Prediction of Mandibular Advancement Device Response Using CPAP Pressure in Different Polysomnographic Phenotypes

Area of Science:

• Sleep Medicine
• Respiratory Medicine
• Medical Devices

Background:

• Obstructive sleep apnea (OSA) management involves various treatment modalities.
• Continuous positive airway pressure (CPAP) and mandibular advancement devices (MADs) are common OSA treatments.
• Predicting treatment response to MADs is crucial for optimizing patient outcomes.

Purpose of the Study:

• To investigate the predictive value of CPAP pressure for MAD treatment response in moderate-to-severe OSA patients.
• To explore the association between polysomnographic phenotypes (sleep stage and positional dependency) and MAD treatment response.
• To identify factors influencing MAD efficacy in treatment-naïve OSA patients.

Main Methods:

• A cohort of treatment-naïve moderate-to-severe OSA patients who opted for MAD over CPAP was studied.
• MAD treatment response was defined by residual apnea-hypopnea index (AHI) levels (<5/h and <10/h).
• Logistic regression and ROC analysis assessed the association and predictability of CPAP pressure and polysomnographic phenotypes with MAD response.

Main Results:

• Response rates for MAD were 25.8% (AHI <5/h) and 48.4% (AHI <10/h).
• Lower anthropometrics, baseline AHI, and supine-predominant OSA were associated with better MAD response.
• CPAP pressure independently predicted MAD response, with an AUROC of 0.635 for AHI <5/h and 0.664 for AHI <10/h.

Conclusions:

• Supine-predominant OSA phenotype and lower CPAP pressure are associated with positive MAD treatment response.
• Sleep stage dependency did not significantly predict MAD response.
• A CPAP level >14 cmH2O can sensitively identify patients unlikely to respond to MAD therapy.