Functional imaging improves patient selection for mandibular advancement device treatment outcome in sleep-disordered breathing

Ondertitel:a prospective study

Study Objectives: Mandibular advancement devices (MAD) are a non-invasive treatment option for patients with obstructive sleep apnea (OSA) and act by increasing the upper airway volume. However, the exact therapeutic mechanism of action remains unclear. The aim of this study was to assess MAD mechanisms using functional imaging, that combines imaging techniques and computational fluid dynamics (CFD) and assess associations with treatment outcome. Methods: One hundred OSA patients were prospectively included and treated with a custom-made MAD at a fixed 75% protrusion. A low-dose CT scan was made with and without MAD for CFD analysis. Patients underwent a baseline and 3-month follow-up polysomnography to evaluate treatment efficacy. A reduction in apnea-hypopnea index (AHI) ≥50% defined treatment response. Results: Overall, 71 patients completed both 3-month follow-up polysomnography and low-dose CT scan with CFD analysis. MAD treatment significantly reduced the AHI (16.5 (10.4-23.6) events/h to 9.1 (3.9-16.4) events/h, P<0.001, median (Q1-Q3)) and significantly increased the total upper airway volume (8.6 (5.4-12.8) cm3 vs. 10.7 (6.4-15.4) cm3; P=0.003), especially the velopharyngeal volume (2.1 (0.5-4.1) cm3 vs. 3.3 (1.8-6.0) cm3; P<0.001). However, subanalyses in responders and non-responders only showed a significant increase in the total upper airway volume in responders, not in non-responders. Conclusions: MAD acts by increasing the total upper airway volume, predominantly due to an increase in the velopharyngeal volume. Responders showed a significant increase in the total upper airway volume with MAD treatment, while there was no significant increase in non-responders. Findings add evidence to implement functional imaging using CFD in routine MAD outcome prediction.

Jaar van publicatie:2022

Trefwoorden:A1 Journal article

Toegankelijkheid:Open