Wojciech Trzepizur1,2,3, Benjamin Adrian4, Marc Le Vaillant5, Nicole Meslier6,4, Jean-Daniel Kün-Darbois7, Frédéric Gagnadoux6,4. 1. INSERM U1063, SOPAM, Angers University, F-49045, Angers, France. wotrzepizur@chu-angers.fr. 2. Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France. wotrzepizur@chu-angers.fr. 3. Département de Pneumologie, CHU, 4 rue Larrey, 49100, Angers, France. wotrzepizur@chu-angers.fr. 4. Department of Respiratory and Sleep Medicine, Angers University Hospital, Angers, France. 5. Institut de Recherche en Santé Respiratoire des Pays de la Loire, Beaucouzé, France. 6. INSERM U1063, SOPAM, Angers University, F-49045, Angers, France. 7. Department of Oral and Maxillo-facial Surgery, Angers University Hospital, Angers, France.
Abstract
OBJECTIVES: Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. We describe the use of a trial of a titratable thermoplastic MAD to predict treatment outcomes with a custom-made MAD. MATERIALS AND METHODS: Patients treated with a thermoplastic MAD as a trial before custom-made MAD manufacturing were included in the study. Sleep recordings and clinical outcomes assessed after 6 months of treatment with each device were compared. Predictive utility of thermoplastic MAD to identify custom-made MAD treatment success defined as a reduction greater than 50% and final apnea-hypopnea index (AHI) less than 10 events/h was evaluated. RESULTS: Thermoplastic MADs were installed in 111 patients, but only 36 patients were finally treated with both devices and were included in the analysis. A significant correlation was observed between the impact of the two devices on the AHI (r=0.85, p<0.0001), oxygen desaturation index (r=0.73, p<0.0001), snoring index (r=0.85, p<0.0001), and Epworth sleepiness scale (r=0.77, p<0.0001). A high positive predictive value (86%) but a low negative predictive value (46%) was observed regarding AHI decrease. CONCLUSIONS: Similar impacts of both MADs were observed on major OSA severity markers and symptoms. The ability of thermoplastic MAD to indicate likelihood of success with custom-made MAD will require further controlled studies. CLINICAL RELEVANCE: Thermoplastic MADs could represent a useful and easily implemented tool to predict the likelihood of success of a custom-made MAD as treatment for OSA.
OBJECTIVES: Mandibular advancement device (MAD) therapy is the most commonly used second-line treatment for obstructive sleep apnea (OSA), but MAD may be ineffective in a subgroup of patients. We describe the use of a trial of a titratable thermoplastic MAD to predict treatment outcomes with a custom-made MAD. MATERIALS AND METHODS:Patients treated with a thermoplastic MAD as a trial before custom-made MAD manufacturing were included in the study. Sleep recordings and clinical outcomes assessed after 6 months of treatment with each device were compared. Predictive utility of thermoplastic MAD to identify custom-made MAD treatment success defined as a reduction greater than 50% and final apnea-hypopnea index (AHI) less than 10 events/h was evaluated. RESULTS: Thermoplastic MADs were installed in 111 patients, but only 36 patients were finally treated with both devices and were included in the analysis. A significant correlation was observed between the impact of the two devices on the AHI (r=0.85, p<0.0001), oxygen desaturation index (r=0.73, p<0.0001), snoring index (r=0.85, p<0.0001), and Epworth sleepiness scale (r=0.77, p<0.0001). A high positive predictive value (86%) but a low negative predictive value (46%) was observed regarding AHI decrease. CONCLUSIONS: Similar impacts of both MADs were observed on major OSA severity markers and symptoms. The ability of thermoplastic MAD to indicate likelihood of success with custom-made MAD will require further controlled studies. CLINICAL RELEVANCE: Thermoplastic MADs could represent a useful and easily implemented tool to predict the likelihood of success of a custom-made MAD as treatment for OSA.
Authors: Craig L Phillips; Ronald R Grunstein; M Ali Darendeliler; Anastasia S Mihailidou; Vasantha K Srinivasan; Brendon J Yee; Guy B Marks; Peter A Cistulli Journal: Am J Respir Crit Care Med Date: 2013-04-15 Impact factor: 21.405
Authors: F Gagnadoux; B Fleury; B Vielle; B Pételle; N Meslier; X L N'Guyen; W Trzepizur; J L Racineux Journal: Eur Respir J Date: 2009-03-26 Impact factor: 16.671
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