title: Endoscopy evaluation to predict oral appliance outcomes in obstructive sleep apnoea.
abstract: The objective of this study was to determine the utility of nasoendoscopy of the upper airway as a predictor of the efficacy of oral appliance treatment in obstructive sleep apnoea (OSA).A total of 61 consecutive patients with moderate-to-severe polysomnographically diagnosed OSA were recruited for this study. Using nasoendoscopy, we prospectively assessed the velopharynx and oro/hypopharynx in each patient while awake and in the supine position. We measured cross-sectional area (CSA), and anteroposterior and lateral diameters of the airway before and after mandibular advancement, and expressed the changes in dimensions as expansion ratios (after/before). We then compared the measurements of responders and nonresponders with oral appliance treatment.The expansion ratio (median (interquartile range)) for the CSA was greater in responders compared with nonresponders in the velopharynx (2.9 (2.3-5.0) versus 1.7 (1.5-1.9), p<0.001) and in the oro/hypopharynx (3.4 (2.5-5.6) versus 2.4 (1.8-3.7), p<0.05). Baseline apnoea-hypopnoea index and the CSA expansion ratio of the velopharynx were independent predictors of oral appliance treatment outcome based on a multivariate logistic regression analysis. The estimated area under the receiver operator characteristic curve was 0.87 and the cut-off value of the expansion ratio was 2.00.These results indicate that nasoendoscopy may have significant clinical utility in predicting the success of oral appliance treatment.
authors.affiliation: Dept of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada Division of Functional Oral Neuroscience, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan k-okuno@dent.osaka-u.ac.jp.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Okuno
authors.affiliation: Division of Functional Oral Neuroscience, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan Center of Oral Functional Disorders, Sasao Dental Clinic, Yamaguchi Prefecture 740-0027, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Sasao
authors.affiliation: Division of Functional Oral Neuroscience, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan.
authors.forename: Kanji
authors.initials: K
authors.lastname: Nohara
authors.affiliation: Division of Functional Oral Neuroscience, Osaka University Graduate School of Dentistry, Osaka 565-0871, Japan.
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Sakai
authors.affiliation: Dept of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Pliska
authors.affiliation: Dept of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
authors.forename: Alan A
authors.initials: AA
authors.lastname: Lowe
authors.affiliation: Division of Respiratory Medicine, Dept of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
authors.forename: C Frank
authors.initials: CF
authors.lastname: Ryan
authors.affiliation: Dept of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC V6T 1Z3, Canada.
authors.forename: Fernanda R
authors.initials: FR
authors.lastname: Almeida
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004724:Endoscopy; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008334:Mandible / Q000503:physiopathology; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D056888:Patient Positioning; D010614:Pharynx / Q000000981:diagnostic imaging / Q000503:physiopathology; D017286:Polysomnography; D011446:Prospective Studies; D012044:Regression Analysis; D020181:Sleep Apnea, Obstructive / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome