{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:00:55Z","timestamp":1785427255486,"version":"3.56.0"},"reference-count":23,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"crossref","award":["24K02654"],"award-info":[{"award-number":["24K02654"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science","doi-asserted-by":"crossref","award":["25K20455"],"award-info":[{"award-number":["25K20455"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"crossref"}]},{"award":["24K02654"],"award-info":[{"award-number":["24K02654"]}],"id":[{"id":"https:\/\/ror.org\/00hhkn466","id-type":"ROR","asserted-by":"publisher"}]},{"award":["25K20455"],"award-info":[{"award-number":["25K20455"]}],"id":[{"id":"https:\/\/ror.org\/00hhkn466","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dent. J.","Dentistry Journal"],"abstract":"<jats:p>Background\/Objectives: Oral appliance (OA) therapy is an established treatment option for patients with mild-to-moderate obstructive sleep apnea (OSA). Although OAs of various designs have been developed, clinical evidence regarding the effectiveness of separated-type OAs in OSA remains limited. We evaluated the clinical outcomes of patients with OSA treated using a custom-made separated-type OA. Methods: This retrospective study included 47 Japanese patients with OSA who were diagnosed using polysomnography and referred for OA therapy between March 2015 and March 2025. Baseline demographic and clinical characteristics were obtained from medical records for all patients. Treatment effectiveness was analyzed in the 27 patients who underwent both baseline and follow-up polysomnography. The normality of within-patient Apnea\u2013Hypopnea Index (AHI) differences was assessed using the Shapiro\u2013Wilk test, and paired comparisons were performed using the paired t-test. Results: Follow-up polysomnography after OA therapy was performed in 27 patients (57.4%). In these patients, AHI significantly decreased from 17.4 \u00b1 8.6 events\/h at baseline to 8.2 \u00b1 5.1 events\/h after OA therapy (mean reduction, 9.23 events\/h; 95% CI, 6.33\u201312.12; paired t-test, p &lt; 0.001). OSA severity classification improved after treatment, and no patients were classified as having severe OSA at follow-up. Conclusions: Treatment with a custom-made separated-type OA was associated with a significant reduction in AHI among patients who underwent follow-up polysomnography, suggesting that separated-type OAs may be a useful option for selected patients with mild-to-moderate OSA. These findings should be interpreted with caution because of the retrospective design and incomplete follow-up data.<\/jats:p>","DOI":"10.3390\/dj14070458","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T15:17:52Z","timestamp":1784647072000},"page":"458","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Effectiveness of a Separated-Type Oral Appliance for Obstructive Sleep Apnea in Japanese Patients"],"prefix":"10.3390","volume":"14","author":[{"given":"Kazutaka","family":"Ikeda","sequence":"first","affiliation":[{"name":"Department of Orthodontics, Division of Oral Health and Development, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5016-4957","authenticated-orcid":false,"given":"Ryo","family":"Kunimatsu","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuzo","family":"Sakata","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Division of Oral Health and Development, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuhito","family":"Sugai","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Division of Oral Health and Development, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shintaro","family":"Ogashira","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, Division of Oral Health and Development, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4439-1579","authenticated-orcid":false,"given":"Kotaro","family":"Tanimoto","sequence":"additional","affiliation":[{"name":"Department of Orthodontics and Craniofacial Developmental Biology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8553, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1161\/CIRCULATIONAHA.111.070813","article-title":"Sleep apnea and cardiovascular disease: A bidirectional relationship","volume":"126","author":"Kasai","year":"2012","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1389","DOI":"10.1001\/jama.2020.3514","article-title":"Diagnosis and management of obstructive sleep apnea: A review","volume":"323","author":"Gottlieb","year":"2020","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1056\/NEJMoa1606599","article-title":"CPAP for prevention of cardiovascular events in obstructive sleep apnea","volume":"375","author":"McEvoy","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1773","DOI":"10.1016\/j.jacc.2024.03.374","article-title":"Mandibular advancement vs CPAP for obstructive sleep apnea: Open your mouth wide and breathe","volume":"83","author":"Emdin","year":"2024","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1002\/cre2.35","article-title":"Assessment of oral appliance for obstructive sleep apnea patients","volume":"2","author":"Makihara","year":"2016","journal-title":"Clin. Exp. Dent. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"215","DOI":"10.5664\/jcsm.3460","article-title":"Oral appliance treatment for obstructive sleep apnea: An update","volume":"10","author":"Sutherland","year":"2014","journal-title":"J. Clin. Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"101557","DOI":"10.1016\/j.smrv.2021.101557","article-title":"Mandibular advancement device design: A systematic review on outcomes in obstructive sleep apnea treatment","volume":"60","author":"Aarab","year":"2021","journal-title":"Sleep Med. Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"143","DOI":"10.5664\/jcsm.8978","article-title":"Long-term compliance and side effects of oral appliances used for the treatment of snoring and obstructive sleep apnea syndrome","volume":"1","author":"Lowe","year":"2005","journal-title":"J. Clin. Sleep Med."},{"key":"ref_9","first-page":"1","article-title":"Feeling and mental stress when wearing an oral appliance for obstructive sleep apnea syndrome: Comparison of mono-block type and two-piece type","volume":"28","author":"Mizuno","year":"2022","journal-title":"J. Jpn. Acad. Occlusion Health"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"American Academy of Sleep Medicine Task Force (1999). Sleep-related breathing disorders in adults: Recommendations for syndrome definition and measurement techniques in clinical research. The report of an American Academy of Sleep Medicine task force. Sleep, 22, 667\u2013689.","DOI":"10.1093\/sleep\/22.5.667"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/S0889-5406(03)00508-0","article-title":"Effect of titrated mandibular advancement and jaw opening on the upper airway in nonapneic men: A magnetic resonance imaging and cephalometric study","volume":"125","author":"Gao","year":"2004","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"zsac044","DOI":"10.1093\/sleep\/zsac044","article-title":"The relationship between mandibular advancement, tongue movement, and treatment outcome in obstructive sleep apnea","volume":"45","author":"Knapman","year":"2022","journal-title":"Sleep"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1111\/j.1365-2842.2009.01946.x","article-title":"Effects of a mandibular advancement device on the upper airway morphology: A cephalometric analysis","volume":"36","author":"Doff","year":"2009","journal-title":"J. Oral Rehabil."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1136\/thx.54.11.972","article-title":"Mandibular advancement oral appliance therapy for obstructive sleep apnoea: Effect on awake calibre of the velopharynx","volume":"54","author":"Ryan","year":"1999","journal-title":"Thorax"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1093\/sleep\/34.4.469","article-title":"Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea","volume":"34","author":"Sutherland","year":"2011","journal-title":"Sleep"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1513\/AnnalsATS.202006-696FR","article-title":"Excessive daytime sleepiness in obstructive sleep apnea. Mechanisms and clinical management","volume":"18","author":"Lal","year":"2021","journal-title":"Ann. Am. Thorac. Soc."},{"key":"ref_17","first-page":"37","article-title":"Craniofacial phenotyping in obstructive sleep apnea\u2013A novel quantitative photographic approach","volume":"32","author":"Lee","year":"2009","journal-title":"Sleep"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"2909","DOI":"10.1007\/s00405-013-2417-0","article-title":"Comparison between mono-bloc and bi-bloc mandibular advancement devices for obstructive sleep apnea","volume":"270","author":"Lee","year":"2013","journal-title":"Eur. Arch. Otorhinolaryngol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Ishiyama, H., Hasebe, D., Sato, K., Sakamoto, Y., Furuhashi, A., Komori, E., and Yuasa, H. (2019). The efficacy of device designs (mono-block or bi-block) in oral appliance therapy for obstructive sleep apnea patients: A systematic review and meta-analysis. Int. J. Environ. Res. Public Health, 16.","DOI":"10.3390\/ijerph16173182"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"\u00d6zk\u00f6yl\u00fc, G., Sara\u00e7, D., Sasany, R., and Umurca, D.G. (2024). Comparison of monoblock and twinblock mandibular advancement devices in patients with obstructive sleep apnea and temporomandibular disorder: Effects on airway volume, polysomnography parameters, and sleepiness scale scores. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04653-4"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1007\/s00784-012-0737-x","article-title":"Long-term oral appliance therapy in obstructive sleep apnea syndrome: A controlled study on dental side effects","volume":"17","author":"Doff","year":"2013","journal-title":"Clin. Oral Investig."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Ishida, E., Kunimatsu, R., Medina, C.C., Iwai, K., Miura, S., Tsuka, Y., and Tanimoto, K. (2022). Dental and occlusal changes during mandibular advancement device therapy in Japanese patients with obstructive sleep apnea: Four years follow-up. J. Clin. Med., 11.","DOI":"10.3390\/jcm11247539"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"30","DOI":"10.2319\/030309-122.1","article-title":"Five years of sleep apnea treatment with a mandibular advancement device. Side effects and technical complications","volume":"80","author":"Willaert","year":"2010","journal-title":"Angle Orthod."}],"container-title":["Dentistry Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/458\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T04:36:50Z","timestamp":1784781410000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2304-6767\/14\/7\/458"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":23,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7]]}},"alternative-id":["dj14070458"],"URL":"https:\/\/doi.org\/10.3390\/dj14070458","relation":{},"ISSN":["2304-6767"],"issn-type":[{"value":"2304-6767","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]}}}