Oral appliance treatment outcome can be predicted by continuous positive airway pressure in moderate to severe obstructive sleep apnea

Abstract

BackgroundStudies show that the therapeutic CPAP pressure is associated with oral appliance (OA) treatment outcome in obstructive sleep apnea (OSA) patients. However, these studies included either CPAP adherent patients using fixed pressure devices, or partly CPAP non-adherent patients using fixed pressure or auto-adjusting (auto-CPAP) devices. In many countries, auto-CPAP is predominately used, and only those non-adherent to therapy need a change to OA. Therefore, studies examining the relationship between CPAP pressures and OA treatment outcome should focus on patients non-adherent to auto-CPAP.PurposeThe purpose of this paper is to assess if CPAP pressures predicted OA treatment outcome in patients non-adherent to auto-CPAP therapy.MethodsThe OA treatment responders and non-responders were defined by two success criteria ((1) AHI < 5; (2) 5 ≤ AHI < 10 and > 50% AHI reduction). Logistic regression analyses were performed for CPAP pressures and baseline variables. ROC curve analyses were used to identify CPAP pressure cutoff values, alone and combined with other explanatory variables, predicting the OA treatment outcome.ResultsEighty-seven patients with moderate or severe OSA were included. Maximum CPAP pressures (CPAPmax) were higher in non-responders by both criteria and were, together with baseline AHI, associated with the OA treatment outcome in multivariate regression analyses. ROC curves identified an optimal CPAPmax cutoff of 12 cm H2O, corresponding to a positive predictive value (PPV) of 0.85 in predicting non-response using criterion 1. A prediction model combining CPAPmax > 12 and baseline AHI ≥ 30 had a PPV of 1.0 for non-response by both criteria.ConclusionsMaximum CPAP pressure was a moderate predictor of OA treatment outcome, but combined with baseline AHI, the ability to identify OA non-responders was high.

Therapeutic Positive Airway Pressure Level Predicts Response to Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea

“…Our observed findings related to HGNS are in accordance with studies investigating the predictive value of therapeutic PAP level for oral appliance therapy (OAT) outcomes. [13][14][15] Oral appliances are orthodontic retainers that advance the mandible to maintain a patent airway. 24 In the first study by Tsuiki et al, a cohort of 35 CPAP-adherent Japanese men (mean age 55 years, BMI 26 kg/m 2 , baseline AHI 37 events/h) were asked to stop using CPAP prior to being fitted with an oral appliance.…”

“…12 This finding is interesting in the setting of three independent studies, which found that patients with low therapeutic PAP levels were more likely to succeed with oral appliances for OSA. [13][14][15] In this study, we sought to determine whether therapeutic PAP level predicts outcomes following HGNS for OSA. Our primary aim was to determine whether there is a difference in reduction of AHI or 4% oxygen desaturation index (ODI4) between patients with low and high PAP levels.…”

Success of Hypoglossal Nerve Stimulation Using Mandibular Advancement During Sleep Endoscopy

“…Both therapeutic PAP level and airway opening response to mandibular advancement (MA) on DISE have been shown to predict successful treatment of OSA with a MAD. 13,14 Recently, our group has shown that akin to MAD patients, HGNS patients with low therapeutic PAP levels are more likely to succeed compared to patients with higher pressure requirements. 15 At present, it is unclear if response to MA during DISE can similarly aid in the selection of HGNS candidates.…”

“…Mandibular advancement devices (MAD) represent a leading nonsurgical alternative to positive airway pressure (PAP) therapy. Both therapeutic PAP level and airway opening response to mandibular advancement (MA) on DISE have been shown to predict successful treatment of OSA with a MAD 13–14 . Recently, our group has shown that akin to MAD patients, HGNS patients with low therapeutic PAP levels are more likely to succeed compared to patients with higher pressure requirements 15 .…”

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

“…A study assessed whether CPAP pressures predicted OAT outcomes in patients that failed auto-CPAP therapy. 295 According to the authors, research has demonstrated that therapeutic CPAP pressure is associated with OAT outcomes in patients with OSA. These studies included either CPAP-adherent patients using fixed pressures or partly CPAP nonadherent individuals using fixed pressures or auto-adjusting (a-PAP) devices.…”