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Sleep Apnoea in Patients with Stable Congestive Heart Failure - An Intervention Study with a Mandibular Advancement Device
Malmö högskola, Faculty of Odontology (OD).
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

In patients with congestive heart failure (CHF), sleep disordered breathing (SDB)--including obstructive and central sleep apnoea as well as periodic breathing--is a common condition and is believed to increase the risk of mortality. Treatment of SDB is considered important in the management of CHF. Improvements in SDB have a positive effect on cardiac output, measured with left ventricular ejection fraction (LVEF); on neurohormonal activity, measured as brain natriuretic peptide (BNP); and on the quality of life. Continuous positive airway pressure has been the traditional method used to treat SDB in patients with CHF, but compliance and tolerability are poor. A mandibular advancement device (MAD) is a dental device recommended for the treatment of sleep apnoea, but the method has never been evaluated in patients with CHF. The aims of the present studies were to evaluate the practical use of the MAD for the treatment of SDB in patients with CHF and to test the hypothesis that this intervention increases the dimensions of the pharyngeal airway (PAW), reduces SDB and BNP, and improves LVEF and the quality of life. Patients with mild to moderate CHF and SDB were evaluated using a portable polysomnographic device, lateral radiographs, cardiological and odontological examinations, and quality of life measures prior to and following intervention with an custom-made MAD. At the short-term follow-up 4-6 weeks after habituation with the MAD, the severity of SDB according to the apnoea-hypopnoea index had decreased from 25.1 +/- 9.4 (mean +/- SD) to 14.7 +/- 9.7 (p = 0.003). An increase in the inferior region of the PAW (7 +/- 5 mm) was observed on radiographs (p = 0.0001). However, no correlation between the effect of the MAD on the dimensions of the PAW and its effect on SDB was found. At the 6-month follow-up, the sleep apnoea-related symptoms had decreased by 31% (p = 0.003). Quality of life remained stable. BNP were reduced from 195.8 +/- 180.5 pg/ml to 148.1 +/- 139.9 pg/ml (p = 0.035). LVEF, however, remained unchanged. At the 12-month follow-up, 64 % of the patients were still using the MAD. Three patients withdrew from the study because of discomfort with the MAD. In most patients, MAD treatment had no severe side effect on the signs or symptoms of temporomandibular disorders. However, dental complications were observed. In conclusion, in patients with stable CHF who are experiencing problems with SDB, MAD intervention appears to reduce the severity of SDB, sleep apnoea-related symptoms, and neurohormonal activity. A lower tendency for PAW collapse may explain the effect observed on SDB. The reduction in plasma BNP may indicate decreased cardiac strain as a result of treatment of SDB. The 5-year survival rate, measured from the start of MAD intervention, was higher in the group that used a MAD than in the group that did not use a MAD (p = 0.036). No severe side effects on the stomatognathic system were observed during the intervention, and most patients--edentulous included--tolerated the treatment well. Impaired oral health, including reduced dentition and edentulousness, seemed to limit the use of the MAD in this group of elderly patients, both because of technical difficulties and because of the increased risk of dental complications. However, because the treatment of SDB is important in the management of CHF, the MAD intervention seems to be a valuable method in the treatment arsenal of SDB.

Place, publisher, year, edition, pages
Malmö University , 2004. , p. 56
Series
Swedish dental journal. Supplement, ISSN 0348-6672 ; 168
Keywords [en]
Sömnapné, Bettfysiologi, Hjärtsvikt
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-7695Local ID: 7927ISBN: 91-628-6230-8 (print)OAI: oai:DiVA.org:mau-7695DiVA, id: diva2:1404635
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2022-06-27Bibliographically approved
List of papers
1. A Mandibular Advancement Device Reduces Sleep Disordered Breathing in Patients with Congestive Heart Failure
Open this publication in new window or tab >>A Mandibular Advancement Device Reduces Sleep Disordered Breathing in Patients with Congestive Heart Failure
2004 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 28, no 4, p. 155-163Article in journal (Other academic)
Abstract [en]

Sleep disordered breathing (SDB) including obstructive and central sleep apnoea/hypopnoea as well as periodic breathing (PB) is common and is believed to increase risk for mortality in patients with congestive heart failure (CHF). Mandibular advancement device (MAD) has widely been recommended for treatment of obstructive sleep apnoea but the method has never been investigated for treatment of SDB in the patients with CHF. The aim with the present study was to examine the effect of MAD intervention on SDB in patients with CHF. The study included 17 male patients, aged 68.4+/-5.7 (mean+/-SD) with stable, mild to moderate CHF due to left ventricular systolic dysfunc-tion and with SDB, expressed as apnoea/hypopnoea index (AHI) > or = 10. The SDB was examined during a single night using an unattended, portable polysomnographic device in the patients home, prior to and following intervention with a individually adjusted MAD. The SDB was evaluated by calculating AHI, PB expressed as the percentage of the total registration time, oxygen desaturation index (ODI) and snoring time. The AHI was reduced by MAD intervention from 25.1+/-9.4 to 14.7+/-9.7 (p=0.003). ODI reduced from 21.1+/-9.0 to 10.5+/-7.8 (p=0.007) and snoring time decreased from 53+/-111 to 18+/-47 seconds (p=0.02). PB was reduced from 55.7+/-25.6 to 40.4+/-26.4 per cent without statistical significance. In conclusion, the MAD intervention may be a feasible method for reducing SDB in patients with stable, mild to moderate CHF and left ventricular systolic dysfunction.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7032 (URN)3001 (Local ID)3001 (Archive number)3001 (OAI)
Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2022-06-27Bibliographically approved
2. The Effect of Mandibular Advancement Device on Pharyngeal Airway Dimension in Patients with Congestive Heart Failure Treated for Sleep Apnea
Open this publication in new window or tab >>The Effect of Mandibular Advancement Device on Pharyngeal Airway Dimension in Patients with Congestive Heart Failure Treated for Sleep Apnea
Show others...
2004 (English)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 28, no 1, p. 1-9Article in journal (Other academic)
Abstract [en]

Continues positive airway pressure (CPAP) is recommended for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) but is not easily tolerated resulting in poor patient compliance. Mandibular advancement device (MAD) is designed to inhibit pharyn-geal airway (PAW) obstruction and may be a valuable alternative. It has been proposed that MAD exerts its effect by increasing PAW dimensions. This has not, however, been clearly demonstrated. The aim of this study was to examine the effect of MAD on PAW dimensions and SA in patients with CHF. Seventeen CHF-patients with mild to moderate heart failure, aged 68 +/- 6 years, (mean +/- SD), range 54-75 years, with sleep apnoea-hypopnea index (AHI) > or = 10 were evaluated. PAW dimensions were studied with and without the MAD, using lateral radiographs in supine position. Nocturnal breathing patterns were studied using a portable polysomnographic device during a single night with and without MAD. A reduction of AHI > or = 30% (arbitrary level) for each individual was regarded as a successful treatment. Mean AHI was reduced from 25.1 +/- 9.4 to 14.7 +/- 9.7 (p = 0.003). The PAW increased in its inferior section in 13 patients (p = 0.0001). AHI decreased > or = 30% in 9 patients (p = 0.003) of whom 8 showed increased PAW dimensions. Reduction of AHI was not significantly related to increased PAW dimensions. In conclusion MAD increased PAW dimensions and reduced SA in patients with CHF. The results may indicate that MAD reduces SA by other mechanism than increasing PAW dimensions.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15535 (URN)3048 (Local ID)3048 (Archive number)3048 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2022-06-27Bibliographically approved
3. The Effect of Treatment of Sleep Apnoea with a Mandibular Advancement Device on Brain Natriuretic Peptide and Quality of Life in Patients with Congestive Heart Failure
Open this publication in new window or tab >>The Effect of Treatment of Sleep Apnoea with a Mandibular Advancement Device on Brain Natriuretic Peptide and Quality of Life in Patients with Congestive Heart Failure
2004 (English)Manuscript (preprint) (Other academic)
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-44555 (URN)
Available from: 2021-07-06 Created: 2021-07-06 Last updated: 2022-06-27Bibliographically approved
4. Use of a Mandibular Advancement Device in Patients with Con-gestive Heart Failure and Sleep Apnoea
Open this publication in new window or tab >>Use of a Mandibular Advancement Device in Patients with Con-gestive Heart Failure and Sleep Apnoea
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2004 (English)In: Gerodontology, ISSN 0734-0664, E-ISSN 1741-2358, Vol. 21, no 2, p. 100-107Article in journal (Refereed)
Abstract [en]

Objective: To evaluate the practical use of the mandibular advancement device (MAD) for treatment of sleep apnoea (SA) in patients with congestive heart failure (CHF) over 1 year. Subjects: Twentyfive patients aged 66 ± 8 years (mean ± SD) met the inclusion criteria and were included in the study. Design: In a prospective, clinical trial, the apnoea-hypopnoea index (AHI), a measure of SA, was determined with a portable device. Failure to enter treatment and compliance, adverse events and signs and symptoms of temporomandibular disorders (TMD) were examined before intervention and 4-6 weeks, 6 months and 1 year after intervention. Results: Six patients had removable dentures of whom four had complete dentures. Before treatment, eight patients reported minor symptoms of TMD. The AHI fell from 19.3 ± 12.1 to 11.8 ± 9.5 (p = 0.004) with use of the device. In most patients, use of the MAD had no severe effects on the signs and symptoms of TMD. Adverse events such as pain in the temporomandibular joints, soreness in the teeth, and tiredness in the jaws were reported by ten patients. Dental complications were observed in two patients. Sixtyfour per cent of the patients were still using the MAD at the 1-year follow-up. Conclusion: both the general and oral health of CHF patients were important in treatment with a MAD. The MAD therapy had no severe effect on the masticatory system and edentulous patients could be treated.

National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-15519 (URN)10.1111/j.1741-2358.2004.00019.x (DOI)15185990 (PubMedID)2-s2.0-2942687737 (Scopus ID)3049 (Local ID)3049 (Archive number)3049 (OAI)
Available from: 2020-03-30 Created: 2020-03-30 Last updated: 2024-02-05Bibliographically approved

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