Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
J Oral Rehabil. 2023 Apr;50(4):308-317. doi: 10.1111/joor.13418. Epub 2023 Feb 1.
Mandibular advancement device (MAD) is a good alternative for patients with obstructive sleep apnea (OSA). However, the treatment response varies amongst individuals.
This study aimed to explore the role of craniofacial features in the response to MADs to improve prognostication and patient selection.
The retrospective trial contained 42 males aged 41.5 ± 9.0 years, and with an apnea-hypopnea index (AHI) of 21.5 ± 13.8 events/h. According to the mandibular plane angle, participants were divided into three groups: low angle (n = 13), average angle (n = 14) and high angle (n = 15). Under the monitoring of home sleep testing, adjustable MADs were used to titrate the mandible forward from 0 mm with an increment of 0.5 mm every day. The polysomnography outcomes, mandibular protrusion amounts, changes in upper airway MRI measurements and nasal resistance were compared amongst the three groups.
The normalisation rate (AHI <5 /h) was 92.3%, 57.1% and 46.7%, respectively, in the low-, average- and high-angle groups (p = .027). The effective protrusion where AHI was reduced by half was 20 (11.3 ~ 37.5) %, 31.3 (23.6 ~ 50) % and 50 (36.9 ~ 64.9) % of the maximal mandibular protrusion, in the low-, average- and high-angle groups (p = .004). Multivariate logistic regression revealed that increased gonion angle (OR = 0.878) and baseline AHI(OR = 0.868) can reduce the probability of normalisation.
The high mandibular plane angle might be an unfavourable factor to MAD treatment and more protrusion was needed to achieve a 50% reduction in AHI. Vertical craniofacial pattern (gonion angle) and baseline AHI constituted the model for predicting the effect of MADs.
下颌前伸装置（MAD）是治疗阻塞性睡眠呼吸暂停（OSA）的一种较好的选择。然而，个体之间的治疗反应存在差异。
本研究旨在探讨颅面特征在 MAD 治疗反应中的作用，以改善预测和患者选择。
这项回顾性试验纳入了 42 名年龄为 41.5±9.0 岁的男性，呼吸暂停低通气指数（AHI）为 21.5±13.8 次/小时。根据下颌平面角，参与者被分为三组：低角组（n=13）、平均角组（n=14）和高角组（n=15）。在家庭睡眠监测的监测下，使用可调节的 MAD 从 0 毫米开始逐渐将下颌前伸，每天增加 0.5 毫米。比较三组之间多导睡眠图结果、下颌前伸量、上气道 MRI 测量值的变化和鼻阻力。
低角组、平均角组和高角组的正常化率（AHI<5 /h）分别为 92.3%、57.1%和 46.7%（p=0.027）。AHI 降低一半时的有效前伸量分别为最大下颌前伸量的 20（11.337.5）%、31.3（23.650）%和 50（36.9~64.9）%，在低角组、平均角组和高角组之间差异有统计学意义（p=0.004）。多变量 logistic 回归显示，下颌角增大（OR=0.878）和基线 AHI（OR=0.868）增加会降低正常化的可能性。
高下颌平面角可能是 MAD 治疗的不利因素，需要更大的前伸量才能使 AHI 降低 50%。垂直颅面形态（下颌角）和基线 AHI 构成了预测 MAD 效果的模型。
