Determinants of treatment outcome after use of the mandibular advancement device in patients with obstructive sleep apnea.
OBJECTIVE
To determine the predictors affecting treatment outcome after application of the mandibular advancement device (MAD).


METHODS
Retrospective analysis.


METHODS
Tertiary care university hospital.


METHODS
A total of 76 patients (68 men and 8 women) who were treated with the MAD for obstructive sleep apnea (OSA) were included from September 2005 through August 2008. All the subjects underwent cephalometry, nocturnal polysomnography, and sleep videofluoroscopy (SVF) before and at least 3 months after receipt of a custom-made MAD. Sleep videofluoroscopy was performed before and after sleep induction and was analyzed during 3 states of awakeness, normoxygenation sleep, and desaturation sleep. Subjects were divided into success and nonsuccess groups depending on treatment outcome.


METHODS
Multiple variables from cephalometry and SVF including the length of the soft palate, retropalatal space, retrolingual space, and mouth opening angle were evaluated during sleep events with or without the MAD between success and nonsuccess group.


RESULTS
The soft palate was significantly longer in the nonsuccess group than in the success group. The retropalatal and retrolingual airway spaces and mouth opening angle were not different between 2 groups. Application of the MAD increased the retrolingual space and decreased the length of the soft palate and the mouth opening angle significantly in both success and nonsuccess groups. However, retropalatal space was widened only in the success group, which showed that retropalatal space may be important in determining treatment response of the MAD.


CONCLUSIONS
The length of the soft palate showed a difference between success and nonsuccess groups, and widening of retropalatal space might be an important factor for successful outcome with MAD application.
Lee
Chul Hee
CH
Department of Otorhinolaryngology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
Kim
Jeong-Whun
JW
Lee
Hyun Jong
HJ
Seo
Beom Seok
BS
Yun
Pil-Young
PY
Kim
Dong-Young
DY
Yoon
In-Young
IY
Rhee
Chae Seo
CS
Park
Jong-Wan
JW
Mo
Ji-Hun
JH
D000328:Adult; D000368:Aged; D002508:Cephalometry / Q000379:methods; D015331:Cohort Studies; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D017090:Occlusal Splints; D010160:Palate, Soft / Q000033:anatomy & histology / Q000502:physiology; D017060:Patient Satisfaction; D017286:Polysomnography / Q000379:methods; D011237:Predictive Value of Tests; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis* / Q000628:therapy*; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult