title: Effects of mandibular posture on obstructive sleep apnea severity and the temporomandibular joint in patients fitted with an oral appliance.
abstract: OBJECTIVE
  The purposes of this study were to assess the relationship between different increments of mandibular protrusion and a reduction of obstructive sleep apnea (OSA) severity and to use magnetic resonance imaging to assess temporomandibular joint (TMJ) morphology and condyle position after the insertion of an oral appliance (OA).
  
  
  METHODS
  Six mild to moderate OSA patients were treated with a titratable OA (Klearway) and changes in the apnea hypopnea index (AHI) secondary to the amount of mandibular advancement were evaluated. In seven patients, the morphology of the TMJ was compared before insertion and after titration of the appliance and the anterior displacement of the condyle with the titrated appliance in place was evaluated.
  
  
  METHODS
  Federal University of São Paulo, Brazil.
  
  
  METHODS
  7 males (mean age 47.4 years, SD 5.6).
  
  
  METHODS
  N/A.
  
  
  RESULTS
  A total of 21 polysomnographic recordings in different mandibular positions were compared. A significant reduction in the mean AHI from 12.21 to 5.64 was seen and the the AHI reduction was related to the amount of mandibular protrusion. In six out of seven patients, the translation of the condyle with the OA was equal to or less than that observed in the maximal open position. No TMJ morphologic parameters revealed significant alterations during the period of the study.
  
  
  CONCLUSIONS
  Sequential polysomnographic studies facilitate OA titration. OA effects on the AHI seem to be dose-dependent on the amount of mandibular protrusion, and the OA proved over the period of one year to be innocuous for TMJ in the treatment of patients with OSA.
authors.affiliation: Department of Oral Health Sciences, The University of British Columbia, Vancouver, Canada. falmeida@interchange.ubc.ca
authors.forename: Femanda Ribeiro
authors.initials: FR
authors.lastname: de Almeida
authors.forename: Lia Rita
authors.initials: LR
authors.lastname: Bittencourt
authors.forename: Clemente Isnard Ribeiro
authors.initials: CI
authors.lastname: de Almeida
authors.forename: Satoru
authors.initials: S
authors.lastname: Tsuiki
authors.forename: Alan A
authors.initials: AA
authors.lastname: Lowe
authors.forename: Sérgio
authors.initials: S
authors.lastname: Tufik
mesh_terms: D000328:Adult; D000886:Anthropometry; D015992:Body Mass Index; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008334:Mandible / Q000033:anatomy & histology*; D008875:Middle Aged; D017286:Polysomnography; D011187:Posture; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis*; D012895:Sleep, REM / Q000502:physiology; D013704:Temporomandibular Joint / Q000033:anatomy & histology*