Latest in DSM Archive March

Latest Findings in DSM - March 2019
Published February 26, 2019

In This Issue:


2019 AADSM Research Grant

The AADSM will be releasing its next request for applications for the 2019 AADSM Research Grant on April 1, 2019. Please check the AADSM Research Page on Monday, April 1 for more details. 

Multislice Computed Tomography Assessment of Airway Patency Changes Associated with Mandibular Advancement Appliance Therapy in Supine Patients with Obstructive Sleep Apnea

Matsumura Y, Ueda H, Nagasaki T, Medina CC, Iwai K, Tanimoto K. 
Sleep Disord. 2019;2019:1-9. doi:10.1155/2019/8509820

“[T]o measure the regional effects of [a mandibular advancement appliance] on the upper airway of supine subjects with OSA using multislice computed tomography (MSCT).”

Study Design and Population:
Study of 13 adults with mild to moderate OSA. The mandibular advancement appliance [MAA] was made of two occlusal splints.

Main Findings:
  • “In most of the assessed airway size variables, significant increases in the anteroposterior diameter and width were observed after MAA therapy.”
  • “We demonstrated that the proportional size of the soft tissue volume, i.e., the soft palate and tongue in the oro-hypopharyngeal region, significantly decreased during use of an MAA. This forward displacement of the soft tissue thereby increases the retroglossal airway space (except the nasopharynx) three-dimensionally.”

The Association Between Sleep Disorders and the Risk of Colorectal Cancer in Patients: A Population-based Nested Case-Control Study

Lin C-L, Liu T-C, Wang Y-N, Chung C-H, Chien W-C.
In Vivo. 2019;33(2):573-579. doi:10.21873/invivo.11513

To explore the relationship between sleep disorders and risk of colorectal cancer.

Study Design and Population:
Nested case-control study of 7,355 Taiwanese patients with colorectal cancer and 29,420 control patients.

Main Findings:
  • The risk of colorectal cancer was 5.69 times higher if a patient had both a sleep disorder and depression.
  • This could be caused by decreased melatonin production and destabilizing of the clock genes, which is caused by disruption of the circadian rhythm. These are potential promoters of cancer.

The Interlinked Rising Epidemic of Insufficient Sleep and Diabetes Mellitus

Chattu V, Chattu S, Burman D, Spence D, Pandi-Perumal S.
Healthcare. 2019;7(1):37. doi:10.3390/healthcare7010037

To explore the relationship of sleep disorders with diabetes mellitus.

Study Design and Population:
Review of literature.

Main Findings:
  • “[S]leep disorders can increase the risk of insulin resistance and diabetes.”
  • OSA is a very common sleep disorder and is associated with a higher prevalence of diabetes.
  • “The relationship between sleep and diabetes is bi-directional.” That is, if diabetes is properly treated, it can lead to better sleep outcomes.
  • Most studies on sleep and diabetes have focused on type 2 diabetes. More research on the relationship between sleep and type 1 diabetes is needed.

Difficult-to-treat OSAS:Combined continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) therapy. A case report

Luzzi V, Brunori M, Terranova S, et al.
Cranio - Journal of Craniomandibular Practice. 2018.

To examine the use of combination CPAP and MAD therapy for difficult-to-treat OSA.

Study Design:
Case report of a 66-year-old man with metabolic syndrome, mouth breathing, atopy and daytime sleepiness. Patient was treated with a MAD as well as low-pressure CPAP.

  • MAD therapy alone did not sufficiently resolve OSA symptoms.
  • Similarly, CPAP therapy alone did not sufficiently resolve OSA symptoms, due to poor patient compliance.
  • Combined therapy successfully treated the OSA, in this case.
“In selected patients, a treatment combining CPAP and MAD might be a more tolerable alternative to CPAP alone. The improved pharyngeal patency, promoted by mandibular advancement and stretching of the pharyngeal muscles, allows operating the CPAP at lower pressures when the MAD alone is not sufficient to induce a safe sleep profile.”

Use of Berlin questionnaire in comparison to polysomnography and home sleep study in patients with obstructive sleep apnea 

Ng SS, Tam W, Chan T-O, et al. 
Respir Res. 2019;20(1):40. doi :10.1186/s12931-019-1009-y

“[T]o evaluate the predictive accuracy of the Berlin questionnaire in patients with suspected OSAS undergoing PSG in the sleep laboratory setting against those going through the Embletta™ portable diagnostic system (Embletta PDS) at home.”

Study Design:
Study of 316 subjects who completed Berlin Questionnaire and the Epworth Sleepiness Scale (ESS). Patients were then randomized to either receive a hospital-based PSG or a home-based sleep test.

Main Findings:
  • The Berlin Questionnaire identified 69.7% of the patients in the HSAT group as high risk and 77.5% of patients in the PSG group as high risk
  • The authors looked at the Berlin Questionnaire’s negative predictive value (i.e. the probability that a patient who receives a negative result really does not have the disease) and its test specificity (i.e. the ability to screen out subjects who didn’t have the disease).
  • The questionnaire had higher negative predictive value and specificity when it was compared with the HSAT than when it was compared with the PSG.
  • This indicates that the questionnaire was better at predicting results for the group using the HSAT.
“The questionnaire was not reliable in predicting OSAS through PSG AHI whereas there was some predictive ability in discriminating patients with OSAS from normal subjects based on home Embletta sleep test.”