Published ahead of print on April 22, 2004, doi:10.1164/rccm.200310-1446OC Am. J. Respir. Crit. Care Med., Volume 170, Number 4, August 2004, 366-370 A more recent version of this article appeared on August 15, 2004
Submitted on November 5, 2003 Remotely Controlled Mandibular Positioner Predicts Efficacy of Oral Appliances in Sleep ApneaWillis H Tsai1,1 Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Alberta, Canada, 2 Department of Pulmonary Physiology and Sleep Laboratory, Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico, 3 Department of Anesthesiology and Critical Care Medicine, Gifu University School of Medicine, Gifu City, Gifu, Japan, 4 ., Calgary, Alberta, Canada, 5 Faculty of Dentistry, University of British Columbia, Vancouver, British Columbia, Canada * To whom correspondence should be addressed. E-mail: jeremmer{at}ucalgary.ca.
Anterior mandibular positioners (AMP) have become increasingly popular as alternatives to continuous positive airway pressure (CPAP) for the treatment of OSA. However, widespread acceptance of AMP is limited by an efficacy rate of 50-80% and an inability to predict which patients will respond to therapy. We evaluated 23 patients with OSA (RDI Key words: Obstructive sleep apnea, treatment, oral appliance, diagnosis
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15 hr-1) with a remotely controlled mandibular positioner (RCMP); a temporary oral appliance that can advance or retract the mandible in a process analogous to changing the mask pressure during a CPAP titration study. We hypothesized that the elimination of respiratory events and significant nocturnal oxygen desaturation during an RCMP overnight study would predict AMP efficacy, as defined by an absolute reduction in RDI to <15 hr-1, a relative reduction in RDI of >30% from baseline, and a subjective improvement in symptoms. AMP compliance was 82% and therapeutic efficacy was 53%. Among compliant patients, the positive and negative predictive value of an RCMP study in predicting AMP treatment success was 90% and 89% respectively. An overnight RCMP study is highly predictive of AMP response.
