Influence of Vertical Mouth Opening on Oral Appliance Treatment Outcome in Positional Obstructive Sleep Apnea

Francesca Milano, Sabrina Mutinelli, Kate Sutherland, Giulia Milioli, Giuseppe Scaramuzzino, Antonella Bacchieri Cortesi, Giuseppe Siciliani, Luca Lombardo, Peter Cistulli
2018 Journal of Dental Sleep Medicine  
JDSM Study Objectives: The supine sleeping posture can heighten the risk of sleep-disordered breathing events. Patients with positional obstructive sleep apnea (OSA) are characterized by a supine apnea-hypopnea index (AHI) that is at least two times higher than in nonsupine positions. This study aimed to assess the influence of mouth opening on the outcome of mandibular advancement splint (MAS) treatment in patients with positional OSA. Methods: The secondary data of 230 individuals treated for
more » ... positional OSA with MAS (standard MAS group) or with MAS plus vertical elastics to prevent mouth opening (MAS+elastics group) were compared in terms of treatment response. Treatment success was defined as at least a 75% reduction in AHI from baseline. Secondary outcomes included the change in AHI, supine AHI, and nonsupine AHI. Results: Both groups showed a significant improvement in AHI with MAS in situ. The improvement in AHI, supine AHI, and nonsupine AHI with MAS was significantly greater in the MAS+elastics group than in the standard MAS group. Treatment success rate was significantly higher in the MAS+elastics group (67.4% versus 36.2%; P < .001). After adjusting for potential confounders, the odds of successful treatment increased 3.8-fold through the use of vertical elastics. Conclusions: This pilot study suggests that vertical elastics that minimize mouth opening enhance the outcome of MAS treatment in patients with positional OSA. These findings support the need for further research to verify the role of vertical elastics with bimaxillary oral appliances to improve the response to treatment in patients with positional OSA.
doi:10.15331/jdsm.6918 fatcat:qggva2fthvfzxdcwdjch64h35m