Oral Dynamic Propulsion Appliance in Treatment of Patients With Obstructive Sleeping Apnea

Treatment Effects of Oral Dynamic Propulsion Appliance During the Sleeping Phase in Patients With Obstructive Sleeping Apnea

Obstructive Sleep Apnea (OSA) is one of the most prevalent sleep disorders, affecting nearly one billion people worldwide. It is characterized by repeated episodes of complete (apnea) or partial (hypopnea) obstruction of the upper airway during sleep, leading to snoring, excessive daytime sleepiness, insomnia, morning headaches, nocturia, behavioral changes, reduced concentration, and serious cardiovascular and metabolic complications such as insulin resistance, type II diabetes, and metabolic syndrome. During the night, patients may experience up to a hundred apnea or hypopnea events lasting from 10 to 120 seconds. Therapy for OSA depends on its severity, defined by five or more obstructive events per hour of sleep. Over the past decade and a half, oral appliances (OAs) have become the treatment of choice for mild to moderate forms of OSA due to their efficacy and comfort. For this purpose, the DYNAMIC PROPULSION ORAL APPLIANCE (DPOA) has been designed with a mechanism that provides controlled, gentle, gradual and automatic mandible movement in propulsion during sleep. Unlike conventional OAs that fix the mandible in only one propulsive position, causing stress to orofacial complex and upper airway structures such as masticatory muscles and the temporomandibular joints, the DPOA provides gradual, automatic mandibular movement to the previously determined propulsive position. This gradual adaptation minimizes stress, reduces side effects, and enhances treatment success. In that way, the DPOA enables complete functional adaptation of the orofacial system and upper airway structures, leading to improved patient comfort and better therapeutic outcome.

The primary objective of the study is to determine the effectiveness of OSA therapy in patients with skeletal Class I (eugnathic jaw relationship) using a DYNAMIC PROPULSION ORAL APPLIANCE (DPOA) with a mechanism that provides controlled, gentle, gradual and automatic mandible movement in propulsion during sleep.

Inclusion Criteria:

• age between 20 and 65 years
• clinically confirmed diagnosis of mild or moderate obstructive sleep apnea (Apnea hypopnea index 15-30 episodes/hour)
• sufficient number of periodontally healthy teeth to support the oral appliance
• written informed consent of conformance with the study protocol

Exclusion Criteria:

• age bellow 20 and over 65 years
• patients not able or not willing to follow the study protocol
• patients with severe OSA (Apnea hypopnea index > 30 episodes/hour) and/or some other breathing disturbances
• patients with psychiatric, neurological or psychosomatic disorders
• patients with Body Mass Index > 29kg/sqm
• pregnancy
• presence of the anatomical obstruction in the airways
• severe periodontal disease (III and IV grade)
• pathological changes in the structures of TMJ, muscles or ligaments
• mandibular protrusion less than 3mm
• orthodontic anomalies, malocclusions, II and III skeletal class, and orthodontic appliances