Sleep Disorders | Sleep Review
Many patients starting CPAP for sleep apnea experience a decrease in their toilet visits in the middle of the night. But do patients who choose mandibular thrusters have the same benefit?
Interview by Bushraa Khatib
When patients with obstructive sleep apnea (OSA) are treated with oral apparatus therapy at the University of Kentucky Pain Clinic, Fernanda Yanez-Regonesi, DDS, MS, an assistant professor on the College of Dentistry’s orofacial pain program, noted that there were many comments during follow-up would give away. ups, that they didn’t wake up to go to the bathroom. This feedback inspired Yanez-Regonesi to investigate the effects of oral appliances on nocturia.
“We found that there is a lot of literature on the use of CPAP machines to improve nocturia in patients with obstructive sleep apnea. however, there was no available literature for MAD [mandibular advance device] Therapy, ”she says. Their study found that more than half (56.6%) of patients no longer presented nocturia at their third follow-up appointment.
[Editor’s Note: Read the full abstract, Improvement in nocturia in obstructive sleep apnea patients with the use of mandibular advancement device, which was presented at the American Academy of Dental Sleep Medicine 2021 virtual annual meeting.]
Yanez-Regonesi emailed the study to Sleep Review. The transcript has been slightly edited for clarity and style.
Why is nocturia a problem for patients with insomnia?
GUY: Nocturia is associated with a sleep disorder. Studies have shown a link between the frequency of nocturnal urination and its negative effects on quality of life and well-being. A study was done to understand how much nocturia is associated with discomfort and impact on patients’ lives. They found that nocturia was significantly associated with impaired quality of life in all dimensions (including movement, vision, hearing, breathing, sleeping, speaking, mental function, depression, sexual activity) in both sexes, except when eating. 1
Fernanda Yanez-Regonesi, DDS, MS
How would you compare the effectiveness of treatment with CPAP versus treatment with MAD therapy for nocturia?
GUY: Studies of CPAP therapy have reported an improvement between 50% and 100%, 2,3 while we saw an improvement of 60%.
Thoughts on how nocturia and OSA are related?
GUY: There have been reports in the literature of an association between OSA and nocturia in adult patients who view nocturia as a predictor or indicator of OSA risk.4,5 Studies have shown that continued respiratory effort during apnea events leads to a false signal in the heart, this causes the production of a water-related hormone (ANP) that leads to urine production and nocturia.6 Nocturia is believed to improve with treatment for OSA.
Did you notice any difference in results between the types of oral devices?
GUY: No significant difference was found between device design or titration and response to therapy.
How long were patients examined?
GUY: The mean follow-up time for our study was 6 ± 3.65 months. We are currently working on a new study to compare four different time points and better understand the immediate, short-term and long-term effects.
What are the clinical implications of your research?
GUY: Nocturia could be used as a subjective measure of improvement during the titration process of MAD. Based on the results of our study, MAD therapy provides a significant improvement in nocturia as a result of OSA, which is another result that is comparable to CPAP therapy.
What further research should be done?
Yanez-Regonesi: Future studies should address whether there is a correlation between improvements in the apnea-hypopnea index (AHI) and changes in nocturia.
Yanez-Regonesi F, Sangalli L, Martinez-Porras A, et al. Improving nocturia in patients with obstructive sleep apnea through the use of a mandibular feeder. Journal of Dental Sleep Medicine. Abstracts of the virtual annual conference 2021: Abstract # 13.
- Tikkinen KAO, Johnson ™ 2., Tammela TLJ et al. Nocturia Incidence, Disorder, and Quality of Life: How Often is Too Often? A population-based study in Finland. Eur Urol. 2010 March; 57 (3): 488-96.
- Vrooman OPJ, van Balken MR, van Koeveringe GA. The effect of sustained positive airway pressure on nocturia in patients with obstructive sleep apnea syndrome. Neurourol Urodyn. 2020 Apr; 39 (4): 1124-8.
- rer B, elikhisar A, elikhisar H, et al. To evaluate sexual dysfunction, lower urinary tract symptoms, and quality of life in men with obstructive sleep apnea syndrome and the effectiveness of continuous positive airway pressure therapy. Urology 121 (2018): 86-92.
- Salas C, Jorge Dreyse J, Contreras A, et al. Differences in patients from ENT medicine and other specialties with sleep apnea. J Otolaryngol head and neck surgery. 2019 Oct 22; 48 (1): 53.
- Basoglu OK, Tasbakan MS. Sex differences in clinical and polysomnographic features of obstructive sleep apnea: a clinical study of 2,827 patients. Sleep breath. 2018 March; 22 (1): 241-9.
- Umlauf MG, Chasens ER, Greevy RA, et al. Obstructive sleep apnea, nocturia, and polyuria in older adults. Sleep. February 1, 2004; 27 (1): 139-44.
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Sleep researchers interested in participating in a Q&A should email the editor[at]sleepreviewmag.com with a link to their relevant study.