J Clin Sleep Med. 2022 Aug 15. doi: 10.5664/jcsm.10232. Online ahead of print.
ABSTRACT
STUDY OBJECTIVES: To evaluate (determinants of) treatment success of mandibular advancement device (MAD) application in a selected phenotype of patients with obstructive sleep apnea (OSA).
METHODS: 90 non-obese patients with moderate OSA (obstructive apnea-hypopnea index (OAHI) ≥ 15 and < 30/h) without comorbidities were prospectively included. Polysomnography (PSG) was performed at baseline and with MAD. A drug-induced sleep endoscopy (DISE) with jaw thrust was performed in 83%.
RESULTS: OAHI reduction ≥ 50% was observed in 73%, OAHI reduction ≥ 50% with OAHI < 10/h in 70%, complete OSA resolution (OAHI < 5/h) in 40%. Patients with non-positional OSA showed a significantly higher rate of complete OSA resolution: post-test probability increased to 67%. In patients with total disappearance of collapse at velum level and at all levels during DISE with jaw thrust, the drop in OAHI was impressive with an infinitively high positive likelihood ratio. However, the proportion of patients having non-positional OSA or the DISE-characteristics as described above was < 20%. The change in snoring disturbance based on a Visual Analogue Scale was 76% (IQR 40-89%, p<0.001) and a statistically significant amelioration in Epworth Sleepiness Scale (especially in somnolent subjects) was observed. High adherence was reported.
CONCLUSIONS: In this pre-defined OSA phenotype, MAD was effective in reduction of OAHI and in amelioration of symptoms. Stratification by non-positional OSA and findings on DISE with jaw thrust increased treatment success defined as reduction in OAHI. However, the clinical relevance can be questioned because only a small number of patients demonstrated these characteristics.
PMID:35962942 | DOI:10.5664/jcsm.10232
