By Peter Blais, RPGST
Additional oral appliance titration from 75% to 90% of maximal protrusion (MP) in patients whose obstructive sleep apnea (OSA) is not completely treated yields an increased therapeutic efficacy in 54% of patients, according to a study.
Author Marijke Dieltjens, PhD, who graduated in 2009 as a biomedical scientist from the University of Antwerp in Belgium, won a 2015 Clinical Research Award from the American Academy of Dental Sleep Medicine for her work on this study. Dieltjens earned her PhD from the University of Antwerp, where she currently works as a postdoctoral fellow. Coauthors are Marc J. Braem, Annelies E. Verbruggen, Paul H. Van de Heyning, and Olivier M. Vanderveken.
In 17% of patients, titration the appliance to 90% of MP resulted in an apnea hypopnea index (AHI) of less than 5 events per hour, according to the study, which is titled “Effect of Titration on the Therapeutic Efficacy of Mandibular Advancement Therapy.”
Dieltjens
Dieltjens tells Dental Sleep Corner: “MAD [mandibular advancement device] therapy is generally started in an arbitrary mandibular protrusion but additional protrusion or ‘titration’ is often required to optimize therapeutic outcome. More protrusion is, however, not always associated with a corresponding reduction in sleep apnea severity and could lead to increased side effects.” So the aim of this study was to investigate whether titration yields a higher therapeutic efficacy in terms of an additional decrease in AHI in patients that started oral appliance therapy at 75% of MP.
The award-winning study is an extension to the prospective clinical trial “Predicting therapeutic outcome of mandibular advancement device treatment in obstructive sleep apnea (PROMAD).”
In Dieltjens study, 17 out of 52 OSA patients (33%) the 75% of MP position yielded an AHI less than 5 events per hour. The remaining 35 patients had an AHI > 5/h under OAT in 75% of MP and gave informed consent to adjust the OAT to the 90% of MP. In this group, the AHI decreased significantly. Nineteen patients (54%) showed a lower AHI in the 90% MP when compared to the 75% MP, whereas in 16 patients (46%) the AHI was higher in the 90% MP when compared to the 75% MP. In 6 patients (17%) the 90% MP resulted in AHI < 5/h.
The post In More Than Half Whose Obstructive Sleep Apnea Isn’t Fully Treated, Further Oral Appliance Titration Helps appeared first on Dental Sleep Corner.