Treatment outcomes of mandibular advancement devices in positional and nonpositional OSA patients

Abstract

Objective The aim of the study was to investigate treatment outcome of mandibular advancement devices (MADs) for positional and non-positional obstructive sleep apnea (OSA). Study design Forty-two positional (supine apnea-hypopnea index [AHI] ≥ 2x’s lateral AHI) and 30 non-positional (supine AHI < 2x’s lateral AHI) OSA patients performed two-nights of sleep study before and after insertion of MADs. Results The decreases in apnea severity based on a reduction in the overall and supine AHI values after MADs therapy were significantly greater for the positional OSA than non-positional OSA group. A multiple linear regression analysis showed that decrease in overall AHI was significantly associated with being in the positional group (standardized coefficient=0.505). Age, body mass index, gender, and time in supine position during sleep did not show significant associations with decrease in overall AHI after MAD therapy. Conclusion Our data suggest that MADs are more effective in positional OSA than non-positional OSA patients.

Prevalence and Clinical Significance of Supine-Dependent Obstructive Sleep Apnea in Patients Using Oral Appliance Therapy

“…13,[20][21][22][23] In addition, the majority of studies evaluating the effect of sleep position on OA m efficacy have reported that OA therapy is more efficacious in patients with sdO-SA. 13,16,17,[24][25][26] However, other studies did not find a difference in success rates between non-sdOSA and sdOSA patients.…”

“…9 The most frequently and widely used defi nition is a supine AHI ≥ twice as high as the non-supine AHI and was fi rst described by Cartwright et al 5 The prevalence of sdOSA in a general population ranges the literature from 46% to 80%, which was comparable to the prevalence of sdOSA in the general population. 13,16,17 These results, however, do not reveal the evolution of sdOSA once OA m has started, and the prevalence of sdOSA under OA m therapy is still unknown. Interestingly, in some patients sdOSA and non-sdOSA are dynamic phenotypes 8 : weight reduction may convert a non-sdOSA patient into sdOSA.…”

MADs and Positional Sleep Apnea: More than Meets the Eye!

“…However, practice trends elsewhere show that duoblocs are increasingly being used. Given conflicting results between earlier studies with monoblocs [2][3][4][5] including present study by Takaesu et al 7 and recent study by Sutherland et al 11 that used a particular type of duobloc, large-scale randomized controlled trials that test different device designs on different populations with a uniform definition of P-OSA are warranted to provide more clarity. Until then, the association between MADs and P-OSA is more complex than meets the eye!…”

“…1 However, prediction of treatment outcome with MADs remains a key unresolved issue, this perhaps becoming more complicated as a plethora of devices have evolved that differ in their design, fabrication, adjustability, allowance of either vertical or lateral jaw movement, and plate connectors. Based on data from earlier studies, [2][3][4][5] factors that predict successful MAD treatment include younger age, lower body mass index (BMI), smaller neck circumference, and supinedependent or positional OSA (P-OSA). 6 However, none of the prior studies 2-5 compared the efficacy of MADs with continuous positive airway pressure (CPAP).…”

“…either monobloc 4,5 or duobloc. 2,3 A common feature of these devices studied in earlier studies [2][3][4][5] was their inability to allow jaw opening in sleep. The most recent study by Sutherland et al 11 used a duobloc which does allow jaw opening in sleep.…”