Abstract
Objective: Previous studies assessing the correlation between airway anatomic factors and success with oral appliance (OA) therapy in the treatment of obstructive sleep apnea (OSA) have failed to reach consensus. We aim to assess the role of regional upper airway obstruction measured by acoustic pharyngometry as a determinant of OA success.
Method: In this outpatient case-series, data from OSA patients (100% CPAP-failures) fitted with a custom OA between 07/2011-01/2012 were reviewed. Regional maximal upper airway collapse was determined on acoustic pharyngometry and classified as retropalatal (RP), retroglossal (RG), or retroepiglottic (RE). Apnea-hypopnea index (AHI) improvement on titration-polysomnography was assessed against regional collapse.
Results: Seventy-five patients (74.7% male, age 49.0 ± 13.6, BMI 29.4 ± 5.2, mean AHI 30.6 ± 20.0) were assessed and their data grouped on the basis of region of maximal collapse on pharyngometry at respiratory residual volume (RP = 29, RG = 28, RE = 18). Overall AHI reduction at OA-titration was –20.2 (95% CI –23.6, –16.8; P < .001) with no significant difference in AHI reduction between groups. There was no significant difference in the rate of response to treatment when defined as >50% AHI reduction plus AHI <20 (RP = 69%, RG = 75%, RE = 83%; P = .545), or rate of cure defined as AHI <5 (RP = 52%, RG = 43%, RE = 72%; P = .146). Correlation of minimum cross-sectional-area and response trended toward significance (r = .202; –.026, .410; P < .1).
Conclusion: Success with oral appliance therapy is not predicted by identification of the region of maximal upper airway collapse as measured by acoustic pharyngometry. OA therapy achieves reasonable objective response and cure rates in patients with primary retropalatal, retroglossal, or retroepiglottic obstruction at the time of initial titration-polysomnography.
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