Mandibular Advancement Device Treatment Efficacy Is Associated with Polysomnographic Endotypes

Abstract

SO, SS, AW and OMV contributed to the study concept and design. SO, MD, MW, JV, MB, OMV collected the data. SO and SS performed the trait analysis and statistical analysis. All authors interpreted the results, performed a critical revision of the article and approved the version to be published.

Breathing Re-Education and Phenotypes of Sleep Apnea: A Review

“…It is known that high loop gain during sleep is determined by a low breath-hold time during wakefulness [ 5 ]. Short breath holding time is a known trait of individuals with chronic idiopathic hyperventilation and other types of dysfunctional breathing [ 97 , 98 , 99 , 100 , 101 , 102 , 103 ].…”

“…Keisel et al [ 102 ] proposed a test consisting of four questions from the Functional Movement Screen (FMS™) and a BHT of 25 s and confirmed that dysfunctional breathing can be predicted by the patient’s ability to hold the breath for 25 s. The important thing to note is that by using breathing exercises that reduce the respiratory rate to lower minute ventilation for periods of time during rest it is possible to improve BHT, and to reduce chemosensitivity to CO 2 . Since chemosensitivity to CO 2 and BHT are both predictors of loop gain, BRE may reduce the loop gain by increasing BHT and lowering chemosensitivity to CO 2 .…”

“…It is apparent that treatment of loop gain is important in the treatment of OSAHS, especially in patients who do not respond to MAD and surgery [ 5 , 104 ]. MADs do nothing to decrease loop gain [ 102 ] and MADs are less effective when a high loop gain is present [ 105 ]. Loop gain is not affected by CPAP, although CPAP is better tolerated in those subjects with high loop gain [ 106 ].…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…359,360 Other trials sought to determine the phenotype of patients that gain the most benefit from OAT, which is difficult to determine with the methodologies used. 361,362 Without clear practice guidelines, the dental sleep medicine practitioner may be frustrated with direct care of their patients with obstructive sleep apnea (OSA), as the available options for available oral appliances has not significantly expanded in recent years.…”

“…Another project examined individual differences in efficacy of MAD therapy among OSA patients. 361 The trail set out to elucidate underlying individual differences in efficacy with OSA endotypic traits calculated from baseline PSG, including collapsibility (airflow at normal ventilatory drive, V passive ), loop gain (drive response to reduced airflow), arousal threshold (drive preceding arousal), compensation (increase in airflow as drive increases), and the ventilatory response to arousal (VRA, increase in drive because of arousal). Responders to MAD therapy have a lower loop gain and milder collapsibility (according to previous knowledge).…”