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Study objectives: To evaluate tone, apraxia and stereognosis dysfunctions in patients with SDB compared with healthy controls, and to monitor the effectiveness of Airway Gym® as an easy‐to‐use myofunctional therapy (MT) modality in terms of the tongue's motor and sensory responses, comparing results before and after therapy. Methods: This was a prospective, non‐randomised pilot study of 25 patients with moderate to severe obstructive sleep apnoea‐hypopnoea syndrome (OSAHS), 25 patients with primary snoring (PS) and 20 healthy controls. Qualitative and quantitative instruments—Iowa Oral Performance Instrument (IOPI), lingual apraxia and stereognosis tests were used to assess tongue sensorimotor function. Results: 22 patients with PS, 21 with OSAHS and all 20 controls ended the therapy. In OSAHS, the Epworth Sleepiness Scale score decreased from 16 ± 7.3 to 12 ± 4.5 after therapy (p = 0.53). In PS and OSAHS groups, the IOPI scores increased significantly. These measures did not change significantly in the controls. Lingual apraxia testing showed that controls performed all the manoeuvres, whereas PS 5.6 ± 1.4 and OSAHS 4.5 ± 1.9 (p = 0.14). In the stereognosis test, the mean number of figures recognised was 2.6 ± 2.2 in OSAHS, 3.3±1.2 in PS and 5.7±0.9 in control group (p < 0.05). Patients with OSAHS recognised circles and ovals less often. Conclusion: Using the Airway Gym®app produced improvements in sensorimotor tongue function in patients with SDB, due to continuous stimulation of the brain based on proprioceptive training required to localise responses when doing the exercises. [ABSTRACT FROM AUTHOR]

Background: The efficiency of the mandibular advancement device (MAD) in patients with obstructive sleep apnoea syndrome (OSAS) has been demonstrated. Nevertheless, the behaviour of the upper airway once MAD is placed and titrated, and its correlation with the apnoea‐hypopnoea index (AHI) is still under discussion. Objectives: To analyse the morphological changes of the upper airway through a bi‐ and three‐dimensional study and correlate it with the polysomnographic variable, AHI. Methods: Patients were recruited from two different hospitals for the treatment of OSAS with a custom‐made MAD. A cone‐beam computer tomography and a polysomnography were performed at baseline and once the MAD was titrated. Results: A total of 41 patients completed the study. Treatment with MAD reduced the AHI from 22.5 ± 16.8 to 9.2 ± 11.6 (p ≤.05). There was a significant increase of the total airway volume with MAD from 21.83 ± 7.05 cm3 to 24.19 ± 8.19 cm3, at the expense of the oropharynx. Moreover, the correlation between the improvement of the AHI and the augmentation of the volume of the upper airway was not statistically significant. Conclusions: The oral device used in this prospective study increased the mean upper pharyngeal airway volume and significantly reduced the AHI. Future studies that measure the muscular tone are needed to completely understand the association between the AHI and the physiological and anatomical response of the upper airway. [ABSTRACT FROM AUTHOR]

Background: There is lack of reliable and accurate methods to predict treatment outcomes of oral appliance (OA) treatment. Acoustic pharyngometry (AP) is a non‐invasive technique to evaluate the volume and minimal cross‐sectional area of the upper airway, which may prove useful to locate the optimal position of OAs. Objective: This retrospective study aimed to evaluate the effect of applying AP to OA treatment of patients with obstructive sleep apnoea (OSA). Methods: All patients (n = 244) treated with OAs following an AP protocol at two dental clinics between 2013 and 2018 were invited to participate. A total of 129 patients accepted the invitation, and 120 patients (75 men, 45 women) were included in the analyses. Mean baseline age, BMI and apnoea hypopnea index (AHI) were 59.1 ± 0.9 years, 27.8 ± 0.4 and 21.9 ± 1.1, respectively. Mean follow‐up time was 318 ± 24 days. Results: AHI at follow‐up was 6.4 ± 0.7, resulting in a treatment success rate of 86.7% (≥50% reduction of baseline AHI). The number of failures (<50% reduction of baseline AHI) did not differ significantly among patients with mild, moderate and severe OSA. 87.6% of the patients reported OA usage every night, and 95.5% reported > 5 hours usage per night, when worn. Conclusion: The AP protocol applied seems to contribute to the excellent effect of OA treatment in this study. Further research on the application of AP in OA treatment is necessary in order to clarify its possible beneficial contribution to improving OA therapy. [ABSTRACT FROM AUTHOR]

Background: Oral myofunctional therapy (MFT) is an effective treatment for mild‐to‐moderate obstructive sleep apnoea (OSA) in middle‐aged patients. However, few reports have described its use in elderly patients with moderate and severe OSA. Moreover, no studies have examined the relationship between changes in tongue pressure with MFT and the severity of OSA. Objective: We conducted an interventional study using MFT to evaluate the effect of MFT on middle‐to‐senior‐aged patients with moderate or severe OSA and compared changes in apnoea‐hypopnea index (AHI) and tongue pressure. Methods: Thirty‐two OSA patients (≥45 years) treated with continuous positive airway pressure (CPAP) were included. MFT was performed in parallel with CPAP. Three days after CPAP discontinuation, polysomnographies were performed and tongue pressures were measured before and after MFT. Results: Patients were 69.3 ± 1.5 years old. After 6 months of MFT, AHI decreased significantly from 34.7 to 29.0/h (P =.03), while tongue pressure significantly increased from 35.9 to 45.6 kPa (P <.01). Seven patients (22%), including 6 of the 12 patients with moderate OSA (50%), experienced successful CPAP discontinuation. Conclusions: MFT can be a useful intervention even among middle‐aged to elderly patients with OSA. Increased tongue pressure may have contributed to the AHI improvement. Clinical trials: Trial registration at www.umin.ac.jp UMIN000027547. [ABSTRACT FROM AUTHOR]

Objectives: Tooth wear is a common finding in adult patients with dental sleep disorders. The aim of this paper was to review the literature on the possible associations between tooth wear and the following dental sleep disorders: sleep‐related oro‐facial pain, oral moistening disorders, gastroesophageal reflux disease (GERD), obstructive sleep apnoea syndrome (OSAS) and sleep bruxism. Methods: A PubMed search was performed on 1 June 2018 using MeSH terms in the following query: Tooth Wear AND (Facial Pain OR Temporomandibular Joint Disorders OR Xerostomia OR Sialorrhea OR Gastroesophageal Reflux OR Sleep Apnea Syndrome OR Sleep Bruxism). Results: The query yielded 706 reports on tooth wear and the mentioned dental sleep disorders. Several associations between tooth wear and the dental sleep disorders were suggested in the literature. It could be concluded that: (a) tooth wear is associated with dental pain and/or hypersensitivity; (b) oral dryness is associated with tooth wear, oro‐facial pain and sleep bruxism; (c) GERD is associated with tooth wear, oro‐facial pain, oral dryness, OSAS and sleep bruxism; (d) OSAS is associated with oral dryness, GERD and sleep bruxism; and (e) sleep bruxism is associated with tooth wear. Conclusions: Tooth wear is associated with the dental sleep disorders oro‐facial pain, oral dryness, GERD and sleep bruxism. The dental sleep disorders are interlinked with each other, which leads to indirect associations as well, and makes the consequences of each single condition difficult to disentangle. Knowledge of these associations is clinically relevant, but more research is needed to confirm their validity. [ABSTRACT FROM AUTHOR]

The association between dental arch morphology and the aetiology of obstructive sleep apnoea (OSA) is not clear. To compare dental arch morphology in 108 Asian adults with and without ''OSA, overnight'' hospital polysomnography was performed, and sleep reports were obtained for all subjects. Standardized digital photographs were also taken of the subjects’ upper and lower study models. Using 25 homologous landmarks, mean OSA and control dental arch configurations were computed, and subjected to finite-element morphometry (FEM), t-tests and principal components analysis (PCA). Mean upper and lower OSA dental arch morphologies were statistically different from respective Control upper and lower arch morphologies ( P < 0·05). FEM of the upper arch indicated that the mean OSA configuration was 7–11% narrower in the transverse plane in the incisor and canine regions when compared with the control configuration, and inter-landmark analysis (ILA) confirmed this finding. FEM for the lower arch indicated that the mean OSA configuration was 10–11% narrower in the antero-posterior plane in the pre-molar and molar regions, and confirmed by ILA. Using PCA, significant differences were also found between the two groups in the lower arch using the first two eigenvalues, which accounted for 90% of the total shape change ( P < 0·001). Supporting their role as aetiological factors, size and shape differences in dental arch morphology are found in patients with OSA. [ABSTRACT FROM AUTHOR]