Camañes-Gonzalvo Sara, Marco-Pitarch Rocío, García-Selva Marina, Bellot-Arcís Carlos, Paredes-Gallardo Vanessa, Falardo Susana, Feliciano Amélia, Montiel-Company José María
Sleep Unit, Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Gascó Oliag nº 1, Valencia, 46010, Spain.
Faculty of Dentistry, Universidad Cardenal Herrera CEU, Valencia, Spain.
Eur Arch Otorhinolaryngol. 2025 Jan;282(1):435-449. doi: 10.1007/s00405-024-08952-y. Epub 2024 Sep 21.
This non-randomized clinical study aims to identify polysomnographic phenotypic characteristics that differentiate responders from non-responders to mandibular advancement devices (MAD) treatment for obstructive sleep apnea (OSA) and to establish a predictive model of treatment response for OSA using oral devices based on the set of anthropometric, demographic, and polysomnographic phenotypic characteristics.
This study was registered under the identifier number: NCT02724865. It prospectively analyzed patients receiving MAD treatment for six years. The MADs used were two-piece adjustable appliances following a standardized protocol. Treatment response was defined according to the latest International Consensus Statement on OSA severity. The study analyzed polysomnographic phenotypes, categorizing them into positional phenotype, sleep-stage phenotype (REM/NREM-OSA), and airway collapsibility phenotype. A logistic regression model and a classification and regression tree were implemented.
A total of 112 patients completed the study (64 responders and 48 non-responders). Positional-OSA patients had higher response rates than non-positional (64.1% vs. 35.9; p 0.032). REM-OSA and apnea-predominant phenotype showed a lower response (p < 0.001). In these phenotypes, most patients were women, with higher body mass index, higher scores in the Epworth Sleepiness Scale, lower minSaO2 in REM-OSA phenotype, and higher T90% in apnea-predominant phenotype.
This study underscores the importance of hypoxic burden in the severity of OSA. The parameters T90% and POSA formed predictive model. Additionally, MAD appears to be less effective in the REM-OSA phenotype. Moreover, although patients with an apnea-predominant phenotype responded less favorably, there was a conversion from apneas to hypopneas, reducing severity.
这项非随机临床研究旨在确定多导睡眠图表型特征，以区分阻塞性睡眠呼吸暂停（OSA）患者中对下颌前移装置（MAD）治疗有反应者和无反应者，并基于一组人体测量学、人口统计学和多导睡眠图表型特征建立使用口腔装置治疗OSA反应的预测模型。
本研究的注册号为：NCT02724865。对接受MAD治疗六年的患者进行前瞻性分析。使用的MAD是遵循标准化方案的两件式可调节矫治器。根据最新的OSA严重程度国际共识声明定义治疗反应。该研究分析了多导睡眠图表型，将其分为体位表型、睡眠阶段表型（快速眼动/非快速眼动-OSA）和气道塌陷表型。实施了逻辑回归模型和分类回归树。
共有112名患者完成了研究（64名有反应者和48名无反应者）。体位性OSA患者的反应率高于非体位性患者（64.1%对35.9%；p = 0.032）。快速眼动-OSA和以呼吸暂停为主的表型反应较低（p < 0.001）。在这些表型中，大多数患者为女性，体重指数较高，爱泼华嗜睡量表得分较高，快速眼动-OSA表型中的最低血氧饱和度较低，以呼吸暂停为主的表型中的T90%较高。
本研究强调了低氧负荷在OSA严重程度中的重要性。参数T90%和体位性OSA形成了预测模型。此外，MAD在快速眼动-OSA表型中似乎效果较差。而且，尽管以呼吸暂停为主的表型患者反应较差，但存在从呼吸暂停转变为呼吸浅慢的情况，降低了严重程度。
