437 Efficacy of a novel oral appliance and the influence of OSA pathophysiological traits on treatment response

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A173-A173
Author(s):  
Benjamin Tong ◽  
Christopher Bull ◽  
Alan Chiang ◽  
Michelle Donegan ◽  
Elizabeth Brown ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Phenotypic Traits ◽  
Oral Appliance Therapy ◽  
Successful Treatment Outcome ◽  
Oral Airway ◽  
Intramuscular Electrodes ◽  
Upper Airway Collapsibility

Abstract Introduction Oral appliance therapy is a recommended alternative to CPAP for OSA. Approximately 50% of patients have a major reduction in OSA severity but successful treatment outcome remains challenging to predict. Previous prediction methods have focused on clinical variables which have poor predictive value. OSA is recognised as a heterogenous disorder caused by 4 pathophysiological traits. The influence of OSA pathophysiological traits on oral appliance treatment outcome has been explored in recent physiological studies using simplified phenotyping methods. In this preliminary report, we prospectively compared differences in the 4 OSA phenotypes between responders and incomplete responders to a novel oral appliance with built in oral airway using gold standard phenotyping methodology. Methods Data from 22 people with OSA (AHI>10events/h) have been analysed to date. A diagnostic in-laboratory PSG was initially conducted to confirm OSA. A detailed physiology PSG was carried out prior to commencement of oral appliance therapy. For this study night participants were instrumented with standard PSG equipment, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular electrodes inserted perorally into the genioglossus to quantify baseline OSA phenotypic traits. Pcrit was quantified via CPAP dial downs and the non-anatomical traits were quantified from naturally occurring apneas and hypopneas. Participants were then fitted with a next generation novel oral appliance with a built-in oral airway (Oventus O2Vent Optima™) and titrated to at least 75% of maximum mandibular advancement. After acclimatization to therapy, participants were invited to undergo a treatment efficacy PSG. Results Oral appliance therapy reduced the AHI by 52% (21[15,31] vs. 11[7,16] events/h, p<0.001). 46% of participants responded to oral appliance therapy based on the definition of AHI < 10events/h. Preliminary analyses indicated that estimates of baseline upper airway collapsibility tended to be different in responders versus non-responders (responders have less collapsible airways). Conclusion The novel oral appliance reduced OSA severity by 50% with resolution of OSA in half of participants. Baseline pharyngeal collapsibility may be an important physiological predictor of treatment outcome. Support (if any):

scholarly journals The impact of oral appliance therapy with moderate mandibular advancement on obstructive sleep apnea and upper airway volume

2019 ◽  
Vol 24 (3) ◽  
pp. 865-873 ◽  
Author(s):  
Riitta Pahkala ◽  
J. Seppä ◽  
R. Myllykangas ◽  
J. Tervaniemi ◽  
V. M. Vartiainen ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Oral Appliance Therapy ◽  
Obstructive Sleep ◽  
The Impact

scholarly journals 1272 Control of Sleep-Associated Respiratory Distress with a Mandibular Advancement Oral Appliance in an Unusual Case of a Patient with a Mild Rather Persistent Nocturnal Baseline Hypoventilation/Hypoxia

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A483-A484
Author(s):  
I Manetta ◽  
A Almeida ◽  
D Schwartz ◽  
M Meira e Cruz
Keyword(s):  
Unusual Case ◽  
Upper Airway ◽  
Oral Appliance ◽  
Interesting Case ◽  
Normal Weight ◽  
Mandibular Advancement ◽  
Therapeutic Success ◽  
Sleep Related Breathing Disorders ◽  
Respiratory Parameters ◽  
Obstructive Sleep

Abstract Introduction Normal respiratory function is crucial for adequate sleep. Sleep Related Breathing Disorders, namely Obstructive Sleep Apnea (OSA) are frequent conditions among a large spectrum of obstructive events in the upper airway which are often linked to significant sleep related oxyhemoglobin dessaturation levels compared to those observed in baseline PSG-oximetry recorded. On the other hand, low baseline oxygen saturation (LBOS) is commonly linked to symptomatic cardiorespiratory disturbances which may adversely impact respiratory outcomes either awake or during sleep. Therefore it is relevant to be aware of the baseline ventilatory status in order to optimize the therapeutic care. Report of Case We present an unusual case of a patient with moderate OSA which was successfully controlled with a Mandibular Advancement Oral Appliance (OAm). Despite the control with the OAm, the patient still maintained a nocturnal pattern of hypoventilation/hypoxia. The 53 yo female patient with normal weight/height ratio (BMI=25,2) complaining of non restorative sleep, tiredness, impaired memory, excessive diurnal sleepiness (Epworth Sleepiness Scale - ESS=10 and bruxism with a PSG diagnosis of moderate OSA (BaselineO2Sat=94%; IAH=17,4 ev/h; ODI=32,9 ev/h; T90=34,7% of TST) was referred for treatment with a OAm. A PM Type 1 positioner was inserted and titrated until 12 mm of advancement (80% of maximal measured protrusion). Within 6 months follow up and after clinical titration, there was a clear symptomatic and objective improvement with resolution of all major complaints including sleepiness (ESS=5). Titration PSG showed a normalization in all parameters (IAH=1,4 ev/h;ODI=4 ev/h;T90=0,1% of TST). Baseline O2 Sat however remained low (93%) in the titration PSG even though no symptoms or signs of a disorder existed even after discounting for Ph related metabolic changes (normal levels of HCO3) Conclusion This is an interesting case of an unusual patient who presented with a LBOS level in the diagnostic PSG. Despite the therapeutic success of the OAm in controlling the sleep related respiratory condition, measured by all otherwise normalized PSG based sleep and respiratory parameters, maintained a LBOS in the titration PSG without any signs or symptoms of disease.

scholarly journals Snoring Remediation with Oral Appliance Therapy Potentially Reverses Cognitive Impairment: An Intervention Controlled Pilot Study

Geriatrics ◽  
2021 ◽  
Vol 6 (4) ◽  
pp. 107
Author(s):  
Preetam Schramm ◽  
Namrata Das ◽  
Emet Schneiderman ◽  
Zohre German ◽  
Jason Hui ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Pilot Study ◽  
Mixed Model ◽  
Linear Mixed Model ◽  
Memory Function ◽  
Upper Airway ◽  
Oral Appliance ◽  
Study Cohort ◽  
Mixed Model Analysis ◽  
Oral Appliance Therapy

Respiration rate (RR) dynamics entrains brain neural networks. RR differences between mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in response to oral appliance therapy (OAT) is unknown. This pilot study investigated if RR during stable sleep shows a relationship to pathological severity in subjects with MCI and AD who snore and if RR is influenced following stabilization of the upper airway using OAT. The study cohort was as follows: cognitively normal (CN; n = 14), MCI (n = 14) and AD (n = 9); and a sub-population receiving intervention, CN (n = 5), MCI (n = 7), AD (n = 6) subjects. The intervention used was an oral appliance plus a mouth shield (Tx). RR maximum (max) rate (breaths/minute) and RR fluctuation during 2116 stable sleep periods were measured. The Montreal cognitive assessment (MoCA) was administered before and after 4 weeks with Tx. Baseline data showed significantly higher RR fluctuation in CN vs. AD (p < 0.001) but not between CN vs. MCI (p = 0.668). Linear mixed model analysis indicated Tx effect (p = 0.008) for RR max. Tx after 4 weeks lowered the RR-max in MCI (p = 0.022) and AD (p < 0.001). Compared with AD RR max, CN (p < 0.001) and MCI (p < 0.001) were higher with Tx after 4 weeks. Some MCI and AD subjects improved executive and memory function after 4 weeks of Tx.

scholarly journals P149 The role of OSA pathophysiological traits on mandibular advancement treatment response and efficacy of a novel mandibular advancement device

2021 ◽  
Vol 2 (Supplement_1) ◽  
pp. A70-A70
Author(s):  
B Tong ◽  
A Osman ◽  
C Bull ◽  
A Chiang ◽  
M Donegan ◽  
...  
Keyword(s):  
Treatment Response ◽  
Gold Standard ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
The Novel ◽  
Oral Airway ◽  
Respiratory Events ◽  
Mandibular Advancement Devices ◽  
Pressure Catheter

Abstract Mandibular advancement devices (MAD) are an effective therapy for OSA. However, treatment response is difficult to predict. Recent studies have investigated the influence of OSA endotypes on MAD outcomes albeit using simplified endotyping methods. We aimed to prospectively quantify and compare OSA pathophysiological traits between responders and non-responders to a novel MAD using gold-standard endotyping methodology. Data from 30 OSA patients (AHI&gt;10events/h) are analysed to date. OSA was confirmed via in-laboratory polysomnography. Next, a detailed physiology night was conducted before MAD therapy. Participants were instrumented with EEG, nasal mask, pneumotachograph, epiglottic pressure catheter and intramuscular genioglossus electrodes to quantify baseline OSA pathophysiological traits. Pcrit was quantified via CPAP drops and non-anatomical traits from naturally occurring respiratory events. Participants were fitted with a novel MAD with a built-in oral airway (Oventus O2Vent Optima™) and titrated to ≥75% of maximum mandibular advancement. A treatment efficacy PSG followed therapy acclimatisation. OSA severity decreased by 41±30% (25.1[16.3,39.2] vs. 12.1[7.3,20.0] events/h P&lt;0.001) with MAD therapy. Similar reductions occurred in participants with high nasal resistance. OSA pathophysiological traits measured by gold-standard methodology were similar between responders and non-responders to MAD (residual AHI&gt;10events/h). MAD responders had less collapsible airways at baseline when measured using simple estimates (Vpassive: 92.5[86.3,97.0] vs. 72.5[43.0,91.3] %Veupnea, P=0.022). The novel MAD reduced OSA severity by ~40% including in those with nasal obstruction. The upper airway was less collapsible in responders to MAD when estimated but not when directly measured. Simple estimates of OSA pathophysiological traits may be used to predict responses to MAD.

Sign in / Sign up

Export Citation Format

Share Document