It is known that a small upper airway or one that is highly collapsible is an important factor in increasing the risk of obstructive sleep.  Therefore, in this study we investigated 3D changes of the nasopharyngeal and oropharyngeal airway apnea in adults, to test the hypothesis that the combined upper airway can be non-surgically improved in adults using Biomimetic Oral Appliance Therapy (BOAT).  BOAT differs from mandibular advancement devices since it aims to correct the nasal cavity and oropharyngeal regions of the upper airway.  After obtaining appropriate consent, 3D Cone-Beam Computerized Tomographic (CBCT) scans of 13 Korean adults diagnosed with midfacial hypoplasia were taken prior to BOAT.  Post-treatment, follow-up 3D CBCT scans were undertaken with no device in the patient’s mouth.  After 3D craniofacial reconstruction was undertaken, pre- and post-treatment nasopharyngeal and oropharyngeal airway volumes (from the nasal cavity to the level of the hyoid bone) were calculated, and the findings were subjected to univariate statistical tests.  The mean age of the sample was 29.6yrs ± 9.0.  The mean treatment time with BOAT was 16.3 ± 5.2 months.  The mean pre-treatment upper airway volume was found to be 43.3cm3 ± 6.5.  Post-treatment, the mean upper airway volume increased by 12% to 48.5cm3 ± 9.6 with no device in the patient’s mouth, which was statistically significant (p < 0.01).  These findings suggest that the morphology of the upper airway can be non-surgically improved in non-growing adults.  These induced upper airway enhancements may correspond to functional airway behavior and might provide an alternative therapy for obstructive sleep apnea in adults.  Further studies are now required to correlate these structural upper airway improvements to polysomnographic parameters during sleep.

Prof. Dave Singh is a US citizen who holds three doctorates. He is the founder and chief medical officer of Vivos Therapeutics, Inc., USA and adjunct professor, sleep medicine, Stanford University, USA. He has over 200 publications in the medical, dental and orthodontic literature and has published several books/book chapters. He has been serving as a board member of the American Sleep and Breathing Academy and is a member of the World Sleep Society.