-hypopnea index (AHI) < 65 events/h) that failed to comply with CPAP therapy. Selected patients will be invited to the clinic to explore alternative treatment options where DISE will be a first step in further identifying upper airway collapse during sleep. By exploring alternative treatment options in CPAP-intolerant patients and systematically documenting their treatment paths, an algorithm can be defined to better guide patients towards personalized treatment for OSA. The follow-up is aimed at 5 years with an inclusion of 170 patients per year, including a drop-out rate of 15%. By leveraging a real-world database, this study aims to bridge the gap between research and clinical practice, facilitating the development of evidence-based guidelines and personalized treatment algorithms for CPAP-intolerant patients. Full article