Mandibular Movement Analysis to Assess Efficacy of Oral Appliance Therapy in OSA

Mandibular Jaw Movement Automated Analysis for Oral Appliance Monitoring in Obstructive Sleep Apnea: A Prospective Cohort Study

Rationale: Oral appliances are second-line treatments after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use as a result of monitoring challenges to assess the treatment effect on OSA. Objectives: To assess the validity of mandibular jaw movement (MJM) automated analysis compared with polysomnography (PSG) and polygraphy (PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in patients with OSA. Methods: This observational, prospective study included 135 patients with OSA eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. Additionally, MJM monitoring at home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was revaluated using Bland-Altman analysis. Changes in AHI during the home-based oral appliance titration process were evaluated using a generalized linear mixed model and a generalized estimating equation model. Results: The automated MJM analysis demonstrated strong agreement with PG in assessing AHI at the end of titration, with a median bias of 0.24/h (limits of agreement, -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across three evaluation conditions: in-laboratory PG (-59.6%; 95% confidence interval, -59.8% to -59.5%), in-laboratory automated MJM analysis (-59.2%; -65.2% to -52.2%), and at-home automated MJM analysis (-59.7%; -67.4% to -50.2%). Conclusions: Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.

Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry

This comprehensive review of the 2018 dental literature is provided to inform busy dentists about progress in the profession. Developed by the Committee on Scientific Investigation of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to one of the 8 sections of the report including (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information that will likely influence day-to-day treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source materials if greater detail is desired. As the profession continues its march toward evidence-based clinical decision-making, an already voluminous library of potentially valuable dental literature continues to grow. It is the intention of this review and its authors to provide assistance in navigating the extensive dental literature published in 2018. It is our hope that readers find this work useful in the clinical management of patients moving forward.

High-Resolution Pulse Oximetry and Titration of a Mandibular Advancement Device for Obstructive Sleep Apnea

Background: To determine whether utilizing high-resolution pulse oximetry is a viable method for evaluating the successful titration of oral appliances for the treatment of obstructive sleep apnea (OSA) patients.

Methods: Of 136 consecutive potentially eligible OSA patients, 133 were fitted with mandibular advancement devices (MADs), and 101 completed all phases of treatment. The vertical and horizontal dimensions of the appliances were adjusted based on three-nights with a high-resolution pulse oximeter during sleep and associated software after each adjustment.

Results: Significant improvements in OSA severity were apparent in patients at all disease severity levels. High-resolution pulse oximetry provided reliable guidance in the titration process of mandibular advancement therapy. In 67 subjects (66.3%), a respiratory event index of <5 events/hour was achieved.

Conclusions: OSA can be effectively treated with a MAD at any severity level, and high-resolution pulse oximetry provides critical information to guide oral appliance titration.