Prevalence and Clinical Significance of Supine-Dependent Obstructive Sleep Apnea in Patients Using Oral Appliance Therapy

Abstract

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 ...

Prevalence and Effect of Supine-Dependent Obstructive Sleep Apnea on Oral Appliance Therapy

“…According to this defi nition, 46 % of patients were diagnosed as having sdOSA. Applying the same defi nition, Dieltjens et al [ 28 ] found a comparable prevalence of 46 % prior to the start of the OA m therapy. In three studies, the prevalence of sdOSA as defi ned by Cartwright's criteria was assessed before starting OA m therapy and ranged from 58 to 80 % [ 21 , 22 , 28 ].…”

“…In a recent study 183 patients with polysomnographic data before and under OA m therapy were evaluated showing a prevalence under OA m therapy ranging from 18 to 34 %, depending on the defi nition used. In addition, it was shown that up to one third of patients shift from non-sdOSA at baseline to sdOSA under OA m therapy [ 28 ].…”

“…1 ). Furthermore, OA m with an integrated titratable mechanism allowing for gradual mandibular protrusion [ 6 ] is superior in their ability to reduce the apnea severity as compared to the monobloc types where upper and lower parts are rigidly interconnected [ 7 ]. Different titratable oral appliances with unique design features are currently available (Fig.…”

Understanding Phenotypes of Obstructive Sleep Apnea: Applications in Anesthesia, Surgery, and Perioperative Medicine

“…88 It may be attributable to unfavorable upper airway anatomy, reduced lung volume, and inability of airway dilator muscles to compensate for the airway collapse in the supine position.…”

The challenges of advancing the evidence for the long-term effectiveness of oral appliance therapy for sleep apnea

“…Apart from the exploration of more effective titration procedures and an enhanced upfront prediction of individual patients' responses to MRD therapy, this efficacy might also be improved by a more accurate documentation of the reasons for any residual OSA under MRD therapy. Among others, there is recent evidence that a residual positional OSA is common as a reason for an incomplete elimination of OSA during MRD therapy [22]. In part, these findings can be explained by the fact that positional or supine-dependent OSA is much more common in patients with mild disease as compared to patients with a higher OSA severity at baseline [23].…”