Comparison of the phenotypic characteristics between responders and non-responders to obstructive sleep apnea treatment using mandibular advancement devices in adult patients: Systematic review and meta-analysis

Camañes-Gonzalvo, Sara; Bellot-Arcís, Carlos; Marco-Pitarch, Rocío; Montiel-Company, José María; García-Selva, Marina; Agustín-Panadero, Rubén; Paredes-Gallardo, Vanessa; Puertas, Francisco J.

doi:10.1016/j.smrv.2022.101644

Cited by 30 publications

(31 citation statements)

References 109 publications

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“…Moreover, the female sex is known to be a positive prognostic factor. 8 The outcome was optimal, and the patient only suffered from transitory neck pain at the beginning of the treatment; additionally, until now, she has not shown signs of temporomandibular dysfunction or problems with dental occlusion, which is uncommon, but typical for MAD treatment.…”

Section: Discussionmentioning

confidence: 85%

“…In fact, the response to treatment was linked to a lower BMI, smaller neck circumference, retrognathia, shorter maxillary bone and soft palate, reduced facial height, shorter distance from the hyoid bone to the third cervical vertebra, shorter airway length, and narrower minimum cross-sectional area. 8,9 Moreover, a study that measured fat mass percentage using dual-energy X-ray absorptiometry showed that the neck-to-abdominal fat percentage ratio predicted OSA severity. 10 We believe that the positive outcome was due to the following factors, as indicated by our case report: retrognathia, no palate narrowing, pharyngeal obstruction, mainly along the anterior-posterior axis and at the base of the tongue, wide protrusive mobility of the jaw, and leptosomic appearance (BMI 20.76 kg/m 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Mandibular Advancement Device for Severe Obstructive Sleep Apnea: A Case Report Indicating a Way to Personalize Treatment

2022

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The mandibular advancement device (MAD) is a therapeutic option for obstructive sleep apnea syndrome (OSAS); however, for severe cases, it has a lower efficacy compared to continuous positive airway pressure (CPAP). This report aimed to present the efficacy of MAD in a patient with severe OSAS who refused CPAP. Video-polysomnography and polygraphy were performed before and after treatment, respectively. Three months after fitting and titrating the MAD, the apnea–hypopnea index was reduced from 56.2 events/h to 1.3 events/h and the minimum oxyhemoglobin saturation increased from 80% to 91%. Snoring time reduced from 75.2% to 0.2%. Our patient presented with low body fat, retrognathia, pharyngeal obstruction mainly along the anteroposterior axis and at the base of the tongue, and the ability to make wide protrusive movements with the jaw. In our opinion, these features could constitute a phenotype that may predict a positive response to MAD treatment even in severe cases of OSAS.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Mandibular Advancement Device for Severe Obstructive Sleep Apnea: A Case Report Indicating a Way to Personalize Treatment

2022

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“…In our study, 67% of patients received the second PSG had OA's therapeutic efficacy, and these results were similar to previous study (i.e., OA therapy is an effective treatment for 60%-70% of patients). 26 Interestingly, 28% of the patients in the user group continued to use OA despite ineffectiveness.…”

Section: Discussionmentioning

confidence: 97%

“…Recent research reported characteristics of responders for OA therapy, which were shorter maxillary length, lower anterior and posterior facial height, and so on. 26 But actually, predicting the response to OA therapy is difficult. Individual variables associated with success include AHI, BMI, Mallampati score, nasopharyngoscopy, spirometry, and craniofacial photography.…”

Section: Discussionmentioning

confidence: 99%

Clinical analysis of patients who dropout in oral appliance therapy in obstructive sleep apnea

Hiraga

Komatsu

Ito

et al. 2022

Oral Science International

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AimThe purpose of this study was to characterize patients who received oral appliance (OA) therapy for obstructive sleep apnea (OSA) and to investigate the factors linked to patient dropout from OA therapy.MethodsThis study included 132 patients with OSA. The patients were categorized into an OA user group or a dropout group. Clinical parameters and craniofacial features were compared.ResultsFifty‐seven patients (43.2%) dropped out of OA therapy. The most common reasons for stopping OA therapy, as reported by patients, were unknown (51%), ineffectiveness (16%), strong discomfort not related to the temporomandibular joint TMJ (e.g., tooth or gum pain; 14%), pain in the TMJ (TMJ; 9%), nasal symptoms (4%), excessive salivation (2%), and other reasons (5%). Body mass index (BMI) and the presence or absence of OSA‐related complications (e.g., cardiovascular disease, cerebrovascular disease, and diabetes) were determined by univariate analysis. Age, BMI, facial axis (Fx), and the presence of OSA‐related complications were determined by multivariate logistic analyses to be risk factors for dropping out of OA therapy.ConclusionsThis study found that more patients than anticipated had discontinued OA treatment for various reasons.

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“…To consider the efficacy of the MAD, we defined the patients’ responses to the MAD treatment as: Effective: defined as an AHI < 10 with decrease of more than 50% from baseline [ 14 , 15 ]. Partially effective: defined as an AHI ≥ 10 with a decrease of more than 50% from baseline.…”

Section: Methodsmentioning

confidence: 99%

Mandibular Torus as a New Index of Success for Mandibular Advancement Devices

Terán

Muñoz-Cacho

Carlos

et al. 2022

IJERPH

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Background: In obstructive sleep apnoea (OSA), treatment with mandibular advancement devices (MADs) reduces patients’ Apnoea–Hypopnoea index (AHI) scores and improves their sleepiness and quality of life. MADs are non-invasive alternatives for patients who cannot tolerate traditional continuous positive airway pressure (CPAP) therapy. The variability of responses to these devices makes it necessary to search for predictors of success. The aim of our study was to evaluate the presence of mandibular torus as a predictor of MAD efficacy in OSA and to identify other potential cephalometric factors that could influence the response to treatment. Methods: This was a retrospective cohort study. The study included 103 patients diagnosed of OSA who met the criteria for initiation of treatment with MAD. Structural variables were collected (cephalometric and the presence or absence of mandibular torus). Statistical analysis was performed to evaluate the existence of predictive factors for the efficacy of MADs. Results: A total of 103 patients who were consecutively referred for treatment with MAD were included (89.3% men); the mean age of the participants was 46.3 years, and the mean AHI before MAD was 31.4 (SD 16.2) and post- MAD 11.3 (SD 9.2). Thirty-three percent of patients had mandibular torus. Torus was associated with a better response (odds ratio (OR) = 2.854 (p = 0.035)) after adjustment for sex, age, body mass index (BMI; kg/m2), the angle formed by the occlusal plane to the sella–nasion plane (OCC plane to SN), overinjection, and smoking. No cephalometric predictors of efficacy were found that were predictive of MAD treatment success. Conclusions: The presence of a mandibular torus practically triples the probability of MAD success. This is the simplest examination with the greatest benefits in terms of the efficacy of MAD treatment for OSA.

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Comparison of the phenotypic characteristics between responders and non-responders to obstructive sleep apnea treatment using mandibular advancement devices in adult patients: Systematic review and meta-analysis

Cited by 30 publications

References 109 publications

Mandibular Advancement Device for Severe Obstructive Sleep Apnea: A Case Report Indicating a Way to Personalize Treatment

Mandibular Advancement Device for Severe Obstructive Sleep Apnea: A Case Report Indicating a Way to Personalize Treatment

Clinical analysis of patients who dropout in oral appliance therapy in obstructive sleep apnea

Mandibular Torus as a New Index of Success for Mandibular Advancement Devices

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