Mandibular advancement devices in obstructive sleep apnea: diagnostic predictors for treatment response and clinical...

Mandibular advancement devices (MADs) represent an established second-line therapy for obstructive sleep apnea (OSA), but therapeutic responses vary considerably. The primary aim of this retrospective pilot cohort study was to evaluate craniofacial characteristics, particularly the ANB angle, as potential diagnostic predictors of treatment response.

Anamnestic, clinical, and poly(somno)graphic data were collected from OSA patients before MAD insertion (t0) and after final titration with poly(somno)graphic confirmation (t1). Cephalometric measurements, including hyoid bone position, were analyzed. Patients were stratified based on the ANB angle (ANB ≤ 4°: group 1; ANB > 4°: group 2). Statistical analysis included independent t‑tests, Pearson correlations, receiver operating characteristic (ROC) curve analysis, and multiple regression models to identify predictors of treatment response.

A total of 38 patients (mean age 57.6 ± 11.7 years; 52% male) were included. Group 2 showed significantly greater reductions in Apnea-Hypopnea Index (AHI) at t1 (-84.6% vs. -39.8%, p < 0.001). ROC analysis identified an optimal ANB cut-off of 4.7° (AUC = 0.791), with 75% sensitivity and 81.2% specificity. In addition to ANB, higher Wits values and a smaller Björk polygon sum (hypodivergent pattern) independently predicted greater AHI reduction. Reductions in AHI were significantly correlated with improvements in Epworth Sleepiness Scale (ESS) scores.

Cephalometric parameters predict a favorable response to MAD therapy for OSA. Integrating cephalometric analysis into the diagnostic workflow may improve patient selection and prognosis.