Study Objective: The prevalence of supine-dependent obstructive sleep apnea (sdOSA) in a general population ranges from 20% to 60%, depending on the criteria used. Currently, the prevalence and evolution of sdOSA once oral appliance therapy with a mandibular advancement device (OA m ) has started is unknown. In addition, literature on the correlation between sdOSA and treatment success with OA m is not unequivocal. The fi rst purpose of this study was to assess the prevalence of sdOSA before and under OA m therapy. Second, the conversion rate from non-sdOSA to sdOSA during OA m therapy was evaluated. The third and fi nal goal was to analyze the correlation between sdOSA and treatment success with OA m therapy in the patient population. Methods: Two hundred thirty-seven consecutive patients (age 48 ± 9 years; male/female ratio 173/64; AHI 20.1 ± 14.7 events/h; BMI 27.2 ± 4.3 kg/m 2 ) starting OA m therapy were included.
Results:The prevalence of sdOSA before the start of OA m therapy, ranged from 27.0% to 67.5%. The prevalence of residual sdOSA under OA m therapy in this study ranged from 17.5% to 33.9%. Second, the conversion rate from non-sdOSA to sdOSA ranged from 23.0% to 37.5%. Third, the presence of sdOSA at baseline was not a signifi cant factor for treatment success with OA m therapy.
Conclusions:The results of this study indicate that the prevalence of sdOSA before and under OA m therapy is relatively high. One-third of patients shift from non-sdOSA to sdOSA. Finally, treatment success for OA m therapy was not signifi cantly correlated with the presence of sdOSA at baseline. Keywords: oral appliance therapy, body position, prevalence, sleep disordered breathing Citation: Dieltjens M, Braem MJ, Van de Heyning PH, Wouters K, Vanderveken OM. Prevalence and clinical signifi cance of supine-dependent obstructive sleep apnea in patients using oral appliance therapy. J Clin Sleep Med 2014;10(9):959-964.
S C I E N T I F I C I N V E S T I G A T I O N SO bstructive sleep apnea (OSA) is a prevalent disorder characterized by repetitive upper airway collapse or upper airway narrowing during sleep, often resulting in hypoxemia and arousal from sleep. 1 It has been described that undiagnosed or untreated OSA is associated with excessive daytime sleepiness, impaired cognitive performance, a reduced quality of life, an increased risk of motor vehicle and occupational accidents, and cardiovascular and cerebrovascular morbidity and mortality.2,3 The severity of OSA is expressed by the apnea-hypopnea index (AHI), defi ned as the average number of apneas and hypopneas per hour of sleep.1,4 In so-called supine-dependent OSA (sdOSA) patients the breathing abnormalities are clustered mainly in the supine posture, whereas non-sdOSA patients have breathing abnormalities in both the lateral and supine postures.5-8 Therefore, it could be of clinical importance to split up the total AHI according to sleep position with the supine AHI (defi ned as the number of apneas and hypopneas per hour of sleep spent in supine position) and the ...