Role of craniofacial phenotypes in the response to oral appliance therapy for obstructive sleep apnea

Abstract

Background: Mandibular advancement device (MAD) is a good alternative for patients with obstructive sleep apnea (OSA). However, the treatment response varies amongst individuals. Objective: This study aimed to explore the role of craniofacial features in the response to MADs to improve prognostication and patient selection. Methods: 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. Results: 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. Conclusion: 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.