ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM
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Title Complete Prostheses Worn at Night May Aggravate the Apnea-Hypopnea Index in Patients with Obstructive Sleep Apnea
Clinical Question For an edentulous patient with obstructive sleep apnea, what is the effect of a complete prosthodontic appliance on obstructive sleep apnea as defined by AHI and patient perceived sleep?
Clinical Bottom Line Complete prostheses likely have an aggravating effect on apnea-hypopnea index (AHI) in edentulous patients with obstructive sleep apnea.
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 21938436Almeida/201223 Elderly edentulous OSA patientsRandomized crossover trial
Key resultsThis study found that patients wearing complete dentures at night had worsened AHI, especially in mild OSA patients. Moderate to severe OSA patients had indeterminate effect on AHI. The authors stated that "the apnea and hypopnea index (AHI) was significantly higher when patients slept with dentures compared to without (25.9 ± 14.8/h vs. 19.9 ± 10.2/h; p < 0.005)."
#2) 19418865Arisaka/200934 Elderly edentulous men and womenCrossover trial
Key resultsThe study stated that the majority of patients sleeping in complete dentures had improved AHI over those who did not. However, it should be noted that five out of 34 patients were recorded to have higher AHI when sleeping with dentures. The authors stated that "the mean AHI in patients sleeping with dentures was lower than that of those without dentures (13.3 +/- 10.0 versus 17.7 +/- 14.6, P= .022)."
#3) 21029154Emami/2012173 elderly edentulous patientsSurvey
Key resultsEdentulous patients experienced good sleep independent of wearing their prostheses. Note: selection criteria did not include OSA.
Evidence Search "Sleep Apnea, Obstructive"[Mesh] AND "Denture, Complete"[Mesh]
Comments on
The Evidence
The first and second studies differed in their conclusion with regard to the effect of wearing complete dentures at night on AHI. The Almeida study pointed to the conclusion that wearing prostheses at night creates a negative effect on AHI, especially in mild OSA patients. The Arisaka et al. study instead pointed to improved AHI when wearing prostheses at night in most of their subjects. As such disparities exist between conclusions to this question, it is necessary for further studies to be carried out on this subject. The Arisaka et al. study had a small sample size, but the F:M ratio was adequately balanced at 18:16. This study relied on portable sleep recording carried out by patients, and so could have been subject to variability from patient to patient. The Almeida et al. study sample size was also small, and was predominately female (F:M ratio 17:6). This study was the only study that performed analysis in a sleep lab. One concern about this study was that patients with mild OSA had greater BMI than those with moderate to severe OSA, which is abnormal with regard to what we know about the etiology of sleep apnea. The investigators claim this should have no effect because BMI did not change during the course of the study. The third study by Emami et el. was adequately randomized as an RCT when comparing conventional versus implant supported dentures, but was concerning as the investigators did not use OSA as one of the inclusion criteria for their analysis on quality of sleep. Instead, they used a survey to determine the quality of sleep in the edentulous population. As such, this study should only be interpreted as a survey.
Applicability This CAT revealed variable results on the effect of wearing complete denture prostheses in patients with obstructive sleep apnea, and so further studies must be done before clinical recommendations can be made with regard to this subject.
Specialty/Discipline (Prosthodontics)
Keywords Obstructive Sleep Apnea, Complete Denture, Edentulous
ID# 2474
Date of submission: 04/22/2013spacer
E-mail rockeyk@livemail.uthscsa.edu
Author Kelsey Rockey
Co-author(s)
Co-author(s) e-mail
Faculty mentor/Co-author Stephan J. Haney, DDS
Faculty mentor/Co-author e-mail haneys2@uthscsa.edu
Basic Science Rationale
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Comments on the CAT
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