01 June 2022

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Self-reported improvement in obstructive sleep apnea symptoms compared to post-treatment ahi with mandibular advancement device therapy: a retrospective study

Authors: Linda Sangalli, Fernanda Yanez Regonesi, Diego Fernandez Vial, Isabel Moreno Hay

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Mandibular advancement device (MAD) is recognized as a treatment option for the management of obstructive sleep apnea (OSA) in mild to moderate cases and/or patients unable to tolerate PAP therapy. According to AADSM guidelines, it is recommended to refer the patient for a post-treatment sleep study to establish the efficacy of MAD. Patients will be referred when the maximal therapeutic benefit has been achieved based on self-reported improvement of OSA symptoms or maximum anatomical protrusion.

The aim of the study was to investigate the difference between responders and non-responders in terms of self-reported improvement of OSA symptoms.

Materials and Methods
Medical chart of patients referred to the Orofacial Pain Clinic at University of Kentucky between 2016 and 2021 for the management of OSA with MAD were retrospectively evaluated. Only participants with a post-treatment sleep study with MAD in situ and with a previous follow-up investigating subjective OSA symptoms were included. Participants were categorized as responders if MAD treatment resulted in 50% improvement in AHI. Subjective symptoms were recorded using a 100-mm Numerical Rating Scale (NRS). OSA symptoms measures were loudness of snoring (0-100 NRS, 0=not snoring at all), witnessed apneas (0-100 NSR, 0=never), sleep quality (0-100 NRS, 0=very sound restful), tiredness upon awakening (0-100 NRS, 0=completely rested), daytime fatigue (0-100 NRS, 0=not at all tired), daytime sleepiness (0-24 Epworth Sleepiness Scale, 0=not sleepy at all).
Differences in pre-, post-treatment variables within and between groups were analyzed with paired t test and independent t test, respectively. Logistic regression was used to investigate if any variable was able to predict the treatment group.

Results
From 79 patients, 6 were excluded due to lack of sleep study or data on subjective OSA symptoms. 73 participants (36 women and 37 men, aged 64.32 ± 10.77), with mean pre-treatment AHI of 20.99 ± 15.84, were evaluated. Of those, 37 (50.68%) were classified as responders and 36 as non-responders (49.32%). The two groups differed in pre- and post-treatment AHI (p =.022 and .000, respectively). The responders had a mean pre-treatment AHI of 25.24 ± 19.67 and a mean post-treatment AHI of 6.99 ± 6.06; the non-responders had a mean pre-treatment AHI of 15.77 ± 8.73 and a mean post-treatment AHI of 15.99 ± 10.39. Pre-treatment AHI was a weak predictor of response to treatment (β =.240, p =.072). Before referring the participant to the post-treatment sleep study, the responders reported a significant improvement in sleep quality compared to the non-responders (21.51 ± 24.07 vs. 34.81 ± 29.66, p =.039), and scored weakly better in tiredness upon awakening compared to the non-responders (22.76 ± 21.16 vs. 32.53 ± 26.02, p =.082). The remaining OSA symptoms measures did not differ between the two groups (all p’s >0.05). None of the self-reported OSA symptoms predicted the treatment group.

Conclusions
Based on the results of this study, among the self-reported OSA symptoms, only sleep quality was significantly improved in responders compared to the non-responders.

Source: www.aadsm.org