Predictors of clinical effectiveness and patient’s self-estimation after mandibular advancement device treatment in Obstructive Sleep Apnea Syndrome cases
Date Issued
2009
Date
2009
Author(s)
Liu, Yi-Min
Abstract
Objectives:Obstructive sleep apnea (OSA) syndrome is a common sleep disordered problem. The diagnosis depends on patient’s clinical symptoms features and polysomnographic examination. Symptoms and signs include repetitive upper airwar obstruction, distruptive snoring and daytime sleepiness. Besides, researchers have published that OSA may be the risk factors of hypertension, ischemic heart diseases and shock, meaning that OSA is a life-concerning generalized medical problem.There are several treatment modalities of OSA and oral appliance is a simple, effective and popular treatment option among them. The etiologic factors and pathogenesis of each patient are different, so the treatment effect of oral appliance varies from each other. However, some specific craniofacial features in successful responders of oral appliances have been reported, but the features varied depending on the samples and study design.he purpose of this study was to evaluate the treatment effect of oral appliance in OSA patients in relation to their basic medical condition, craniofacial features, polysomnographic data and the improvement of self-estimated symptoms. We hope to illustrate an effective and specific method for predicting treatment response of oral appliance. aterials and methods: his was a prospective cross-section study. A total of 83 patients from Sleep Center in National Taiwan University had related clinical symtoms and signs, and were diagnosed as moderate ro severe OSA by polysomnography. Then patients were arranged for adjustable mandibular advancement oral appliance therapy in Special Clinic of Oral Appliance in Dental Department of NTU. Pre-treatment age, height and weight were recored, so the BMI were derived. Besides, baseline cephalometry was performed on each patient. Three months after treatment, patients came back to Sleep Center for follow-ups and received post-treatment polysomnography. In the meanwhile, patients were asked to answer the questionnaire of SF-36 before treatment and 3 months after treatment to assess the self-estimated responses of the treatment. Forty-four patients quit this study due to various reasons, and a total of 39 patients were recruited. The subjects were divided into two groups on the basis of the degree of changes in AHI: responders (>50% AHI reduction) and non-responders (<50% AHI reduction).aired t test was performed to examine the changes after treatment. Univariate and multivariate regression analyses were used for searching possible variables to predict the response of treatment.esults: The number of responders in this study was 26 and the males were predominant. The success rate of oral appliance therapy in this study was 66.67%. Average weights and BMI of all the samples significantly decreased after treatment. Improvement in polysomnographic findings were noted as well. Predictors of oral appliance treatment outcome were successfully derived in clinically valid regression models. The characteristics of responders were with low mandibular plane angle, larger nasopharnyx and oropharynx and wider inferior upper airway space. However, non-responders usually had retrognathic mandible, inferiorly and anteriorly positioned hyoid bone, longer soft palate, larger basicranial flexure. Besides, the pre-treatment rate of oxygen saturation <90% was higher in non-responders. From the analysis of questionnaire, both physical and mental conditions were better in responders than in non-responders either before or after oral appliance treatment, though only pretreatment mental and total health scores reached statisical difference. Gender difference and some specific craniofacial features seem to be related to the change of self-estimated responses. onclusion: The treatment effects of oral appliance in patients with OSA were related to multiple factors, including gender, age, weight, craniofacial structures and pre-treatment polysomnography. Therefore, clinicians can predict better treatment outcome if proper indication was established for different treatment modalities.
Subjects
obstructive sleep apnea
oral appliance
cephalometric analysis
SF-36 questionaire
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