OSA Mandibular Advancement Devices Optimized by Jaw Movement Monitoring

Mandibular advancement devices may be optimized for the treatment of obstructive sleep apnea (OSA) per respiratory effort through technology designed to monitor mandibular jaw movement with said devices.¹

A new study presented in the late-breaking abstracts of SLEEP 2024 in Houston, TX, this weekend showed a validated mandibular jaw movement monitoring technology adequately determined a dose-response association between mandibular advancement device (MAD) protrusion levels and sleep duration with elevated respiratory effort during titration. The findings could help to determine optimal treatment approach and advancement levels during MAD titration.

Investigators led by Dr. Jean-Benoit Martinot, head of the sleep laboratory at CHU UCL Namur in Belgium, noted that the effect of MAB devices on respiratory effect remains poorly established—despite the former being a proven method of OSA treatment and the latter being a key outcome in sleep apnea improvement.

“Increased respiratory effort is an important feature of OSA, recently shown to be associated with hypertension and type-2 diabetes,” the team wrote. “While prior studies have established the efficacy of MADs therapy in decreasing the apnea-hypopnea index (AHI), the effect of MAD treatment on respiratory effort burden remains unexplored.”

Indeed, prior research from Martinot et al. determined that the proportion of time spent in a state of increased respiratory effort per mandibular jaw movement measurement is a critical predictor of type 2 diabetes prevalence in patients with OSA.²

In this current study, Martino and colleagues included 93 patients with OSA who were eligible for MAD treatment.¹ The custom-made MAD device—NOA, from OrthoApnea in Spain—is comprised of 2 individual splints that hold the mandible in a controlled forward position during sleep.³ The device provides iterative adjustments based on the symptoms of individual patients, investigators noted.

The team conducted home sleep tests using mandibular jaw movement automated analysis via Sunrise technology from their Namur institution, for 4 time points: pre-treatment, minimal, intermedia and optimal protrusion levels.¹

At initial OSA diagnoses per polysomnography, mean AHI was 28.79±14.40 /h and baseline respiratory effort was 24.17±14.95%TST. Investigators observed a significant dose-response link between respiratory effort and MAD device protrusion level via regression analysis;respiratory effort reductions of 2.63%TST (95% CI, 2.52 – 2.86) was observed per mL of MAD device advancement.

Martinot and colleagues additionally observed that the respiratory effort effect was mainly due to reductions in patient obstructive AHI scores; scores would decrease by 1.43 %TST (95% CI, 1.38 – 1.47) for each one-event-per-hour reduction in AHI. During device titration, respiratory effort and AHI responded in different patterns; the former decreased by averages of 75.5%, 80.4% and 83.6% per each of the 3 protrusion levels, whereas AHI decreased by 47.7%, 58.6% and 59.7%, respectively

Both respiratory effort and AHI were independent contributors to patient snoring improvement, the team also found. Snoring symptom scores decreased 10.6% correlative to 8.27±15.69%TST reductions in respiratory effort, even in instances when AHI did not decrease by >50%.In cases when AHI did achieve ≥50% reduction, 12.5% of all cases will exhibited respiratory efforts values about the upper limit of normality (15%TST).

“Monitoring (respiratory effort) along with other metrics via at-home MJM analysis allows for identifying the optimal advancement level during MAD titration,” the team concluded. “This approach would enhance the treatment efficacy by enabling personalized adjustments based on multiple physiological outcomes.”

References

1. ^{Martinot JB, Pepin JL, Le-Dong NN, Clause D, et al. Oral Appliance Therapy for Obstructive Sleep Apnea: Dose-Response Relationship Between Mandibular Protrusion and Improvement in Respiratory Effort Burden. Paper presented at: Associated Professional Sleep Societies (SLEEP) 2024 Annual Meeting. Houston, TX. June 1 – 5, 2024.}
2. ^{Martinot JB, Le-Dong NN, Borel AL, Tamisier R, Malhotra A, Pépin JL. Respiratory effort during sleep and the rate of prevalent type 2 diabetes in obstructive sleep apnoea. Diabetes Obes Metab. 2023;25(10):2815-2823. doi:10.1111/dom.15169}
3. ^{OrthoApnea. OrthoApnea NOA: Customized according to the mandibular biomechanics of each patient. Web page. Accessed June 1, 2024. https://www.orthoapnea.com/en/orthoapnea-noa/}