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Mandibular advancement device therapy for obstructive sleep apnea : a prospective study on predictors of treatment success

Petri, Niels ; Christensen, Ib Jarle ; Svanholt, Palle ; Sonnesen, Liselotte ; Wildschiødtz, Gordon and Berg, Søren LU (2019) In Sleep Medicine 54. p.187-194
Abstract

Objective: To survey potential predictors of success of mandibular advancement device (MAD) therapy in patients with obstructive sleep apnea (OSA), and in particular, to examine anatomical narrowings and sleep-related collapse levels in the upper airway. Methods: This was a prospective study of 62 OSA patients (median apnea–hypopnea index [AHI] of 34), who were treated with a custom-made, monobloc MAD. The upper airway was examined by inspection, nasopharyngoscopy, overnight acoustic reflectometry recording collapses, and cephalometry of soft tissue dimensions (in addition to skeletal parameters). MAD treatment was controlled by polysomnograpy before and after at least five weeks from the beginning of treatment. Independent predictors... (More)

Objective: To survey potential predictors of success of mandibular advancement device (MAD) therapy in patients with obstructive sleep apnea (OSA), and in particular, to examine anatomical narrowings and sleep-related collapse levels in the upper airway. Methods: This was a prospective study of 62 OSA patients (median apnea–hypopnea index [AHI] of 34), who were treated with a custom-made, monobloc MAD. The upper airway was examined by inspection, nasopharyngoscopy, overnight acoustic reflectometry recording collapses, and cephalometry of soft tissue dimensions (in addition to skeletal parameters). MAD treatment was controlled by polysomnograpy before and after at least five weeks from the beginning of treatment. Independent predictors of actual reduction in AHI and treatment success (reduction in AHI ≥ 50% with residual AHI < 10) were determined, using multivariable linear and logistic regression. Results: Positional OSA (POSA) and nonsupine AHI (adjusted for upper airway narrowness and collapses, together with gender, age, body mass index, neck circumference, and baseline AHI) were the only independent predictors: POSA indicative for success, and nonsupine AHI inversely related to success. Cephalometry was not predictive. Two predictive models were proposed, one based on POSA having a specificity of 70% and sensitivity of 69%, and the other based on nonsupine AHI, generating a receiver operating characteristic (ROC) curve (area under ROC = 0.78). Using the ROC model, specificity could be increased to 80% without lowering sensitivity. Conclusions: Only variables related to sleep position proved to be independent predictors of success with MAD therapy. The results could be explained by the MAD counteracting the mandible from moving backwards when sleeping supine.

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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acoustic reflectometry, Cephalometry, Mandibular advancement device, Obstructive sleep apnea, Positional sleep apnea, Predictors of outcome
in
Sleep Medicine
volume
54
pages
8 pages
publisher
Elsevier
external identifiers
  • pmid:30580193
  • scopus:85058714073
ISSN
1389-9457
DOI
10.1016/j.sleep.2018.09.033
language
English
LU publication?
yes
id
68d1d56a-41c2-4871-a79b-ef08337867c4
date added to LUP
2019-01-02 13:13:35
date last changed
2022-09-23 17:10:58
@article{68d1d56a-41c2-4871-a79b-ef08337867c4,
  abstract     = {{<p>Objective: To survey potential predictors of success of mandibular advancement device (MAD) therapy in patients with obstructive sleep apnea (OSA), and in particular, to examine anatomical narrowings and sleep-related collapse levels in the upper airway. Methods: This was a prospective study of 62 OSA patients (median apnea–hypopnea index [AHI] of 34), who were treated with a custom-made, monobloc MAD. The upper airway was examined by inspection, nasopharyngoscopy, overnight acoustic reflectometry recording collapses, and cephalometry of soft tissue dimensions (in addition to skeletal parameters). MAD treatment was controlled by polysomnograpy before and after at least five weeks from the beginning of treatment. Independent predictors of actual reduction in AHI and treatment success (reduction in AHI ≥ 50% with residual AHI &lt; 10) were determined, using multivariable linear and logistic regression. Results: Positional OSA (POSA) and nonsupine AHI (adjusted for upper airway narrowness and collapses, together with gender, age, body mass index, neck circumference, and baseline AHI) were the only independent predictors: POSA indicative for success, and nonsupine AHI inversely related to success. Cephalometry was not predictive. Two predictive models were proposed, one based on POSA having a specificity of 70% and sensitivity of 69%, and the other based on nonsupine AHI, generating a receiver operating characteristic (ROC) curve (area under ROC = 0.78). Using the ROC model, specificity could be increased to 80% without lowering sensitivity. Conclusions: Only variables related to sleep position proved to be independent predictors of success with MAD therapy. The results could be explained by the MAD counteracting the mandible from moving backwards when sleeping supine.</p>}},
  author       = {{Petri, Niels and Christensen, Ib Jarle and Svanholt, Palle and Sonnesen, Liselotte and Wildschiødtz, Gordon and Berg, Søren}},
  issn         = {{1389-9457}},
  keywords     = {{Acoustic reflectometry; Cephalometry; Mandibular advancement device; Obstructive sleep apnea; Positional sleep apnea; Predictors of outcome}},
  language     = {{eng}},
  month        = {{02}},
  pages        = {{187--194}},
  publisher    = {{Elsevier}},
  series       = {{Sleep Medicine}},
  title        = {{Mandibular advancement device therapy for obstructive sleep apnea : a prospective study on predictors of treatment success}},
  url          = {{http://dx.doi.org/10.1016/j.sleep.2018.09.033}},
  doi          = {{10.1016/j.sleep.2018.09.033}},
  volume       = {{54}},
  year         = {{2019}},
}