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Three-dimensional assessment of anatomical balance and oral appliance treatment outcome in obstructive sleep apnoea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

Mandibular advancement splints (MAS) are an effective treatment for obstructive sleep apnoea (OSA). However, MAS are not equally efficacious across all patients and the reasons are not well understood. Craniofacial and upper airway structure individually influence MAS response. We aimed to assess anatomical balance, defined as the ratio of upper airway soft tissue (ST) volume to maxillomandibular enclosure volume, between MAS treatment responders and non-responders.

Methods

OSA patients (apnoea-hypopnea index (AHI) >10 h−1) were recruited for MAS treatment. Magnetic resonance imaging of the upper airway was performed during wakefulness without and with MAS in situ. Images were processed for volumetric analysis of upper airway soft tissues (tongue, soft palate, paraphayrngeal fat pads and lateral pharyngeal walls) and three-dimensional cephalometry to acquire intra-mandibular space area (IMA) and total maxillomandibular (Mm) volume. Anatomical balance ratios were compared between MAS treatment responders (AHI <10 h−1 + 50 % reduction) and non-responders.

Results

Image analysis was completed in 69 patients (68 % male, age 50.5 ± 10.1 years, BMI 29.6 ± 5.0 kgm2, AHI 27.0 ± 14.7 h−1) including 36 responders. Soft tissue volumes did not differ between MAS responders and non-responders. Non-responders had increased ST/IMA compared to responders (4.9 ± 0.6 vs. 4.6 ± 0.6, p = 0.031). In multivariate logistic regression with AHI and BMI, ST/IMA was the only predictive variable (p = 0.036, ROC AUC 0.7). However, changes in ST/Mm did not directly relate to treatment response.

Conclusions

Anatomical imbalance assessed by intra-mandibular space area was associated with poor MAS treatment response. However, changes in anatomical balance with mandibular advancement did not reflect treatment outcome as static imaging may not adequately capture improvements in upper airway function.

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Authors and Affiliations

  1. Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, and Sydney Medical School, University of Sydney, Acute Services Building 8A Reserve Road, St Leonards, NSW, 2065, Sydney, Australia

    Kate Sutherland, Andrew S. L. Chan & Peter A. Cistulli

  2. Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia

    Kate Sutherland

Authors
  1. Kate Sutherland
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  2. Andrew S. L. Chan
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  3. Peter A. Cistulli
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Corresponding author

Correspondence to Kate Sutherland.

Ethics declarations

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

The National Health and Medical Research Council of Australia, SomnoMed Ltd. provided support in-kind in provision of mandibular advancement splints for the study.

Conflict of interest

PAC holds an endowed Academic Chair position at the University of Sydney, funded by ResMed Inc. He has received research support from ResMed, SomnoMed, Zephyr Sleep Technologies and Exploramed Inc. He is a consultant to Zephyr Sleep Technologies and NovoNordisk. He has a pecuniary interest in SomnoMed, resulting from previous involvement in research and development. Other authors have no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Sutherland, K., Chan, A.S.L. & Cistulli, P.A. Three-dimensional assessment of anatomical balance and oral appliance treatment outcome in obstructive sleep apnoea. Sleep Breath 20, 903–910 (2016). https://doi.org/10.1007/s11325-015-1304-x

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  • DOI: https://doi.org/10.1007/s11325-015-1304-x

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