| Our Research
Dr. Lowe has lectured extensively both nationally
and internationally in the areas of neurophysiology and orthodontics
with particular emphasis on the control of tongue posture, the surgical
and orthodontic management of open-bite malocclusions, the future role
of undergraduate orthodontic training and the etiology and treatment of
snoring and Obstructive Sleep Apnea. Current research projects under
his direction include an analysis of the relative effectiveness of
specific oral appliances used in the treatment of snoring and
Obstructive Sleep Apnea. His research activities have been funded by
both provincial and federal governments and he has published
extensively. In addition, he has successfully filed three U.S. patents.
Dr. Lowe was awarded a grant by the Canadian government through the
National Centres of Excellence (Inspiraplex) program to undertake a
four year multicenter clinical trial to compare in patients with
Obstructive Sleep Apnea the effectiveness, side effects and compliance
of a new oral appliance (Klearway™) and nasal continuous positive
airway pressure.
Areas of special interest and accomplishments:
i) The evaluation of specific oral appliances for
the treatment of snoring and obstructive sleep apnea. The Faculty of
Dentistry at The University of British Columbia is the leading research
center in the world in the field of oral appliances and the treatment
of snoring and obstructive sleep apnea. The results of crossover trials
of two oral appliances as compared to nasal CPAP have impacted sleep
physicians worldwide. An NCE multicenter intent-to-treat clinical trial
which compared an adjustable oral appliance (invented by the writer and
patented by UBC) to nasal CPAP has received international acclaim. A
covert compliance monitor for intraoral use has been developed and
patented. Testing of a remotely controlled titration device used during
overnight sleep studies may provide simpler and shorter titration
protocols for sleep apnea patients. A large retrospective survey of
some 400 patients treated in our Sleep Disorder Clinic will provide
valuable information as to subject perceptions of long term (more than
five year) wear.
ii) The quantification of dentoskeletal,
neuromuscular and soft tissue variables in subjects with snoring and
Obstructive Sleep Apnea. The first published cephalometric standards
for sleep apnea subjects based on our data and are extensively used by
physicians, dentists, orthodontists and sleep specialists. Ongoing
evaluations of long term treatment effects and the cephalometric
predictors of good and poor responders are underway.
iii) The study of the mechanisms which initiate
and coordinate tongue and jaw muscle activity as they relate to jaw
position, respiration, snoring and sleep apnea. Our findings of
atypical tongue muscle activity related to changes in the vertical
dimension in skeletal open bite subjects have a direct influence on
orthodontic clinical practice. Abnormalities in genioglossus muscle
activity are being evaluated in both control and sleep apnea subjects
in both awake and asleep projects. Changes in jaw position during
sleep are being quantified with a JAWSENS device during standard
polysomnography
iv) The development of a computerized model and
cephalometric analysis facility for both research and clinical
purposes. Two and three dimensional analyses of specific
orofacial structures for various skeletal subtypes and in control and
sleep apnea subjects have provided clinical standards for diagnostic
and therapeutic purposes. A Microscribe System, which records the
position of a point in three dimensions and does not expose a patient
to any form of radiation, is used to quantify craniofacial form.
v) The testing of various titration monitors
for clinical application in snoring and sleep apnea patients.
Reports from bed partners are notoriously unreliable so we have
published evaluations of two portable monitors and are currently
testing a third. Such monitors will significantly improve the
success rates of various oral appliances as we develop reliable outcome
measures prior to traditional polysomnography obtained in a sleep
laboratory.
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Maps