Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review

Bonetti, Giulio Alessandri; Ippolito, Daniela Rita; Bartolucci, Maria Lavinia; D’Antò, Vincenzo; Parenti, Serena Incerti

doi:10.4041/kjod.2015.45.6.308

Cited by 35 publications

(31 citation statements)

References 28 publications

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“…However, the exact craniofacial structures relating to response vary, due to factors such as small samples, different measurements, and variations in treatment response definitions. 18 In this study, we used a novel application of facial photographic phenotyping. We identified four Logistic regression was used to develop prediction models for treatment response by all three criteria: (1) AHI < 5 events/h plus ≥ 50% reduction, (2) AHI < 10 events/h plus ≥ 50% reduction, (3) ≥ 50% AHI reduction.…”

Section: Discussionmentioning

confidence: 99%

Awake Multimodal Phenotyping for Prediction of Oral Appliance Treatment Outcome

Sutherland

Chan

Ngiam

et al. 2018

Journal of Clinical Sleep Medicine

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Study Objectives: An oral appliance (OA) is a validated treatment for obstructive sleep apnea (OSA). However, therapeutic response is not certain in any individual and is a clinical barrier to implementing this form of therapy. Therefore, accurate and clinically applicable prediction methods are needed. The goal of this study was to derive prediction models based on multiple awake assessments capturing different aspects of the pharyngeal response to mandibular advancement. We hypothesized that a multimodal model would provide robust prediction. Methods: Patients with OSA (apnea-hypopnea index [AHI] > 10 events/h) were recruited for treatment with a customized OA (n = 142, 59% male). Participants underwent facial photography (craniofacial structure), spirometry (mid-inspiratory flow at 50% vital capacity [MIF50] and mid-expiratory flow at 50% vital capacity [MEF50] and the ratio MEF50/MIF50) and nasopharyngoscopy (velopharyngeal collapse with Mueller maneuver and mandibular advancement). Treatment response was defined by 3 criteria: (1) AHI < 5 events/h plus ≥ 50% reduction, (2) AHI < 10 events/h plus ≥ 50% reduction, (3) ≥ 50% AHI reduction. Multivariable regression models were used to assess predictive utility of phenotypic assessments compared to clinical characteristics alone (age, sex, obesity, baseline AHI). Results: Craniofacial structure and flow-volume loops predicted treatment response. Accuracy of the prediction models (area under the receiver operating characteristic curve) for each criterion were 0.90 (criterion 1), 0.79 (criterion 2), and 0.78 (criterion 3). However, these prediction models including phenotypic assessments did not provide a statistically significant improvement over clinical predictors only. Conclusions: Multimodal awake phenotyping does not enhance OA treatment outcome prediction. These office-based, awake assessments have limited utility for robust clinical prediction models. Future work should focus on sleep-related assessments. Citation: Sutherland K, Chan AS, Ngiam J, Dalci O, Darendeliler MA, Cistulli PA. Awake multimodal phenotyping for prediction of oral appliance treatment outcome.

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Section: Discussionmentioning

confidence: 99%

Awake Multimodal Phenotyping for Prediction of Oral Appliance Treatment Outcome

Sutherland

Chan

Ngiam

et al. 2018

Journal of Clinical Sleep Medicine

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“…Lateral cephalometry can identify craniofacial characteristics that could have an effect on treatment response, although no definitive clinical recommendations are available because of inherent methodological weaknesses of the currently available studies. 38 Reported improvements in subjective daytime sleepiness and health perceptions were found in both treatment groups, underscoring the therapeutic benefit of CPAP and MAD therapy at all timepoints during the follow-up period, even in patients with severe OSA. Similar findings in different studies using the same questionnaires (pooled) were reported in a review article by Chan and asociates.…”

Section: Discussionmentioning

confidence: 72%

A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder

El-Solh

Homish

Ditursi

et al. 2017

Journal of Clinical Sleep Medicine

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Study Objectives: Despite the overall improvement in posttraumatic stress disorder (PTSD) symptomatology with continuous positive airway pressure (CPAP) therapy, adherence to CPAP is far worse in veterans with PTSD compared to the general population with obstructive sleep apnea (OSA). The aim of this study was to compare the efficacy, adherence, and preference of CPAP versus mandibular advancement device (MAD) and the effect of these treatments on health outcomes in veterans with PTSD. Methods: Forty-two subjects with PTSD and newly diagnosed OSA by polysomnography were treated in a randomized, crossover trial of 12 weeks with CPAP alternating with MAD separated by a 2-week washout period. The primary outcome was the difference in titration residual apnea-hypopnea index (AHI) between CPAP and MAD. Secondary outcome measures included PTSD Checklist and health-related quality of life (Medical Outcomes Study 36-Item Short Form and Pittsburgh Sleep Quality Index). Results: Analyses were limited to the 35 subjects (mean age 52.7 ± 11.6 years) who completed the trial, regardless of compliance with their assigned treatment. CPAP was more efficacious in reducing AHI and improving nocturnal oxygenation than MAD (P < .001 and P = .04, respectively). Both treatments reduced PTSD severity and ameliorated scores of the Medical Outcomes Study Short Form 36 and Pittsburgh Sleep Quality Index, although no differences were detected between the CPAP and MAD arms. The reported adherence to MAD was significantly higher than CPAP (P < .001), with 58% preferring MAD to CPAP. Conclusions: Although CPAP is more efficacious than MAD at improving sleep apnea, both treatment modalities imparted comparable benefits for veterans with PTSD in relation to PTSD severity and health-related quality of life. 1 Veterans having PTSD suffer from nonrestorative sleep and nightmares leading to heightened state of arousal and anxiety, increased severity of depression, and poor quality of life.2 Accruing evidence suggests that patients with PTSD are at higher risk for sleep-disordered breathing than the general population.3,4 In a series of studies looking at postdeployment combat veterans with PTSD, rates of overall sleep disturbance symptoms approached 90%, with up to 70% considered to be at high risk for OSA. and substance abuse. BRIEF SUMMARYCurrent Knowledge/Study Rationale: In veterans with posttraumatic stress disorder (PTSD), the disturbed sleep can worsen the cognitive-behavioral manifestations of PTSD and contribute to poor mental and physical health outcomes. Because adherence to treatment with CPAP is less than optimal in this population, this study was undertaken to examine the clinical efficacy, compliance, and quality of sleep of mandibular advancement devices (MAD) compared to CPAP in veterans with OSA and PTSD. Study Impact: Although CPAP is more efficacious in eliminating respiratory events, both MAD and CPAP result in similar beneficial changes in daytime sleepiness, PTSD symptomatology, and healthrelated quality of life measures in v...

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“…Classically, shorter soft palate length, larger retropalatal airway space, lower hyoid bone position, and a smaller mandible are associated with favorable MAD treatment response. 1,65 Two recent systematic reviews, 70,71 however, exploring cephalometric predictors for MAD response found a majority of observational studies on cephalometric predictors had flawed designs and failed to control for known confounding factors such as age, gender, body mass index, and baseline AHI. Definitions of treatment success were inconsistent, and heterogeneity in design prevented data synthesis and meta-analysis.…”

Section: Cephalometrymentioning

confidence: 99%

Oral Appliances in the Management of Obstructive Sleep Apnea

Yow

2019

Sleep Medicine Clinics

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Airway imaging with cone-beam computed tomography, magnetic resonance imaging and nasal endoscopy showed anteroposterior (AP) mandibular protrusion predominantly increases the caliber of the airway at the retropalatal area via lateral expansion and displacement of parapharyngeal fat pads 2,6-13 while the tongue and tongue-base muscles shift forward. 2,9,13 The lateral widening from AP movement is attributed to stretching of soft tissue connections KEYWORDS OSA Oral appliance Mandibular advancement Tongue stabilizer KEY POINTSThe concept in oral appliances for obstructive sleep apnea (OSA) management is protrusion of the mandible and/or tongue for structural effects on the upper airway. The upper airway is a muscular tube and its dimensions are enlarged with mandibular and tongue advancement. Protrusion of the mandible and tongue stretches the muscles, thereby reducing upper airway collapsibility with airway shape change and increase in muscle tone. Oral appliances are effective and evidence-based options in managing OSA.

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Cephalometric predictors of treatment outcome with mandibular advancement devices in adult patients with obstructive sleep apnea: a systematic review

Cited by 35 publications

References 28 publications

Awake Multimodal Phenotyping for Prediction of Oral Appliance Treatment Outcome

Awake Multimodal Phenotyping for Prediction of Oral Appliance Treatment Outcome

A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder

Oral Appliances in the Management of Obstructive Sleep Apnea

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