Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2021; 9(10): 2312-2319
Published online Apr 6, 2021. doi: 10.12998/wjcc.v9.i10.2312
Changes in sleep parameters following biomimetic oral appliance therapy: A case report
G Dave Singh, Shamshudin Kherani
G Dave Singh, Institute of Craniofacial Sleep Medicine, Vivos Therapeutics, Inc., Highlands Ranch, CO 80129, United States
Shamshudin Kherani, Dental Clinic, Kherani Dental at Aspen, Calgary T3H0N6, Canada
Author contributions: Singh GD, analyzed and interpreted the findings, reviewed the literature, contributed to manuscript drafting and is responsible for intellectual content; Kherani S was the patient’s dentist, contributed to manuscript drafting and is responsible for intellectual content. Both authors issued final approval for the version to be submitted.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest except that Professor G. Dave Singh DMD PhD DDSc is Founder and Chief Medical Officer of Vivos Therapeutics, Inc.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: G Dave Singh, DMD, PhD, DDSc, Professor, Institute of Craniofacial Sleep Medicine, Vivos Therapeutics, Inc., 9137 S Ridgeline Blvd # 135, Highlands Ranch, CO 80129, United States. drsingh@drdavesingh.com
Received: October 15, 2020
Peer-review started: October 15, 2020
First decision: December 28, 2020
Revised: January 4, 2021
Accepted: February 19, 2021
Article in press: February 19, 2021
Published online: April 6, 2021
Abstract
BACKGROUND

Mandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA.

CASE SUMMARY

An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance®, Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient’s mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions.

CONCLUSION

In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Long-term follow up studies are required to verify these novel findings.

Keywords: Obstructive sleep apnea, Biomimetic oral appliance therapy, Continuous positive airway pressure, Mandibular advancement device, Case report

Core Tip: Mandibular advancement devices (MADs) are considered to be a first line therapy in adult cases of mild to moderate obstructive sleep apnea that are unable to comply with continuous positive airway pressure. However, both MADs and continuous positive airway pressure represent a lifetime of therapy and there is a risk that the underlying condition may worsen over time as the patient undergoes ageing. In contrast, biomimetic oral appliance therapy differs from MADs since it attempts to mimic normal craniofacial growth and development. The primary target of biomimetic oral appliance therapy is the nasomaxillary complex, which is non-surgically corrected even in adult cases followed by re-coordination with the mandible.