Functional imaging using computational fluid dynamics to predict treatment success of mandibular advancement devices in sleep-disordered breathing

2007 ◽  
Vol 40 (16) ◽  
pp. 3708-3714 ◽  
Author(s):  
J.W. De Backer ◽  
O.M. Vanderveken ◽  
W.G. Vos ◽  
A. Devolder ◽  
S.L. Verhulst ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Computational Fluid Dynamics ◽  
Functional Imaging ◽  
Sleep Disordered Breathing ◽  
Treatment Success ◽  
Mandibular Advancement ◽  
Mandibular Advancement Devices ◽  
Disordered Breathing

Beyond the Apnoea–Hypopnoea Index – Prognostic Value of Other Elements of Polysomnography to Describe Sleep-disordered Breathing in Heart Failure

2009 ◽  
Vol 5 (2) ◽  
pp. 53
Author(s):  
Philip B Adamson ◽  
Keyword(s):  
Heart Failure ◽  
Standard Method ◽  
Patient Population ◽  
Prognostic Value ◽  
Sleep Disordered Breathing ◽  
Treatment Success ◽  
Multiple Components ◽  
Severity Of The Disease ◽  
Disordered Breathing

There is increasing appreciation of the prevalence of sleep-disordered breathing (SDP) in heart failure. As we examine this patient population, the difficulties of determining success in the treatment of SDB are becoming evident. The apnoea–hypopnoea index (AHI) is the standard method of measuring both the severity of the disease and treatment success, but in itself is a composite of multiple components. This article examines both current and developing measurements in the treatment of SDB.

Cost Benefit and Utility Decision Analysis of Turbinoplasty with Adenotonsillectomy for Pediatric Sleep-Disordered Breathing

2019 ◽  
Vol 161 (2) ◽  
pp. 343-347 ◽  
Author(s):  
Grace Baik ◽  
Scott E. Brietzke
Keyword(s):  
Sensitivity Analysis ◽  
Decision Analysis ◽  
Sleep Disordered Breathing ◽  
Treatment Success ◽  
Cost Benefit ◽  
Decision Analysis Model ◽  
Analysis Model ◽  
Baseline Model ◽  
Turbinate Hypertrophy ◽  
Disordered Breathing

Objectives Use decision analysis techniques to assess the potential utility gains/losses and costs of adding bilateral inferior turbinoplasty to tonsillectomy/adenoidectomy (T/A) for the treatment of obstructive sleep-disordered breathing (oSDB) in children. Use sensitivity analysis to explore the key variables in the scenario. Study Design Cost-utility decision analysis model. Setting Hypothetical cohort. Subjects and Methods Computer software (TreeAge Software, Williamstown, Massachusetts) was used to construct a decision analysis model. The model included the possibility of postoperative complications and persistent oSDB after surgery. Baseline clinical and quality-adjusted life year (QALY) parameters were estimated using published data. Cost data were estimated from Centers for Medicare and Medicaid 2018 databases ( www.cms.gov ). Sensitivity analyses were completed to assess for key model parameters. Results The utility analysis of the baseline model favored the addition of turbinoplasty (0.8890 vs 0.8875 overall utility) assuming turbinate hypertrophy was present. Sensitivity analysis indicated the treatment success increase (%) provided by concurrent turbinoplasty was the key parameter in the model. A treatment success increase of 3% of turbinoplasty was the threshold where concurrent turbinoplasty was favored over T/A alone. The incremental cost-effectiveness ratio (ICER) of $27,333/QALY for the baseline model was favorable to the willingness-to-pay threshold of $50,000 to $100,000/QALY for industrialized nations. Conclusions The addition of turbinoplasty for children with turbinate hypertrophy to T/A for the treatment of pediatric oSDB is beneficial from both a utility and cost-benefit analysis standpoint even if the benefits of turbinoplasty are relatively modest.

scholarly journals Treatment Success with Titratable Thermoplastic Mandibular Advancement Devices for Obstructive Sleep Apnea: A Comparison of Patient Characteristics

2017 ◽  
Vol 96 (3) ◽  
pp. E25-E32 ◽  
Author(s):  
Tang-Chuan Wang ◽  
Yung-An Tsou ◽  
Yi-Fan Wu ◽  
Chia-Chang Huang ◽  
Wesley Wen-Yang Lin ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Visual Analogue Scale ◽  
Sleep Quality ◽  
Analogue Scale ◽  
Treatment Success ◽  
Mandibular Advancement ◽  
Apnea Hypopnea Index ◽  
Obstructive Sleep ◽  
Mandibular Advancement Devices

A titratable thermoplastic mandibular advancement devices (MAD) is clearly an effective treatment option in some patients with obstructive sleep apnea (OSA). Determining which patients may be more likely to respond to treatment with thermoplastic MADs and to adhere to treatment would be of obvious clinical relevance. This was an experimental descriptive study (N = 60). Patients with OSA were instructed to wear a titratable thermoplastic MAD for 3 months. Treatment success was defined as a ≥50% reduction from baseline in the apnea-hypopnea index (AHI) or AHI <10 when wearing MAD. Adherence was defined as MAD use ≥5 nights/week. Treatment was successful in 66.7% of patients and 60.0% were adherent. All Polysomnographic parameters and visual analogue scale scores (sleep quality, snoring, waking refreshed) were significantly improved after treatment. The patients in whom treatment failed had significantly higher neck circumferences (39.3 cm vs. 37.5 cm, p = 0.014), higher baseline AHI values (26.6 vs. 18.0, p = 0.016), and smaller AHI reduction (-31.8 vs -53.1, p < 0.001) than those in the group in whom treatment succeeded. There were no significant differences in Polysomnographic, cephalometric, or visual analogue scale measures between patients for whom treatment was and was not successful, regardless of baseline values or the change rates after the MAD was placed. Titratable thermoplastic MADs can improve indicators of sleep quality, even in patients in whom treatment is considered to have failed.

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