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CC BY-NC-ND 4.0 · Sleep Sci 2024; 17(01): e55-e63
DOI: 10.1055/s-0043-1776752
Original Article

Effectiveness of Mandibular Advancement Devices in Positional OSA Patients: A Retrospective Analysis of Predictive Variables in a Sample of Adult Patients

Floriana Pintucci
1   Dentistry, Private Practice, Ferrara, Italy
,
Francesca Cremonini
2   Department of Orthodontics, University of Ferrara, Ferrara, Italy
,
Giulia Romagnolo
2   Department of Orthodontics, University of Ferrara, Ferrara, Italy
,
Gianluca Giorgio Marrano
3   Department of Otolaryngology, Morgagni-Pierantoni Hospital, Forlì, Italy
,
Francesca Barbanti
3   Department of Otolaryngology, Morgagni-Pierantoni Hospital, Forlì, Italy
,
Giorgio Alfredo Spedicato
4   Statistics Department, Bicocca University, Milano, Italy
,
Claudio Vicini
5   Department of Otolaryngology, University of Bologna, Bologna, Italy
,
Luca Lombardo 
6   School of Orthodontics, University of Ferrara, Ferrara, Italy
› Institutsangaben Funding The author(s) received no financial support for the research.
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Abstract

Objectives To evaluate the efficacy of mandibular advancement devices (MADs) in improving apnea-hypopnea index (AHI) in positional obstructive sleep apnea (POSA), compared with a control group of nonpositional OSA (NPOSA) patients, from mild to very severe degree, in order to to find the main variables characterizing the examined group as potential predictors of treatment success.

Materials and Methods In the present observational study, we retrospectively collected polysomnographic records of 39 positional adult patients, divided into 30 supine isolated OSA (siOSA) and 9 supine predominant OSA (spOSA) undergoing MADs from 2003 to 2019, and compared with those of a control group of 47 NPOSA patients. Demographics and anthropometrical data, home sleep apnea test (HSAT) records, drug-induced sleep endoscopy (DISE) results, and dental casts evaluation were analyzed pre- and post-treatment with MADs.

Results A prevalence of the male sex (86%), mean age of 49,4 ± 14.98 years, and mean body mass index (BMI) of 26.74 ± 4.29 kg/m2 were found among the OSA patients with significant differences between the three groups for sex and BMI. After MADs, the HSAT revealed significant reduction of AHI in all of the groups, with greater reduction of the supine AHI in POSA and significant reduction of the snore index for NPOSA. The hypopharynx section (H) of the NOHL Index, a fourth degree of hypopharyngeal collapse and an anteroposterior pattern was the most frequent to occur (19.9%) from DISE exam. No significant correlation between the initial total AHI and the dental variables was found, except for a reduced maxillary intermolar distance.

Conclusion MADs are effective in reducing AHI in POSA and NPOSA patients from mild to very severe degree. Supine AHI decreased after treatment with MADs mainly in siOSA and spOSA patients compared with the NPOSA group. The snore index decreased significantly after treatment with MADs in all groups, showing the greater reduction in the NPOSA group. The tongue base (H) represented the most frequent anatomic area of collapse and there was a high prevalence of upper maxillary constriction.

Keywords

obstructive sleep apnea - mandibular advancement - supine position


Publikationsverlauf

Eingereicht: 07. Juni 2022

Angenommen: 18. Mai 2023

Artikel online veröffentlicht:
20. Februar 2024

© 2024. Brazilian Sleep Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Giles TL, Lasserson TJ, Smith BJ, White J, Wright J, Cates CJ. Continuous positive airways pressure for obstructive sleep apnoea in adults. Cochrane Database Syst Rev 2006; (01) CD001106
    PubMedGoogle Scholar
  • 2 Wolkove N, Baltzan M, Kamel H, Dabrusin R, Palayew M. Long-term compliance with continuous positive airway pressure in patients with obstructive sleep apnea. Can Respir J 2008; 15 (07) 365-369
    CrossrefPubMedGoogle Scholar
  • 3 Lim J, Lasserson TJ, Fleetham J, Wright J. Oral appliances for obstructive sleep apnoea. Cochrane Database Syst Rev 2006; 2006 (01) CD004435
    PubMedGoogle Scholar
  • 4 Barnes M, McEvoy RD, Banks S. et al. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med 2004; 170 (06) 656-664
    CrossrefPubMedGoogle Scholar
  • 5 Ramar K, Dort LC, Katz SG. et al. Clinical Practice Guideline for the treatment of obstructive sleep apnea and snoring with oral Appliance therapy: An Update for 2015. J Clin Sleep Med 2015; 11 (07) 773-827
    CrossrefPubMedGoogle Scholar
  • 6 Alessandri-Bonetti G, Ippolito DR, Bartolucci ML, D'Antò V, Incerti-Parenti S. Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review. Korean J Orthod 2015; 45 (06) 308-321
    CrossrefPubMedGoogle Scholar
  • 7 Hawsawi, Mosaab A. Cephalometric Predictors of Success for Mandibular Advancement Device (MAD) Therapy in Obstructive Sleep Apnea (OSA) Patients Treated at an Academic Institution: Retrospective Study. Tufts University School of Dental Medicine, ProQuest Dissertations Publishing; 2019
    Google Scholar
  • 8 An HJ, Baek SH, Kim SW, Kim SJ, Park YG. Clustering-based characterization of clinical phenotypes in obstructive sleep apnoea using severity, obesity, and craniofacial pattern. Eur J Orthod 2020; 42 (01) 93-100
    PubMedGoogle Scholar
  • 9 Marklund M, Stenlund H, Franklin KA. Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 2004; 125 (04) 1270-1278
    CrossrefPubMedGoogle Scholar
  • 10 Lee SA, Paek JH, Chung YS, Kim WS. Clinical features in patients with positional obstructive sleep apnea according to its subtypes. Sleep Breath 2017; 21 (01) 109-117
    CrossrefPubMedGoogle Scholar
  • 11 Joosten SA, O'Driscoll DM, Berger PJ, Hamilton GS. Supine position related obstructive sleep apnea in adults: pathogenesis and treatment. Sleep Med Rev 2014; 18 (01) 7-17
    CrossrefPubMedGoogle Scholar
  • 12 Joosten SA, Sands SA, Edwards BA. et al. Evaluation of the role of lung volume and airway size and shape in supine-predominant obstructive sleep apnoea patients. Respirology 2015; 20 (05) 819-827
    CrossrefPubMedGoogle Scholar
  • 13 Schwab RJ, Pasirstein M, Plerson R. et al. Identification of upper airway with volumetric magnetic resonance imaging. Am J Respir Crit Care Med 2003; 168 (05) 522-530
    CrossrefPubMedGoogle Scholar
  • 14 Chan AS, Sutherland K, Schwab RJ. et al. The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 2010; 65 (08) 726-732
    CrossrefPubMedGoogle Scholar
  • 15 Kim KT, Cho YW, Kim DE, Hwang SH, Song ML, Motamedi GK. Two subtypes of positional obstructive sleep apnea: Supine-predominant and supine-isolated. Clin Neurophysiol 2016; 127 (01) 565-570
    CrossrefPubMedGoogle Scholar
  • 16 Kastoer C, Dieltjens M, Oorts E. et al. The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review. J Clin Sleep Med 2016; 12 (10) 1411-1421
    CrossrefPubMedGoogle Scholar
  • 17 Vicini C, De Vito A, Benazzo M. et al. The nose oropharynx hypopharynx and larynx (NOHL) classification: a new system of diagnostic standardized examination for OSAHS patients. Eur Arch Otorhinolaryngol 2012; 269 (04) 1297-1300
    CrossrefPubMedGoogle Scholar
  • 18 Gracco A, Buranello M, Cozzani M, Siciliani G. Digital and plaster models: a comparison of measurements and times. Prog Orthod 2007; 8 (02) 252-259
    Google Scholar
  • 19 Bates D, Mächler M, Bolker B, Walker S. Fitting Linear Mixed-Effects Models Using lme4. J Stat Softw 2015; 67 (01) 1-48 DOI: 10.18637/jss.v067.i01.
    CrossrefGoogle Scholar
  • 20 R Core Team. R: A Language and Environment for Statistical Computing. Vienna, Austria: R Foundation for Statistical Computing; 2018. https://www.R-project.org/
    Google Scholar
  • 21 Milano F, Mutinelli S, Sutherland K. et al. Influence of Vertical Mouth Opening on Oral Appliance Treatment Outcome in Positional Obstructive Sleep Apnea. J Dent Sleep Med 2018; 5: 1
    CrossrefGoogle Scholar
  • 22 Johns MW. A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 1991; 14 (06) 540-545
    CrossrefPubMedGoogle Scholar
  • 23 Marklund M, Persson M, Franklin KA. Treatment success with a mandibular advancement device is related to supine-dependent sleep apnea. Chest 1998; 114 (06) 1630-1635
    CrossrefPubMedGoogle Scholar
  • 24 Mador MJ, Kufel TJ, Magalang UJ, Rajesh SK, Watwe V, Grant BJ. Prevalence of positional sleep apnea in patients undergoing polysomnography. Chest 2005; 128 (04) 2130-2137
    CrossrefPubMedGoogle Scholar
  • 25 Sunnergren O, Broström A, Svanborg E. Positional sensitivity as a confounder in diagnosis of severity of obstructive sleep apnea. Sleep Breath 2013; 17 (01) 173-179
    CrossrefPubMedGoogle Scholar
  • 26 Chung JW, Enciso R, Levendowski DJ, Morgan TD, Westbrook PR, Clark GT. Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109 (05) 724-731
    CrossrefPubMedGoogle Scholar
  • 27 Joosten SA, Hamza K, Sands S, Turton A, Berger P, Hamilton G. Phenotypes of patients with mild to moderate obstructive sleep apnoea as confirmed by cluster analysis. Respirology 2012; 17 (01) 99-107
    CrossrefPubMedGoogle Scholar
  • 28 Sutherland K, Chan ASL, Ngiam J, Dalci O, Darendeliler MA, Cistulli PA. Awake multimodal phenotyping for prediction of oral appliance treatment outcome. J Clin Sleep Med 2018; 14 (11) 1879-1887
    CrossrefPubMedGoogle Scholar
  • 29 Barnes H, Edwards BA, Joosten SA, Naughton MT, Hamilton GS, Dabscheck E. Positional modification techniques for supine obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev 2017; 36: 107-115
    CrossrefPubMedGoogle Scholar
  • 30 Vicini C, Colabianchi V, Marranno GG. et al. Description of the relationship between NOHL classification in drug-induced sleep endoscopy and initial AHI patients with moderate to severe OSAS, and evaluation of the results obtained with oral appliance therapy. Acta Otorhinolaryngol Ital 2020; 40 (01) 50-56 DOI: 10.14639/0392-100X-2290.
    CrossrefPubMedGoogle Scholar
  • 31 Vroegop AV, Vanderveken OM, Boudewyns AN. et al. Drug-induced sleep endoscopy in sleep-disordered breathing: report on 1,249 cases. Laryngoscope 2014; 124 (03) 797-802
    CrossrefPubMedGoogle Scholar
  • 32 Liu SY, Guilleminault C, Huon LK, Yoon A. Distraction Osteogenesis Maxillary Expansion (DOME) for Adult Obstructive Sleep Apnea Patients with High Arched Palate. Otolaryngol Head Neck Surg 2017; 157 (02) 345-348
    CrossrefPubMedGoogle Scholar
  • 33 Marino A, Nota A, Caruso S, Gatto R, Malagola C, Tecco S. Obstructive sleep apnea severity and dental arches dimensions in children with late primary dentition: An observational study. Cranio 2021; 39 (03) 225-230
    CrossrefPubMedGoogle Scholar
  • 34 Gasparini G, Azzuni C, Rinaldo FM. et al. OSAS treatment with oral appliance: assessment of our experience through the use of a new device. Eur Rev Med Pharmacol Sci 2013; 17 (03) 385-391
    PubMedGoogle Scholar
  • 35 Pahkala R, Seppä J, Myllykangas R. et al. The impact of oral appliance therapy with moderate mandibular advancement on obstructive sleep apnea and upper airway volume. Sleep Breath 2020; 24 (03) 865-873
    CrossrefPubMedGoogle Scholar
  • 36 Chen H, Eckert DJ, van der Stelt PF. et al. Phenotypes of responders to mandibular advancement device therapy in obstructive sleep apnea patients: A systematic review and meta-analysis. Sleep Med Rev 2020; 49: 101229
    CrossrefPubMedGoogle Scholar
  • 37 Uniken Venema JAM, Doff MHJ, Joffe-Sokolova D. et al. Long-term obstructive sleep apnea therapy: a 10-year follow-up of mandibular advancement device and continuous positive airway pressure. J Clin Sleep Med 2020; 16 (03) 353-359
    CrossrefPubMedGoogle Scholar