BACKGROUND: It has been recognized that mandibular advancement splint (MAS) treatment is effective in some, but not all, patients with obstructive sleep apnea (OSA). Hence there is a need for a simple and reliable clinical tool to assist in the differentiation of treatment responses. We hypothesized that abnormalities of flow-volume curves, together with other clinical variables, may have clinical utility in the prediction of MAS treatment outcome. METHODS: Fifty-four patients with known OSA underwent MAS treatment. Expiratory and inspiratory flow-volume curves were measured in the erect and supine positions to derive midinspiratory flow (MIF(50)) and the ratio of expiratory to inspiratory flow at 50% of vital capacity (MEF(50):MIF(50)). Multivariable logistic regression was performed to identify additional significant clinical variables in the prediction of treatment outcome. RESULTS: The mean (+/- SD) apnea-hypopnea index (AHI) in 35 responders was significantly reduced from 28.9 +/- 13.7 to 6.7 +/- 5.8/hour (p<0.001). In 19 nonresponders there was no significant change in AHI. MIF(50) was lower (6.04 +/- 1.80 vs. 6.88 +/- 1.08 L/second; p=0.035) and the MEF(50):MIF(50) ratio was higher (0.82 +/- 0.23 vs. 0.61 +/- 0.15; p=0.001) in responders than nonresponders. Logistic regression analysis revealed that the MEF(50):MIF(50) ratio was the most important predictive factor for MAS treatment outcome, but that body mass index, age, and baseline AHI were also contributory. CONCLUSIONS: These data suggest that flow-volume curves, in combination with other factors such as body mass index, age, and baseline AHI, may have a useful clinical role in the prediction of treatment outcome with MAS.
BACKGROUND: It has been recognized that mandibular advancement splint (MAS) treatment is effective in some, but not all, patients with obstructive sleep apnea (OSA). Hence there is a need for a simple and reliable clinical tool to assist in the differentiation of treatment responses. We hypothesized that abnormalities of flow-volume curves, together with other clinical variables, may have clinical utility in the prediction of MAS treatment outcome. METHODS: Fifty-four patients with known OSA underwent MAS treatment. Expiratory and inspiratory flow-volume curves were measured in the erect and supine positions to derive midinspiratory flow (MIF(50)) and the ratio of expiratory to inspiratory flow at 50% of vital capacity (MEF(50):MIF(50)). Multivariable logistic regression was performed to identify additional significant clinical variables in the prediction of treatment outcome. RESULTS: The mean (+/- SD) apnea-hypopnea index (AHI) in 35 responders was significantly reduced from 28.9 +/- 13.7 to 6.7 +/- 5.8/hour (p<0.001). In 19 nonresponders there was no significant change in AHI. MIF(50) was lower (6.04 +/- 1.80 vs. 6.88 +/- 1.08 L/second; p=0.035) and the MEF(50):MIF(50) ratio was higher (0.82 +/- 0.23 vs. 0.61 +/- 0.15; p=0.001) in responders than nonresponders. Logistic regression analysis revealed that the MEF(50):MIF(50) ratio was the most important predictive factor for MAS treatment outcome, but that body mass index, age, and baseline AHI were also contributory. CONCLUSIONS: These data suggest that flow-volume curves, in combination with other factors such as body mass index, age, and baseline AHI, may have a useful clinical role in the prediction of treatment outcome with MAS.
Authors: Kate Sutherland; Hisashi Takaya; Jin Qian; Peter Petocz; Andrew T Ng; Peter A Cistulli Journal: J Clin Sleep Med Date: 2015-08-15 Impact factor: 4.062
Authors: Kate Sutherland; Craig L Phillips; Amanda Davies; Vasanth K Srinivasan; Oyku Dalci; Brendon J Yee; M Ali Darendeliler; Ronald R Grunstein; Peter A Cistulli Journal: J Clin Sleep Med Date: 2014-09-15 Impact factor: 4.062
Authors: Whitney Mostafiz; Oyku Dalci; Kate Sutherland; Atul Malhotra; Vasanth Srinivasan; M Ali Darendeliler; Peter A Cistulli Journal: Chest Date: 2011-02-03 Impact factor: 9.410
Authors: Kate Sutherland; Sheryn A Deane; Andrew S L Chan; Richard J Schwab; Andrew T Ng; M Ali Darendeliler; Peter A Cistulli Journal: Sleep Date: 2011-04-01 Impact factor: 5.849
Authors: Kate Sutherland; Olivier M Vanderveken; Hiroko Tsuda; Marie Marklund; Frederic Gagnadoux; Clete A Kushida; Peter A Cistulli Journal: J Clin Sleep Med Date: 2014-02-15 Impact factor: 4.062