1

"When you are a hammer", the proverb goes, "everything looks like a nail".

To my knowledge current apnea testing involves a multitude of sensors that record the position of various parts of the body but do not evaluate the position and motions of the jaw and the number of apnea events indicates either a go/no-go decision about CPAP.

However, the location of the jaw can in some cases be manipulated by a physical appliance resulting in a relatively simple, passive solution.

In fact, armed with sufficient data it may be possible to identify currently unidentified jaw and dental problems that might be creating or contributing significantly to the apnea.

In addition the collected data may lead to other insights such as a patient shown to be grinding their teeth, resting their jaw on their hand during sleep, etc.

I would imagine that all that would be involved is a sensor on the skull (already present) and one (or better yet, three, for each axis) on the jaw.

Note: At the heart of this is my suspicion that dental and jaw issues account for a significant part of apnea, confirmed by the efficacy of the new appliance.

Related:

Has a correlation between sleep apnea and grinding of teeth been identified or ruled out?

2

There are specialists who do different degrees of positional assessments - specifically orthodontists, dentists, or maxillofacial surgeons (usually those who specialize in TMJ). Also, some practicing D.O. physicians and massage therapists who specialize in cranial OMT may address positioning.

OSA is not the only potential complication of poor mandibular alignment (or TMD); it can cause headaches, dizziness, tooth wear, sensitivity, clicking, jaw pain...

I cannot cite the name of the device because I do not remember, but I pilot tested a nighttime monitoring device that monitored the amplitude of muscle contraction of the masseter (jaw clenching muscle) as well as body position, movements, pulse, O2 saturations, and noise (snoring). The goal was to correlate hypoxia with positioning, HR, clenching, snoring etc. The application of the results, however, are still in development. The investigators were a physician (D.O.) and orthodontist who work together on individuals with TMD.

I anticipate more of these will be available in the future.

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2

As I pointed out in the comments under your other related question, mandibular advancement devices are not a new idea.

From my experience as a diagnosed sufferer of chronic OSA (Obstructive Sleep Apnoea), I underwent the home sleep study you described and it was not a "go/no go" test for CPAP, it was a yes/no test for sleep apnoea.

It was suggested in 2014 (before the paper you linked was written) that I use a mandibular advancement device to keep my lower jaw forward whilst sleeping. The boil and bite ones worked for a limited time (usually for a month or, if your lucky, slightly longer) and then you have to throw it away and buy another as they wear out.

I could have opted for a custom made one from the dentist, or Somnowell for £1,500 and I have been told they can last 10 years due to their construction and materials used.

In contrast to a CPAP I now use, they are half the price at £600-£700 — Much more cost effective.

Whilst I am not dismissing your notion that mandibular advancement devices help, while custom made devices cost so much, CPAP will be my recommendation.

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  • Thank you for sharing your thoughts and experience. This question is about the advisability of adding jaw position to apnea testing. Did they analyze your jaw movement when they suggested the less expensive solution or did they determine that you had apnea and as a matter of course recommended the device? My thought is that not all apneas are jaw related and by modifying the test might suggest whether jaw position will or will not solve the apnea problem. My thought is that better data would make for better solutions. Do the devices always work and knowing the jaw's activity adds nothing? – Ruminator Apr 29 '19 at 14:41
  • @Ruminator - The suggestion to use the mandibular advancement device was as the first option. The jaw movement pulls the tongue forward so therefore keeps the airway open. It does work, but unless you pay for the custom made one you are going to fork out a lot of money over the year. (£50 x 12 = £600 min) the same as the lowest cost CPAP. – Chris Rogers Apr 29 '19 at 14:49
  • If the source of the problem was not the jaw's position, might there not be a downside to manipulating the jaw's position each night and actually contribute to mandibular joint issues or other side effects? My thought is that lots of things dispensed by doctors "work" but in the end the cure is worse than the disease. Making use of the opportunity to record and analyze jaw position, grinding and sleeping "wrong" should, I would think, lead to better treatment plans. – Ruminator Apr 29 '19 at 14:56
  • @Ruminator - I think that would be a valid separate question – Chris Rogers Apr 29 '19 at 15:16
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    Please note that in general, jaw positioning devices only are recommended for mild obstructive sleep apnea, and in some cases moderate. – DoctorWhom Apr 30 '19 at 4:00

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