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Use of Flow–Volume Curves to Predict Oral Appliance Treatment Outcome in Obstructive Sleep Apnea

¹ Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, University of Sydney, Sydney, Australia; ² Department of Respiratory and Sleep Medicine, St. George Hospital, University of New South Wales, Sydney, Australia; ³ Discipline of Orthodontics, Sydney Dental Hospital, University of Sydney, Sydney, Australia; ⁴ Department of Statistics, Macquarie University, Sydney, Australia; and ⁵ Woolcock Institute of Medical Research, Sydney, Australia

Correspondence and requests for reprints should be addressed to Peter Cistulli, M.D., Ph.D., Centre for Sleep Health and Research, Royal North Shore Hospital, St. Leonards, NSW 2065, Australia. E-mail: cistullip{at}med.usyd.edu.au

Background: It has been recognized that mandibular advancement splint (MAS) treatment is effective in some, but not all, patients with obstructive sleep apnea (OSA). Hence there is a need for a simple and reliable clinical tool to assist in the differentiation of treatment responses. We hypothesized that abnormalities of flow–volume curves, together with other clinical variables, may have clinical utility in the prediction of MAS treatment outcome.

Methods: Fifty-four patients with known OSA underwent MAS treatment. Expiratory and inspiratory flow–volume curves were measured in the erect and supine positions to derive midinspiratory flow (MIF₅₀) and the ratio of expiratory to inspiratory flow at 50% of vital capacity (MEF₅₀:MIF₅₀). Multivariable logistic regression was performed to identify additional significant clinical variables in the prediction of treatment outcome.

Results: The mean (± SD) apnea–hypopnea index (AHI) in 35 responders was significantly reduced from 28.9 ± 13.7 to 6.7 ± 5.8/hour (p < 0.001). In 19 nonresponders there was no significant change in AHI. MIF₅₀ was lower (6.04 ± 1.80 vs. 6.88 ± 1.08 L/second; p = 0.035) and the MEF₅₀:MIF₅₀ ratio was higher (0.82 ± 0.23 vs. 0.61 ± 0.15; p = 0.001) in responders than nonresponders. Logistic regression analysis revealed that the MEF₅₀:MIF₅₀ ratio was the most important predictive factor for MAS treatment outcome, but that body mass index, age, and baseline AHI were also contributory.

Conclusions: These data suggest that flow–volume curves, in combination with other factors such as body mass index, age, and baseline AHI, may have a useful clinical role in the prediction of treatment outcome with MAS.

Key Words: obstructive sleep apnea, spirometry • mandibular advancement splint

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Oral appliance therapy is being used increasingly in obstructive sleep apnea; however, reliable predictors of treatment outcome remain to be determined. What This Study Adds to the Field Flow–volume curves may be useful in the prediction of treatment outcome associated with mandibular advancement splinting for obstructive sleep apnea.

 

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