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Obstructive Sleep Apnea
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Sleep Disordered Breathing

Watermark Medical (ARES™)
Dental Publications:

Impact of Age and Position on Severity of Gender-specific Sleep Disordered Breathing
Daniel Levendowski, Chris Berka, Djordje Popovic, Tim Zavora, Daniela Scarfeo, Philip Westbrook Advanced Brain Monitoring, Inc.

A previous report found a significant correlation between differences in gender specific length of the pharyngeal airway and obstructive sleep apnea (OSA) severity [1]. This study investigates the impact of age on gender-specific positional and non-positional OSA.

Sleep/wake Classification using Head Actigraphy, Snoring and Airflow Signals
Djordje Popovic, Vladislav Velimirovic, Indu Ayappa, Daniel Levendowski, Tim Zavora, David Rapoport, Philip Westbrook, Advanced Brain Monitoring, New York University School of Medicine

Actigraphy is often used in ambulatory devices to differentiate wakefulness from sleep but its accuracy is limited by the inability to distinguish quiet wakefulness from sleep and active wakefulness from arousals resulting from sleep disordered breathing. This study investigates the accuracy of a novel algorithm which combines actigraphy, nasal flow and snoring obtained from the forehead in order to differentiate sleep from wake.

Factors Impacting Mandibular-Repositioning-Device Therapy at One-month
Todd Morgan, Jon Montague, Victoria Melzer, Djordje Popovic, Daniel Levendowski Scripps Memorial Hospital, La Costa Dental Group, Advanced Brain Monitoring

There are a limited number of studies which have directly compared differences in efficacy between two mandibular repositioning devices (MRD), or validated procedures which can be provided to a novice dentist to improve the likelihood of successful MRD outcomes. The goals of this prospective study were to: a) determine if there were differences in outcomes between two commercially available MRD appliances, and 2) assess differences in outcomes between an expert and novice dental office using standardized protocols.

Impact of Time on the Treatment Efficacy of Mandibular Repositioning Devices
Dan Levendowski,Todd Morgan, Jon Montague, Victoria Melzer, Djordje Popovic, Philip Westbrook Advanced Brain Monitoring, Inc., Scripps Memorial Hospital, La Costa Dental]

A limited number of studies have measured changes in sleep-disorderedbreathing subsequent to treatment with mandibular repositioning devices (MRD). This pilot study assesses changes in efficacy and/or need for routine adjustment to optimize outcomes.

Benefit of Mandibular Repositioning Device Therapy in Patients with Moderate and Severe OSA
Daniel Levendowski, Todd Morgan, Victoria Melzer, Djordje Popovic, Daniela Scarfeo, Philip Westbrook Advanced Brain Monitoring, Scripps Memorial Hospital, La Costa Dental

AASM practice parameters recommend mandibular repositioning devices (MRD) in patients with mild- to moderate-obstructive sleep apnea (OSA). Those with increased sleep disordered breathing, however, show the greatest benefit in Quality of Life Years resulting from therapeutic intervention. This study assesses outcomes resulting from MRD therapy in patients with moderate and severe OSA.

Assessing Change in OSA Severity During a Non-treatment Wash-Out Period – is there a Halo Effect?
Daniel Levendowski, Todd Morgan, Djordje Popovic, Victoria Melzer, Daniela Scarfeo, Philip Westbrook Advanced Brain Monitoring, Scripps Memorial Hospital, La Costa Dental

Dentists who treat obstructive sleep apnea with mandibular repositioning devices (MRD) do not routinely obtain pre-treatment apnea/hypopnea index (AHI) values with the same equipment used to assess treatment outcomes. Once treatment has been initiated, health/safety concerns impact the recommendation to temporarily suspend therapy to obtain reference values. There is limited data to support the assumption that the AHI values return to an untreated baseline levels in the first night after treatment has been suspended. This pilot study attempts to address this question.

Predicted Prevalence of OSA in Population of Dental Patients Undergoing Moderate Sedation Compared to a Cohort of General Dentistry Patients
Richard A. Gagne, Daniel Levendowski, Daniela Scarfeo, and Philip Westbrook Private Practice in Oxnard CA, Advanced Brain Monitoring

Anxiety toward dental treatment is increasingly being managed with parenteral sedation techniques. Agents used in these techniques compromise the patency of the airway, suppress respiratory drive, and poses risk of adverse outcomes in patients with obstructive sleep apnea (OSA). The goal of this investigation was to assess the prevalence of undiagnosed OSA in a population of patients undergoing parenteral sedation for dentistry.

Predicting Changes in AHI Resulting from Mandibular Repositioning Device Therapy
Daniel Levendowski, Todd Morgan, John Patrickus, Victoria Melzer, Jon Montague, Djordje Popovic, Philip Westbrook Advanced Brain Monitoring, Scripps Memorial Hospital, Northeast Wisconsin Dental, La Costa Dental

Identification of patients likely to have successful outcomes could increase the use of mandibular repositioning devices (MRD) as the first choice of therapy for obstructive sleep apnea (OSA). One approach suggests patients with positional OSA (supine AHI / non-supine AHI >2) will have better outcomes. Another model does not make predictions when individuals have an AHI < 15. This study investigates predictors associated with successful MRD outcomes.

Assessing Changes in the Apnea/Hypopnea Index Resulting from Increased Vertical Dimension of Occlusion of Mandibular Repositioning Devices
Daniel Levendowski, Djordje Popovic, Todd Morgan, Victoria Melzer, Philip Westbrook Advanced Brain Monitoring, Scripps Memorial Hospital, La Costa Dental

Mandibular repositioning devices (MRD) are frequently used in the treatment of mild and moderate obstructive sleep apnea (OSA) but guidelines for determining the optimal vertical dimension of occlusion (VDO) are lacking. The goal of this investigation is to asses the impact of VDO on the improvements in apnea/hypopnea index (AHI) of OSA patients treated with MRD.

Oral Appliance Efficacy in Positional and Non-Positional OSA Patients.
Chung J, Enciso R, Levendowski D et al. Sleep Breath 2009, in-press

Seventy-nine patients treated with the Tap III or Herbst oral appliances were stratified into positional (n=44) and non-positional (n=35) OSA categories based on the supine to non-supine AHI ratio > 2.0. The percentage of patients with > 50% reduction in AHI was 89% for the positional group and 57% for the non-positional group. The percent time supine significantly increased in the positional group even as the AHI decreased. Oral appliances are more effective in positional OSA than non-positional OSA patients.