title: Oral Appliance Treatment Response and Polysomnographic Phenotypes of Obstructive Sleep Apnea.
abstract: OBJECTIVE
  Mandibular advancement splints (MAS) are an effective treatment for obstructive sleep apnea (OSA); however, therapeutic response is variable. Younger age, female gender, less obesity, and milder and supine-dependent OSA have variably been associated with treatment success in relatively small samples. Our objective was to utilize a large cohort of MAS treated patients (1) to compare efficacy across patients with different phenotypes of OSA and (2) to assess demographic, anthropometric, and polysomnography variables as treatment response predictors.
  
  
  METHODS
  Retrospective analysis of MAS-treated patients participating in clinical trials in sleep centers in Sydney, Australia between years 2000-2013. All studies used equivalent customized two-piece MAS devices and treatment protocols. Treatment response was defined as (1) apnea-hypopnea index (AHI) < 5/h, (2) AHI < 10/h and ≥ 50% reduction, and (3) ≥ 50% AHI reduction.
  
  
  RESULTS
  A total of 425 patients (109 female) were included (age 51.2 ± 10.9 years, BMI 29.2 ± 5.0 kg/m2). MAS reduced AHI by 50.3% ± 50.7% across the group. Supine-predominant OSA patients had lower treatment response rates than non-positional OSA (e.g., 36% vs. 59% for AHI < 10/h). REM-predominant OSA showed a lower response rate than either NREM or non-stage dependent OSA. In prediction modelling, age, baseline AHI, and anthropometric variables were predictive of MAS treatment outcome but not OSA phenotype. Gender was not associated with treatment outcome.
  
  
  CONCLUSIONS
  Lower MAS treatment response rates were observed in supine and REM sleep. In a large sample, we confirm that demographic, anthropometric, and polysomnographic data only weakly inform about MAS efficacy, supporting the need for alternative objective prediction methods to reliably select patients for MAS treatment.
authors.affiliation: Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney Medical School, University of Sydney, Australia.|Woolcock Institute of Medical Research, University of Sydney, Australia.
authors.forename: Kate
authors.initials: K
authors.lastname: Sutherland
authors.affiliation: Department of Respiratory Medicine, Toranomon Hospital, Tokyo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Takaya
authors.affiliation: Department of Respiratory and Sleep Medicine, St George Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Jin
authors.initials: J
authors.lastname: Qian
authors.affiliation: Department of Statistics, Macquarie University, Sydney, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Petocz
authors.affiliation: Department of Respiratory and Sleep Medicine, St George Hospital, University of New South Wales, Sydney, Australia.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Ng
authors.affiliation: Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney Medical School, University of Sydney, Australia.|Woolcock Institute of Medical Research, University of Sydney, Australia.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Cistulli
mesh_terms: D017677:Age Distribution; D005260:Female; D006801:Humans; D008297:Male; D019186:Mandibular Advancement; D008875:Middle Aged; D017286:Polysomnography / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000628:therapy*; D016896:Treatment Outcome
keywords: obstructive sleep apnea; oral appliance; polysomnography; treatment response
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