Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 Aug 11;24(1):931.
doi: 10.1186/s12903-024-04623-w.

Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial

Amira A M M Attia  1 , Sally S Awad  2 , Manar Mansour  3 , Hemmat Baz  4 , Khaled M Zahran  5 , Abdelbaset M Saleh  6
Affiliations
Randomized Controlled Trial

Effects of different treatments for obstructive sleep apnea on temporomandibular joint: a randomized clinical trial

Amira A M M Attia et al. BMC Oral Health. .

Abstract

Background: In recent years, obstructive sleep apnea (OSA) has been increasingly recognized as a significant health concern. No previous studies assessed the effect of recommended treatment modalities of patients with OSA on the temporomandibular joint (TMJ). The current study aimed to evaluate the effect of different treatment modalities of OSA, such as continuous positive airway pressure (CPAP), mandibular advancement device (MAD), and oral myofunctional therapy (OMT) on subjective symptoms, clinical, and radiographic signs of temporomandibular disorders.

Patients & methods: This hospital-based prospective randomized controlled clinical trial study was approved by the institutional review board and formal patient consent, 39 OSA patients, ranging in age from 19 to 56 after confirmation with full night Polysomnography (PSG) with healthy TMJ confirmed clinically and radiographically with magnetic resonance imaging (MRI) were randomly allocated into three treatment groups. Group 1: 13 patients were managed with CPAP after titration, group 2: 13 patients were managed with digitally fabricated MAD, and group 3: 13 patients were managed with OMT. The following parameters were evaluated before and 3 months after the intervention. Pain using a visual analogue scale (VAS), maximum inter-incisal opening (MIO), lateral movements, and clicking sound of TMJ. MRI was done before and 3 months after the intervention.

Results: Out of the 83 patients enrolled, 39 patients completed the treatment. There were no statistically significant differences in lateral jaw movements or clicking, and no significant difference in MRI findings between the three studied groups before and after the intervention. The OMT group showed a statistically significant difference in pain (p = 0.001), and MIO (p = 0.043) where patients experienced mild pain and slight limitation in mouth opening after 3 months of follow-up in comparison to MAD and CPAP groups.

Conclusion: CPAP and MAD are better for preserving the health of TMJ in the treatment of OSA patients. While OMT showed mild pain and slight limitation of MIO (that is still within the normal range of mouth opening) compared to CPAP and MAD.

Trial registration: The study was listed on www.

Clinicaltrials: gov with registration number (NCT05510882) on 22/08/2022.

Keywords: Continuous positive airway pressure, oral myofunctional therapy; Mandibular advancement device; Obstructive sleep apnea; Pain; Temporomandibular disorder.

PubMed Disclaimer

Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
MAD three-dimensional design with opening for breathing designed by exocad software
Fig. 2
Fig. 2
Three-dimensional printed MAD
Fig. 3
Fig. 3
Flow Chart according to the CONSORT guidelines
Fig. 4
Fig. 4
(A & B) before the intervention, C&D after the intervention in OMT group, show normal unchanged disc shape and position in closed and open position
See this image and copyright information in PMC

References

    1. Rapoport DM. POINT: is the Apnea-Hypopnea Index the Best Way to quantify the severity of sleep-disordered breathing? Yes. Chest. 2016;149(1):14–6. 10.1378/chest.15-1319 - DOI - PubMed
    1. Yaggi HK, Strohl KP. Adult obstructive sleep Apnea/Hypopnea syndrome: definitions, risk factors, and Pathogenesis. Clin Chest Med. 2010;31(2):179–86. 10.1016/j.ccm.2010.02.011 - DOI - PubMed
    1. Benjafield AV, Ayas NT, Eastwood PR, et al. Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. Lancet Respiratory Med. 2019;7(8):687–98.10.1016/S2213-2600(19)30198-5 - DOI - PMC - PubMed
    1. Lyons MM, Bhatt NY, Pack AI, et al. Global burden of sleep-disordered breathing and its implications. Respirol (Carlton Vic). 2020;25(7):690–702.10.1111/resp.13838 - DOI - PubMed
    1. Xian ZX, Wang X, Chen YC, et al. Preliminary assessment of portable sleep monitoring for diagnosis of obstructive sleep apnea in children. Sleep Breath. 2024;28(1):419–25. 10.1007/s11325-023-02919-9. 10.1007/s11325-023-02919-9 - DOI - PMC - PubMed

Publication types

MeSH terms

Associated data