Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing

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.

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“…[6][7][8][9][10][11] Based on that, the need for identifying potential anatomy-based outcome predictors for MAD treatment has emerged.…”

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confidence: 99%

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

Guarda-Nardini

Manfredini

Mion

et al. 2015

Journal of Clinical Sleep Medicine

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“…[47][48][49][50][51] In the case of PT these are residual % TST in supine position, AHI in nonsupine position, and compliance.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Ravesloot¹,

White

Heinzer

et al. 2017

Journal of Clinical Sleep Medicine

108

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Study Objectives:In approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position. This is referred to as position-dependent OSA or POSA. Patients with POSA can be treated with a small device attached to either the neck or chest. These devices-a new generation of devices for positional therapy (PT)-provide a subtle vibrating stimulus that prevents patients adopting the supine position. The objectives of this study were to determine whether PT is effective in improving sleep study variables and sleepiness, and to assess compliance. Methods: A systematic review and meta-analysis. Results: Three prospective cohort studies and four randomized controlled trials were included in this review. Combined data for studies reporting on the effect of PT show that there was a mean difference of 11.3 events/h (54% reduction) in apnea-hypopnea index and 33.6% (84% reduction) in percentage total sleeping time in the supine position. The standardized mean difference for both parameters demonstrated a large magnitude of effect (> 0.8 in both cases). Conclusions: There is strong evidence that the new generation of devices for PT are effective in reducing the apnea-hypopnea index during short-term follow-up. These devices are simple-to-use for patients and clinicians and are reversible. Under study conditions with short-term follow-up, compliance is high; however, long-term compliance cannot be assessed because of lack of reliable data. Additional long-term, high-quality studies are needed to confirm the role of PT as a single or as a combination treatment modality for OSA patients and to assess long-term compliance. Keywords: compliance, meta-analysis, obstructive sleep apnea, positional, positional therapy, systematic review Citation: Ravesloot MJ, White D, Heinzer R, Oksenberg A, Pépin JL. Efficacy of the new generation of devices for positional therapy for patients with positional obstructive sleep apnea: a systematic review of the literature and meta-analysis. J Clin Sleep Med. 2017;13(6):813-824. I NTRO DUCTI O NIn approximately 56% to 75% of patients with obstructive sleep apnea (OSA), the frequency and duration of apneas are influenced by body position.1-5 Various definitions of positiondependent obstructive sleep apnea (POSA) have been applied in literature, but the most common classification system and definition marks a distinction between two groups of patients: positional patients (PP) 6 and nonpositional patients (NPP). 3,4,7In PP, desaturations, cyclic variations in heart rate, loud snoring, and apneas and hypopneas appear almost exclusively in the supine position. 8 Cartwright first described the arbitrary cutoff point of a difference of 50% or more in apnea index between supine and nonsupine positions. In the medical literature many have applied modified versions of Cartwright's criteria. In 1998, Marklund et al. defined supine-dependent sleep apnea as a supine apnea-hypopnea index (AHI) ≥ 10 events/h, together with a lateral AHI < 10 ev...

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“…That study showed that a thermal microsensor embedded in the resin of the device is a valid measure of adherence. The average usage was 6.6+1.3h per night in 82% of the 51 patients who regularly used the MADs (Level of Evidence III) [33]. Some predictors of adherence have been attributed to the material and equipment type, the presence of mandibular mobility and the adjustment in terms of the protrusion.…”

Section: Adherence To Madmentioning

confidence: 99%

Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults

Chaves¹,

Fabbro²,

Machado³

et al. 2017

int arch med

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Introduction: This article is based on Clinical Guidelines for obstructive sleep apnoea (OSA) established by a taskforce coordinated by the Brazilian Sleep Association. Objective:The aim of this article is to evaluate the available scientific evidence regarding the efficacy, adherence and safety of using mandibular advancement devices (MAD) as a therapeutic course for treating obstructive sleep apnoea in adult patients. Method:Active searches were performed in the PubMed/MEDLINE, EMBASE, Scielo/LILACS and Cochrane Library databases. Methodological aspects were used to rank the levels of evidence according to the criteria of the Centre for Evidence-Based Medicine at Oxford.

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Objective measurement of compliance during oral appliance therapy for sleep-disordered breathing

Cited by 214 publications

References 36 publications

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

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

Efficacy of the New Generation of Devices for Positional Therapy for Patients With Positional Obstructive Sleep Apnea: A Systematic Review of the Literature and Meta-Analysis

Use Of Mandibular Advancement Devices For Obstructive Sleep Apnoea Treatment In Adults

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