Oral appliance decreases snoring rate, loudness.
Researchers tested the Thornton Adjustable Positioner II (TAP II) and found that the device reduced lingual snoring, and, unexpectedly, reduced palatal snoring even more.
The TAP II device was created by a prosthodontist, and it consists of separate maxillary and mandibular components. The appliance is gradually adjusted in order to move the lower jaw forward by up to a maximum of 6 mm of protrusion, with the goal of reducing snoring.
"This is a very nice oral appliance," said Dr. Mair, director of pediatric otolaryngology at Wilford Hall Medical Center, Lackland Air Force Base, San Antonio. "It is different from the devices you may see at the Iocal drugstore for $29.95. Those 'boil and bite' appliances can lead to problems with dental malocclusion. The TAP II is custom made and can be titrated as needed."
In this prospective, observational clinical trial, the study participants wore the device for 3 weeks. During that period, the device was gradually adjusted by 0.25 mm at a time. At the end of 3 weeks, changes in sleep and snoring patterns were observed.
Of the 57 patients who were recruited initially, 17 did not complete the study because of military transfers or deployments, dental problems, temporomandibular joint pain, or for other reasons.
On average, the study participants were 44.8 years old, weighed 187 pounds, and had a respiratory disturbance index of 14.4, with 364 snoring events/hour.
Researchers used the SNAP device, developed by Snap Labs, Glenview, Ill., to measure overnight snoring.
This device records continuous pulse-oximetry data and makes an acoustical recording from a microphone positioned near the patient's upper lip. Propriety software analyzes the recorded sounds to determine the amount and anatomic site of snoring.
After use of the TAP II for 3 weeks, the rate of snoring decreased from 364 to 216 events per hour. Average and maximal snoring loudness both decreased by about 5 dB each; these reductions were statistically significant.
The percentage of all snoring sounds originating from the palate decreased from 66% to 47%. The percentage of snoring originating from the tongue base increased from 11% to 16.6% (not statistically significant), while the number of tongue-based events decreased.
The researchers hypothesized that TAP II would have its strongest effect on tongue-based snoring, but instead it had the greatest effect on palatal snoring.
"We concluded that TAP II is effective in reducing palatal flutter snoring as measured by an objective test, and this demonstrates that oral appliances can have dynamic physiologic effects at airway levels other than the tongue base," Dr. Mair said.
The study enrolled only 10 patients with significant obstructive sleep apnea, thus decreasing its power to detect changes in sleep apnea with oral appliance use.
After the study period, the respiratory disturbance index declined from 14.4 to 10.4, not quite reaching statistical significance. The apnea index declined from 5.1 to 3.2; the hypopnea index declined from 10.2 to 7.6.
Patients reported a low amount of jaw and tooth pain associated with TAP II and had good compliance during the study period. However, after completion of the 3-week study, patients were followed for 6 months, during which time compliance declined, with about 50% of patients reporting use of the TAP II on at least 50% of nights.
BY ELAINE ZABLOCKI
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|Publication:||Internal Medicine News|
|Date:||Feb 15, 2006|
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