Francesco Bortolotti

Obstructive sleep apnea (OSA) is a multifactorial sleep breathing disorder, seriously impacting quality of life and involving approximately 1 billion of the world’s population. It is characterized by episodes of total cessation of breathing or decreases in airflow during sleep. Available data suggest that most cases of OSA remain undiagnosed even in developed countries. This is due to a lack of widespread knowledge about this pathology and the medical morbidities and mortality it brings about, among both laypeople and physicians. Moreover, despite receiving indications about the need to undergo specific evaluations for OSA signs and symptoms, sometimes patients do not pay sufficient attention to the problem. This is probably due to a lack of correct information on these issues. The present investigation analyzed the level of knowledge about OSA pathology and the sources through which a group of OSA patients gained information on their condition. A survey of 92 patients diagnosed with OSA (mean age 60.55 ± 10.10) and referred to the Unit of Orthodontics and Dental Sleep Medicine of the University of Bologna was conducted by means of a questionnaire investigating sociodemographic characteristics, the level of general knowledge on OSA pathology and its possible medical consequences. Despite about two third (67.38%) of the population demonstrating extensive knowledge, remarkably, a group of subjects (20.65%) had poor awareness of the OSA condition. A statistically significant correlation emerged between the level of knowledge about OSA and the level of education (p = 0.002). A great effort should be made to improve the quality of information and the communication modalities for OSA to enable a fully appropriate awareness of the condition among patients.

Disturbed nocturnal sleep contributes to the central sensitization of pain, thus predisposing to orofacial pain. Central disorders of hypersomnolence are characterized by excessive daytime sleepiness (EDS) not linked to impairment of nocturnal sleep or misaligned circadian rhythms. The main disorder of this group is narcolepsy type 1 (NT1), which seems to be related to alterations in pain perception mediation, supposedly caused by low orexin levels. The aim of this study was to evaluate the pain sensitivity and the prevalence of temporomandibular disorders (TMDs) in patients with NT1. After a 3-day hospital evaluation with laboratory polysomnography, 39 consecutive adult patients diagnosed with NT1 and 39 matched heathy controls were evaluated by means of Axis I and Axis II of the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) protocol. Furthermore, pain sensitivity was investigated by measuring the pressure pain thresholds (PPTs) on the head–neck muscles by means of a Fischer algometer. No significant differences were found between the PPTs of the two groups for all the muscles evaluated, nor in the prevalence of TMD diagnoses, but the NT1 group reported significantly higher values in the Patient Health Questionnaire (PHQ-9), corresponding to a depressive state. The present study presents an important investigation into NT1 patients, showing no alterations in pain perception and no differences in the prevalence of TMD diagnosis compared to the controls.

Obstructive sleep apnea (OSA) is a highly prevalent sleep breathing disorder characterized by the collapse of the pharyngeal walls that entails recurrent episodes of cessation of breathing or decrease in airflow while sleeping. This results in sleep fragmentation, decreased oxygen saturation and an increase in the partial pressure of carbon dioxide, causing excessive daytime sleepiness, hypertension and increased prevalence of cardiovascular morbidity and mortality. Mandibular advancement devices (MAD) represent a valid alternative therapy to Continuous Positive Airway Pressure, thrusting the mandible forward, increasing the lateral diameter of the pharynx and reducing the collapsibility of the airway. Several investigations have focused on the detection of the best mandibular advancement amount in terms of effectiveness and tolerance, but few and contrasting data are available on the role of occlusal bite raise in reducing the apnea/hypopnea index (AHI). The aim of this systematic review with meta-regression analysis was to investigate the effect of the bite raise of MAD on AHI values in adult patients affected by OSA. An electronic search was performed in MEDLINE, the Cochrane Database, Scopus, Web of Science and LILACS. Randomized controlled trials (RCT) investigating the effectiveness of MAD in OSA patients were included. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias with the Cochrane risk-of-bias tool for randomized trials (RoB2). Six RCT were included. The success rate of each study was computed: (mean baseline AHI − mean post treatment AHI)/mean baseline AHI. The GRADE scores indicated that the quality of evidence was very low. The meta-regression analysis showed that there was no correlation between the occlusal bite raise and the AHI improvement.

Background: The gold standard for the diagnosis of sleep bruxism (SB) is laboratory polysomnography (L-PSG) recording. However, many clinicians still define SB using patients’ self-assessment and/or clinical tooth wear (TW). The purpose of this cross-sectional controlled study was to compare the prevalence of TW, head-neck muscles sensitivity and Temporomandibular Disorders (TMD) between SB and non-SB patients diagnosed with L-PSG in a cohort of patient with sleep disorders (SD). Methods: 102 adult subjects with suspected SD underwent L-PSG recording to assess the presence of sleep disorder and SB. TW was clinically analyzed using TWES 2.0. The pressure pain threshold (PPT) of masticatory muscles were assessed using a Fisher algometer. Diagnostic criteria for TMD (DC/TMD) were used to evaluate the presence of TMD. SB self-assessment questionnaires were administered. TWES score, PPT, TMD prevalence and questionnaire results were compared between SB and non-SB patients. Results: 22 SB patients and 66 non-SB patients with SD were included. No significant differences emerged between groups in regards to TW, the PPT values, or SB’s self-assessment questionnaires as well the prevalence of TMD. Conclusion: in a SD population, TW is not pathognomonic of active SB and SB self-assessment is not reliable. There seems to be no correlation between SB, TMD and head/neck muscle sensitivity.

The early stages of orthodontic treatment are frequently associated with pain that can vary in intensity and duration, representing one of the main reasons for treatment discontinuation. Whilst the use of drugs is recognised as being effective to control orthodontic pain, there are no reliable data indicating the best first archwire for efficacy and minimum discomfort. A prospective controlled cohort study was conducted to compare the intensity and the characteristics of orthodontic pain during the first 15 days of treatment with 2 archwires. Fifty subjects were enrolled and divided into two groups: one received 0.012 inch stainless steel (SS) as the first archwire; the other, a 0.014 inch super-elastic nickel–titanium (Ni-Ti) archwire. Patients compiled a visual analogue scale to measure pain intensity over 15 days, a questionnaire for pain characteristics, the Somatosensory Amplification Scale and the State-Trait Anxiety Inventory to control the psychosocial component of pain. Dental casts were digitally analysed to evaluate the initial arch length discrepancy. In the first 3 days of treatment, the mean VAS values of the SS group were significantly lower than those of the Ni-Ti group (p < 0.05). No significant differences emerged between the groups concerning pain characteristics. The 0.012 inch SS archwire could be used at the beginning of orthodontic treatment to minimise pain perception and improve compliance.

Background Mandibular advancement devices (MADs) are used to treat patients with obstructive sleep apnea (OSA). To date, there are no data that identify the most effective MAD design for apnea‐hypopnea index (AHI) reduction. Objectives The purpose of this systematic review is to investigate the effectiveness of different MAD designs in AHI reduction and oxygen saturation improvement in OSA patients. Search Methods An electronic search was performed in MEDLINE, Cochrane Database, Scopus, Web of Knowledge and LILACS. Selection Criteria Randomized controlled trials (RCTs) investigating the reduction of AHI on adult patients wearing MAD for OSA were included. Data Collection and Analysis the quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) and the risk of bias by the Cochrane Collaboration’s tool for assessing risk of bias in randomized controlled trial. The success rate of each study was computed: [(mean baseline AHI–mean AHI after treatment)/mean baseline AHI]. Results fifty RCTs were included. The risk of bias resulted with some concerns in most of the studies. The GRADE scores indicated that the quality of evidence was very low. The meta‐analysis showed a success rate with mono‐bloc and duo‐bloc MADs respectively of 0.821[0.722‐0.887] and 0.547[0.443‐0.637]. The mono‐bloc compared with duo‐bloc better improved the minimum oxygen saturation (10.048[7.733‐12.363] and 3.357[2.290‐4.423] respectively). Conclusions there is a very low quality body of evidence that mono‐bloc MADs are more effective in reducing AHI and improving minimum oxygen saturation compared with duo‐bloc MADs. Registration: the study protocol was registered on PROSPERO (n. CRD42019118084).