MRI of the pharynx and treatment efficacy of a mandibular advancement device in obstructive sleep apnoea syndrome

Abstract

In obstructive sleep apnoea syndrome (OSAS), prosthetic mandibular advancement devices (MAD) seem to be a promising treatment alternative to conventional continuous positive airway pressure therapy. Unfortunately, while they are effective in some patients, they are ineffective in others or may even worsen OSAS. At present, it is not known whether predictors can be defined which allow for estimation of the potential effect of oral appliances on the severity of OSAS.Clinical and polysomnographical efficacy of a MAD was evaluated in 15 patients with OSAS. In addition, ultrafast magnetic resonance imaging (MRI) of the pharynx was performed in 13 of these patients at rest during transnasal shallow respiration and during performance of the Muller manoeuvre, both with and without the MAD, and the site of closure was determined.The MAD reduced the mean apnoea/hypopnoea index (AHI) from 19.8±14.5 to 7.2±7.4·h−1. Seven subjects (53.8%) had at least a 50% reduction in AHI to a value <10·h−1with the MAD, whereas the MAD was ineffective in six patients. Five of the seven treatment responders had no significant pharyngeal obstruction during the manoeuvre with the device, while all of them had pharyngeal obstruction when not equipped with the device. Four of the six patients with treatment failure had a single velopharyngeal obstruction and two a combined obstruction of the velo‐ and glossopharynx during the Muller manoeuvre while wearing the device.The results of this study suggest that airway patency during the Muller manoeuvre while wearing a mandibular advancement device may be predictive of the success of obstructive sleep apnoea syndrome treatment with a mandibular advancement device.

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

“…The airway was still open during a Muller manoeuvre and mandibular advancement in good responders compared with a clear collapse in poor responders visualised by nasendoscopy [45]. A previous small study produced similar results by magnetic resonance imaging [57]. A model of the upper airway using combined upper airway imaging and computational fluid dynamics has been used to evaluate the influence of MADs on upper airway volume and resistance and this method has future potential for the prediction of treatment success [48].…”

“…In addition, 21 further clinical trials that highlighted particular aspects of MAD treatment, such as the mechanisms of action and prediction of treatment outcome, were identified [1][2][3][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60][61]. A table is available in the online supplementary material.…”

Influence of treatment on leptin levels in patients with obstructive sleep apnoea

“…Patients who refused CPAP therapy were offered a mandibular advancement device (for details see [12]) or a "conservative treatment" (sleep hygiene and dietetic measures).…”

Obstructive sleep apnea: Aetiology, diagnosis, treatment

“…oraz Sanner i wsp. 31,43,44 Istnieją także doniesienia przedstawiające zależność efektywności leczenia i stopnia nasilenia OBS. Badania Hoffsteina, porównujące skuteczność terapii OBS aparatami wewnątrzustnymi i CPAP wskazują na lepszą skuteczność leczenia z zastosowaniem CPAP.…”