Anatomically Based Outcome Predictors of Treatment for Obstructive Sleep Apnea with Intraoral Splint Devices: A Systematic Review of Cephalometric Studies

Abstract

Aims:The aim of this review is to summarize data from the literature on the predictive value of anatomy-based parameters, as identifi ed by cephalometry, for the effi cacy of mandibular advancement devices (MAD) for the treatment of obstructive sleep apnea (OSA). Methods: Articles were initially selected based on their titles or abstracts. Full articles were then retrieved and further scrutinized according to predetermined criteria. Reference lists of selected articles were searched for any missed publications. The selected articles were methodologically evaluated. Results: Of an initial 311 references, 13 were selected that assessed correlations between polysomnographic and cephalometric variables. The majority of studies demonstrated a correlation between treatment effectiveness and features as determined by cephalometric analysis, such as the mandibular plane angle, hyoid bone distance to mandible, antero-posterior diameter of the maxilla, tongue area, cranial base, and soft palate. Conclusions:The mandibular plane angle and the distance between hyoid bone and mandibular plane was found to have a predictive value for MAD effectiveness in OSA patients. However, the relative weak and somewhat inconsistent cephalometric data suggest that decisions based solely on these factors cannot be recommended, especially because an integrated analysis of other risk factors (e.g., age, sex, BMI) should also be taken into account.

Phenotypes in obstructive sleep apnea: A definition, examples and evolution of approaches

“…In one study using multivariate analyses and controlling for age, BMI and sex, only a long soft palate and large cranial base angulation [98] predicted failure of MAD (negative predictive value 98%). While some reports support these findings, others identify alternate correlations of treatment success, and most are limited by small and heterogeneous sample sizes without consideration of known important factors (BMI, sex, neck circumference) [99]. Similar conclusions have been made regarding cephalometric data on prediction of surgical outcomes [100].…”

Biomechanical effect of mandibular advancement device with different protrusion positions for treatment of obstructive sleep apnoea on tooth and facial bone: A finite element study

“…It also notably enhances subjective and objective measurements of sleepiness and quality of life, and improves arterial stiffness . The primary mechanism of the MAD is to move the mandible forward, increase the retroglossal airway space and decrease the collapsibility of the velopharynx . CPAP decreases the apnoea‐hypopnea index (AHI) scores and improves oxygen saturation levels more efficiently than a MAD.…”

Evaluation of factors that influence the success rate of OSA treatment with a customised adjustable MAD device - a retrospective study

“…Possible future improvements of the present protocol could be evaluation of other patient related parameters such as body mass and neck circumference 26 , and assessment of quality of life, since other parameters in addition to AHI can explain the clinical success of therapy 3 , 27 . Further studies could also take into account skeletal features 28 , 29 and volumetric assessment of the upper airway 30 , 31 .…”