Usefulness of a Titratable Mandibular Positioner During Sleep Endoscopy as a Prediction Tool for Treatment Outcome with Mandibular Advancement Devices: DISE-SAM Protocol

Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. However, different maneuvers have been performed during the performance of drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response, and to determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, a BMI of 27.90 (SD = 4.19) kg/m2 and a mean AHI of 26.51 (SD = 21.23). Results showed no relationship between severity and MAD recommendation. Also, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the inter-examiner bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices

Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).

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

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.

Predictive Factors of Therapeutic Response According to Craniofacial Skeletal Biotype in Patients with Sleep Apnoea Syndrome using Mandibular Advancement Devices: A Pilot Study

Background: In the scientific literature, there is no consistency of results regarding the effectiveness of mandibular advancement devices (MADs) for sleep apnoea treatment. We have considered facial growth as an important predictor of treatment. In this study we analysed that how facial biotype can influence the therapeutic effect of MADs according to polysomnographic records in SAHS patients.Methods: The study enrolled 46 patients with mild to moderate SAHS diagnosed by a polysomnographic test. Using cephalometry, we classified all the patients according their facial biotype (mesofacial, brachyfacial or dolichofacial). Shapiro-Wilk test was used to choose the parametric or non-parametric tests. The quantitative variables were described with the arithmetic mean with its standard deviation or the median with its interquartile range. The hypothesis tests used were Pearson’s chi-squared test, paired sample Student's t test, the Wilcoxon test, one-way ANOVA, Kruskal-Wallis test and Mann-Whitney U test. A p < 0.05 was considered statistically significant.Results: The respiratory disturbance index (RDI) results were: brachyfacial patients had a reduction to 15 events/hour (p < 0.001), the mesofacial patients had a reduction to 14 events/hour (p < 0.001) and the dolichofacial patients did not show a significant reduction in the RDI. The oxygen desaturation index (ODI) results were as follows: brachyfacial patients had a reduction in ODI episodes to 45 episodes/hour (p = 0.001), mesofacial patients had a reduction to 18 episodes/hour (p = 0.001). The dolichofacial patients did not show a reduction in this index. As far as the number of arousals, in the brachyfacial group, the number of awakenings with MAD therapy was reduced to 23 events/hour (p = 0.003), while in the mesofacial group, it was reduced to 37 episodes/hour (p = 0.012). The same behaviour was observed in the dolichofacial group, did not have a reduction in the number of awakenings during sleep after MAD therapy.Conclusions: The facial biotype influences the effectiveness of MAD therapy and is considered a good predictive factor. Dolichofacial patients failed to obtain a significant result in the polysomnographic records using a MAD for sleep apnoea treatment.

Mandibular Advancement Devices (MAD) as a Treatment Alternative for Obstructive Sleep Apnea Syndrome (OSAS)

Background: Continuous Positive Airways Pressure therapy (CPAP) is the gold standard treatment of the Obstructive Sleep Apnea Syndrome (OSAS), however, the scarce adherence to the therapy requires the evaluation of other therapeutic alternatives. Objective: The aim of the present study was to assess the effectiveness of Mandibular Advancement Devices (MAD) in subjects affected by OSAS who had interrupted the treatment with CPAP and to make comparative evaluations. Methods: Eighteen subjects (15 males and 3 females), aged between 27 and 60 years, with a diagnosis of moderate to severe OSAS were included. Inclusion criteria: polysomnographic examination before treatment (T0) and after 1 month from the beginning of the therapy with CPAP(T1), interruption of the treatment due to loss of compliance, Epworth Sleepiness Scale (ESS) questionnaire filled out at T0 and T1. Subjects started the treatment with MAD and polysonnographic examination was prospectively executed after 3 months (T2) and 1 year (T3). One-way analysis of the variance (ANOVA) was used to compare data of polysonnographic examination performed at T0, T1, T2 and T3 as well as the differences of ESS scores recorded at different timing. Results: Compared to baseline (T0), all functional parameters tested showed statistically significant differences at T1, T2 and T3 (p < 0.001), meanwhile no differences were found between data recorded after therapy with MAD (T2 and T3) and with CPAP (T1). Similar results were also found with the score of ESS among different timelines (p < 0.001). Conclusion: These findings suggest that MAD could be a valid alternative for the treatment of OSAS in those patients with scarce adherence to the CPAP therapy.