Predictors Of Success For Oral Appliance Therapy In Obstructive Sleep Apnea Patients Based On Initial Craniofacial Characteristics.
Abstract: Aims: 1. To evaluate the association of Obstructive Sleep Apnea (OSA) severity with age, BMI and certain craniofacial characteristics. 2. To compare these characteristics among the three different categories of OSA severity. 3. To investigate whether any of these characteristics could predict the success of oral appliance (OA) therapy. Hypotheses: 1. There is a positive association between ... read morethe increase in OSA severity and cephalometric variables, age and BMI. 2. The success of OAs in treating OSA can be predicted by evaluating certain craniofacial characteristics on lateral cephalographs. 3. There is a significant difference in craniofacial hard and soft tissue characteristics between mild, moderate and severe OSA cases. Materials & Methods: Records of 108 OSA patients, consecutively treated with OAs in the Dental Sleep Medicine Clinic at Tufts University School of Dental Medicine, were reviewed retrospectively. Fifty-two subjects were included. We studied BMI, age, gender and seven cephalometric measurements: 1. Mandibular plane angle (MP), 2. Vertical distance between MP and the most superior point of the hyoid bone (MP-H), 3. ANB angle (ANB), 4. Soft tissue ANB angle (S.T. ANB), 5. Upper lip position to a true vertical line (UL-VL), 6. Lower lip position to a true vertical line (LL-VL), and 7. Soft tissue chin position to a true vertical line (C-VL). Three different definitions of success were evaluated: 1. At least 50% reduction in initial AHI, 2. Residual AHI ≤ 10 after treatment, and 3. Residual AHI ≤ 5. Results: The sample was classified into: Mild (n=16, 30.8%), moderate (n=26, 50%) and severe (n=10, 19.2%) OSA groups. No statistically significant differences were found between the three groups (P>0.05). Median initial AHI = 17.1 (IQR = 15.5), was reduced on follow-up to 9.2 (IQR = 13.8). BMI (median= 28.3, IQR = 5.9) had a weak association with the increased AHI; rs = 0.28, P = 0.045. OA therapy resulted in 51.9%, n= 27, 55.7%, n= 29 and 30.7%, n= 16 successful outcomes, using the first, second and third methods of defining success, respectively. Two cephalometric parameters were positively associated with success: MP (1st and 3rd definition) and C-VL (3rd definition). Area under the curve (AUC) statistics were MP = (0.67 & 0.68), C-VL = (0.71), respectively. Conclusion: A weak positive correlation was found between BMI and OSA severity. The MP and C-VL were significantly associated with the outcome of OA therapy. These two cephalometric characteristics showed poor and fairly modest predictability for the success of OA therapy, respectively. However, these results should be interpreted with caution and their clinical significance should be investigated further in future studies.
Thesis (M.S.)--Tufts University, 2016.
Submitted to the Dept. of Orthodontics.
Advisor: Georgios Kanavakis.
Committee: Matthew Finkelman, Leopoldo Correa, and Carroll Ann Trotman.
Keywords: Dentistry, and Medicine.read less