dr. sc. GALIĆ TEA, dr. dent. med.
: OUTCOMES OF OBSTRUCTIVE SLEEP APNEA TREATMENT BY INTRAORAL SPLINTS
Doctoral dissertation full text
prof. dr. sc. ĐOGAŠ ZORAN
Qualifying research publications:
*Galic T*, Bozic J, Ivkovic N, Gunjaca G, Ticinovic Kurir T, Dogas
Z. Effects of mandibular advancement device treatment on arterial stiffness
and glucose metabolism in patients with mild to moderate obstructive sleep
apnea: a prospective 1 year study. Sleep Breath 2016;20:69-77.
IF (JCR 2015) 2.332
*Galic T*, Bozic J, Pecotic R, Ivkovic N, Valic M, Dogas Z.
Improvement of cognitive and psychomotor performance in patients with mild
to moderate sleep apnea treated with mandibular advancement device: a
prospective 1 year study. J Clin Sleep Med 2016;12:177-186.
IF (JCR 2015) 2.710
OSA is a sleep-disordered breathing characterized by recurrent episodes of the upper airway collapse during sleep associated with repetitive partial or complete interruptions of breathing during sleep. There is an independent association between OSA and the risk for cardiovascular events. OSA is associated with impaired endothelial function and elevated risk of cardiovascular morbidity and mortality. Moreover, OSA may contribute to the development of insulin resistance and type 2 diabetes. OSA is also associated with the range of significant psychological and cognitive consequences, suboptimal speed of thinking and responding, which is crucial in driving performance and associated with the risk for motor vehicle accidents. More recently, oral appliances have been proven to be effective treatment for OSA. Oral appliances are indicated in patients with mild to moderate OSA (10 ≤ AHI ≤ 30 events/h), as well as for those patients who do not tolerate or comply with CPAP.
The aim of this study was to investigate the potential benefits of MAD therapy in patients with mild to moderate OSA over the course of 1 year, specifically assessing its effects on polysomnographic data, respiratory parameters and oxygen blood saturation, arterial stiffness and the set of selected metabolic parameters. In the second study the aim was to to investigate the potential benefits of MAD therapy in patients with mild to moderate OSA over the course of 1 year on long-term cognitive and psychomotor performance and quality of life.
A total of 15 patients with mild to moderate OSA were treated with MAD and were followed up after 3 months and 1 year of therapy. Physical examination, sleep studies in the sleep center, arterial stiffness assessment and laboratory analyses were obtained at the baseline and at the time of follow-up. The patients were tested on three different tests of cognitive and psychomotor performance (CRD-series) and questionnaires (ESS and SF-36) were used to assess their quality of life and excessive daytime sleepiness.
There was a significant decrease in AHI after 1 year of therapy when compared to baseline (22.2±5.9 to 9.7±4.5, P<0.001). Furthermore, MAD therapy was associated with reduced levels of fasting plasma glucose values after 1 year of therapy (5.26±0.52 to 4.89±0.51 mmol/L, P<0.001), as well as fasting plasma insulin values (14.1±7.8 to 10.9±6.4 μU/ml, P<0.05) and HOMA-IR (3.3±1.8 to 2.4±1.4, P<0.001). There was also significant improvement in pulse wave velocity (9.3±1.9 m/s at baseline to 8.1±1.7 m/s, P<0.05) after 1 year of MAD therapy.
In the second study there was significant improvement on all three CRD-series tests used after 1 year of MAD therapy, considering total test solving time (TTST) and minimal single task solving time (MinT), whereas total number of errors committed during the tests (TE) remained unchanged. Self-reported measures, excessive daytime sleepiness (ESS score from 9,9±3,8 at baseline to 6,0±2,8 after 1 year of MAD therapy, P<0,05), and three domains of quality of life (social functioning, general health perception and health change following MAD therapy) showed significant improvements after 1 year of MAD therapy.
In conclusion, the MAD therapy in mild to moderate OSA patients showed significant improvements after 1 year of therapy in subjective and objective OSA symptoms and cardiovascular, metabolic and neurocognitive parameters. Therefore, MAD could be offered as a distinct, efficacious modality of treatment for patients with OSA.
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