Comparing Two Mandibular Positioning Techniques for Dental Sleep Appliances

Study Overview
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Brief Summary
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This is a prospective study that directly compares the use of speech vs an anterior protrusive technique for mandibular positioning.

Detailed Description
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Obstructive sleep apnea is a medical condition where a person has great difficulty with breathing, or stops breathing all together, while asleep. This is a medical condition for which one of the current standard treatments is the use of a custom-made dental appliance to help hold the person's airway open while asleep so that the person does not suffocate while sleeping. Current methodology within dentistry is to position the mandible based on the person's maximum ability to position their mandible forward as the starting point and then slowly move the bottom jaw forward as necessary. Recent literature has shown that different mandibular positioning techniques may require less protrusion, less titrations, and potentially decreased side effects compared with the traditional protrusive techniques. One of the most promising techniques involves the use of speech to determine mandibular position. This technique would not require that a patient place their jaw outside of their normal functional range and could potentially decrease the face pain/jaw joint problems commonly associated with the use of oral sleep appliances for the treatment of obstructive sleep apnea. The use of speech as the determinant for where to position the mandible is important for muscular balance. Minimal research has been done in this area, with most studies being either retrospective or confounded by other variables. This will be the first prospective study that directly compares the use of speech vs an anterior protrusive technique for mandibular positioning.

Official Title
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Two Cohort Prospective Single Blinded Patient Crossover Trial Comparing Anterior Protrusive and Sibilant Phoneme Mandibular Positioning Techniques for Dental Sleep Appliances

Conditions
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Sleep Apnea, Obstructive, Occlusal Splints

Intervention / Treatment
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* Other: Speech positioning technique


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patient diagnosed with obstructive sleep apnea, and Prescription/order for a dental sleep appliance 18 years or older Treatment planned in accordance with AADSM treatment guidelines Exclusion Criteria: There are no separate exclusion criteria

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Anterior Protrusive<br>use of anterior protrusive positioning technique | Other: Speech positioning technique<br>* Speech positioning technique<br>|
| Experimental: Speech Position<br>use of speech positioning technique | Other: Speech positioning technique<br>* Speech positioning technique<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Apnea-hypopnea index (AHI) | Measurement to determine whether both mandibular positioning techniques provide similar management of obstructive sleep apnea | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Overjet | Measurement to determine whether there is a significant difference in final treatment mandibular position between the positioning techniques. | 3 months |