Original Articles



Acoustic Reflection: Review and Clinical Applications for Sleep-Disordered Breathing

Viviano, JS. Sleep and Breathing, volume 6, number 3, 2002 p. 129-149

Abstracted / Indexed by Index Medicus / MEDLINE


Summary: Sleep-disordered breathing (SDB) affects more than 4% of the adult population with an even higher prevalence within high risk groups. Nasal continuous positive air pressure (nCPAP), although considered the current gold standard treatment for SDB demonstrates poor patient compliance. Alternative therapies, such as palatal surgeries and airway orthotics lack validated candidacy selection protocols; resulting in varying success rates. Although much has been published over the last several years regarding the effect of these therapies on the upper airway, no publication has presented an accounting of the use of acoustic reflection (AR) to evaluate airway characteristics pre and post treatment with these alternative therapies. MORE...



Assessing Orthotic Normalization of Pharyngeal Dynamics

Viviano JS, CRANIO, volume 22, number 3, 2004 p. 192-208

Abstracted / Indexed by Index Medicus / MEDLINE


Summary: Airway orthotic therapy, considered mainstream in the treatment of sleep disordered breathing, has been demonstrated to normalize both structure and function of the pathological airway through manipulation of mandibular posture. Although effective, the literature reports a variable rate of success and no validated candidacy selection protocol. Acoustic reflection has been used to evaluate and document the upper airway and its dynamics with and without an orthotic in place. This paper will discuss use of acoustic reflection to assess the level of airway normalization resulting from protrusive and vertical repositioning of the mandible, and its utility to establish orthotic candidacy, construction, titration and maintenance parameters. MORE...



Normalizing the Pathological Airway

Sleep Review: The Journal for Sleep Specialists

Viviano JS, Sleep Review, Volume 3, number 1, 2002 p. 

The term “airway orthotic” (AO) is derived from the belief that these tooth-retained oral devices work by manipulating the jaw into the posture that best stabilizes the airway, thus normalizing airway behavior. Several studies have demonstrated their ability to normalize both airway structure and function through manipulation of mandibular posture.1-4 Although officially condoned for the treatment of sleep-disordered breathing (SDB) by the American Academy of Sleep Medicine in 1995,5 to date, issues such as AO candidacy selection, construction parameters, and titration settings continue to be dealt with through mostly anecdotal findings and subjective evaluation. MORE...



Mandibular Advancement Achieved through a Stepped Mouthpiece Mouthpiece Design

Can Change the Size of the Upper Airways

Nikander, K. Petherbridge, I. Scarberry, E. Von Hollen, D. Viviano, J. Chrystyn, H

Respiratory Drug Delivery POSTER 2010