Prediction of oral appliance efficiency in patients with apnoea using phrenic nerve stimulation while awake

Abstract

BackgroundIn patients with sleep apnoea, primary oropharyngeal collapse of the upper airway during sleep is an important predictor of treatment success with an oral appliance. Phrenic nerve stimulation is able to induce upper airway obstruction and was therefore used to mimic the target for an efficient treatment with an oral appliance. Objective To test if the site(s) of upper airway collapse identified by means of bilateral anterior magnetic stimulation during wakefulness could predict the efficacy of treatment with an oral appliance in patients with obstructive sleep apnoea. Methods The site(s) of upper airway collapse while awake were identified by examining the flowepressure relationship of flow-limited twitches when measuring velopharyngeal and oropharyngeal pressure. Once the mandibular advancement titration had been completed, the efficacy of mandibular advancement was documented during an in-lab sleep study. Results 33 patients (24 men and 9 women, apnoeaehypopnoea index (AHI) 32.5617

CPAP Pressure for Prediction of Oral Appliance Treatment Response in Obstructive Sleep Apnea

“…29 Objectively validated tests of MAS treatment function may ultimately be required to accurately predict treatment response. 10,[30][31][32][33] For example a single-night titration study of mandibular advancement using an available commercial remotely controlled titration device or assessment of upper airway response to mandibular advancement via nasendoscopy to observe the airway response during drug-induced sleep or even wakefulness. [34][35][36] However in CPAP failure patients with known therapeutic pressure, this information in conjunction with age and OSA severity characteristics, may be useful to give an indication of the likelihood of success with MAS as an alternative therapy.…”

A Feedback-Controlled Mandibular Positioner Identifies Individuals With Sleep Apnea Who Will Respond to Oral Appliance Therapy

“…The overall therapeutic success rates for the 2 populations, 71% and 76%, is somewhat greater than some published reports, 21,24,53,54 but comparable to others. 19,20,23,27,33 ODI was selected as the measure by which to assess OSA in all baseline and outcome studies, all of which were home sleep tests. Over the course of the study, more than 800 full-night tests were carried out (approximately 2 baseline and 2 outcome tests for each participant).…”

“…25,26 Disease severity, body position during sleep, age, sex, weight, and other anatomical features and clinical variables have been investigated and found to correlate with outcome. [26][27][28][29][30][31][32][33][34][35][36][37] with pharyngeal imaging and nasoendoscopy. 29,[38][39][40][41] However, none of these approaches has been shown in prospective studies to identify individuals who will experience therapeutic success with oral appliance therapy.…”

“…26,29,30,44 Additional individual-specific factors including younger age, female sex, and moderate obesity (characterized by lower BMI and neck circumference) may predict a successful outcome with oral appliance therapy. 22,27,29,30,39 However, complete resolution of OSA by oral appliance therapy has been reported in individuals with severe OSA and obesity. 43,54,56 Craniofacial features including shorter soft palate length, 35,57,58 higher hyoid bone position, 58,59 greater angle between the cranial base and mandibular plane, 34 and retrognathic mandible 31 have also been reported to predict favorable outcome of oral appliance therapy.…”

“…New techniques such as nasoendoscopy during drug-induced sleep or while awake, 40,41 cone-beam computed tomography scans, 38,62 multisensor catheters, 27,39 and nasopharyngoscopy 29 that assess anatomical and functional characteristics of upper airways may ultimately prove to provide clinical utility. Currently, however, none have been tested prospectively and none would appear to convey the predictive accuracy, convenience, and applicability documented in the current study for the FCMP test.…”