Using prospectively established rules for interpreting the polysomnographic data, the mandibular titration study predicted mandibular repositioning appliance therapeutic outcome with significant accuracy, particularly with regard to accurately predicting therapeutic success. As well, among the participants predicted to be therapeutically successful with mandibular repositioning appliance therapy, the effective target protrusive position provided efficacious mandibular protrusion in the majority.

Dental changes are as important as skeletal changes to attaining the final occlusal results. Long-term, prospective, double-blinded, randomized clinical trials are needed to support these conclusions.

Study Objectives: Mandibular protruding oral appliances represent a potentially important therapy for obstructive sleep apnea (OSA). However, their clinical utility is limited by a less-than-ideal efficacy rate and uncertainty regarding an efficacious mandibular position, pointing to the need for a tool to assist in delivery of the therapy. The current study assesses the ability to prospectively identify therapeutic responders and determine an efficacious mandibular position. Methods: Individuals (n = 202) with OSA participated in a blinded, 2-part investigation. A system for identifying therapeutic responders was developed in part 1 (n = 149); the predictive accuracy of this system was prospectively evaluated on a new population in part 2 (n = 53). Each participant underwent a 2-night, in-home feedback-controlled mandibular positioner (FCMP) test, followed by treatment with a custom oral appliance and an outcome study with the oral appliance in place. A machine learning classification system was trained to predict therapeutic outcome on data obtained from FCMP studies on part 1 participants. The accuracy of this trained system was then evaluated on part 2 participants by examining the agreement between prospectively predicted outcome and observed outcome. A predicted efficacious mandibular position was derived from each FCMP study. Results: Predictive accuracy was as follows: sensitivity 85%; specificity 93%; positive predictive value 97%; and negative predictive value 72%. Of participants correctly predicted to respond to therapy, the predicted mandibular protrusive position proved efficacious in 86% of cases. Conclusions: An unattended, in-home FCMP test prospectively identifies individuals with OSA who will respond to oral appliance therapy and provides an efficacious mandibular position. Clinical Trial Registration: The trial that this study reports on is registered on www.clinicaltrials.gov, ID NCT03011762, study name: Feasibility and Predictive Accuracy of an In-Home Computer Controlled Mandibular Positioner in Identifying Favourable Candidates for Oral Appliance Therapy Keywords: home sleep test, obstructive sleep apnea, oral appliance therapy, predictive accuracy, sleep-disordered breathing Citation: Remmers JE, Topor Z, Grosse J, Vranjes N, Mosca EV, Brant R, Bruehlmann S, Charkhandeh S, Jahromi SA. A feedback-controlled mandibular positioner identifies individuals with sleep apnea who will respond to oral appliance therapy. J Clin Sleep Med. 2017;13(7):871-880. I NTRO DUCTI O NObstructive sleep apnea (OSA) is a chronic disease caused by repeated narrowing or closure of the pharynx during sleep. The disease compromises quality of life, 1,2 increases risk of accidents, [3][4][5] and is associated with an increased risk of cardiovascular events 6 and reduced survival rate. 7,8 Continuous positive airway pressure (CPAP), the standard therapy for this disease, is efficacious and benign. However, long-term compliance with CPAP is low, 9,10 and this may contribute to its ineffectiveness in preventing adverse...

Dentists are being inundated with outrageous email and print claims regarding dental sleep medicine education. Examples of claims that have hit my inbox include: " …join the members…producing over $70, 000 a month in oral appliances…" "…reduce overhead…" " …the only course that establishes the dentist as primary treatment providers…" " …get started immediately after one weekend…" And if you believe these claims, I have a bridge to sell you.Dental sleep medicine (DSM) is a growing field and there are full time fellowship programs of one to two years emerging at a few dental schools. However the majority of dentists will get their training in DSM through post-dental school continuing education. There is good quality evidence-based education available for those interested in DSM. The courses offered by the American Academy of Dental Sleep Medicine are a leading example of quality, evidence based DSM education. This journal is also a source of evidence-based, peer-reviewed scientific information in DSM. There is no need to partake in educational offerings from questionable sources.The practice of DSM has features that are uncommon in general dentistry. Although there are technical aspects, it is primarily intellectual work that cannot be done by a dentist working alone. Diagnosis, treatment and follow up of patients with sleep-disordered breathing is a collaborative, interdisciplinary activity. Collaboration with physicians is critical at diagnosis, treatment, follow-up, and-in some cases-years later if oral appliance therapy (OAT) is no longer effective and alternative or additional therapies need to be considered. Courses that aim to educate dentists and physicians together such as the 2018 Sleep Medicine Trends course will be an important component to future interdisciplinary team building.DSM practitioners treat a chronic disease; this is not a field with "quick fix" treatments. Once you begin OAT the patient is your responsibility for years. Managing inevitable side effects, particularly occlusal changes, continues to be an important challenge in DSM. Despite these challenges, many dentists have found DSM to be a satisfying and rewarding addition to their practices. Many more are beginning to explore the field. Don't be fooled by outrageous claims of pots of gold. Practicing quality DSM requires a considerable body of knowledge and training. There are good quality offerings out there. Don't cheat yourself-go for quality. Don't buy the bridge. CITATIONDort LC. And if you believe that, I have a bridge to sell you.

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