Individualised Therapy for Obstructive Sleep Apnoea: Predictive Models and Anatomical Phenotyping of Mandibular Advancement Devices Responses

IF 2.4 3区医学 Q2 DENTISTRY, ORAL SURGERY & MEDICINE

Orthodontics & Craniofacial Research Pub Date : 2025-01-24 DOI:10.1111/ocr.12900

Sara Camañes-Gonzalvo, José María Montiel-Company, Marina García-Selva, Andrés Plaza-Espín, Tomàs Pérez-Carbonell, Vanessa Paredes-Gallardo, Carlos Bellot-Arcís, Rocío Marco-Pitarch

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引用次数: 0

Abstract

Objectives

This non-randomised clinical study aimed to identify the phenotypic characteristics that distinguish responders from non-responders. Additionally, it sought to establish a predictive model for treatment response to obstructive sleep apnoea (OSA) using mandibular advancement devices (MAD), based on the analysed phenotypic characteristics.

Material and Methods

This study, registered under identifier NCT05596825, prospectively analysed MAD treatment over 6 years using two-piece adjustable appliances according to a standardised protocol. Two response definitions aligned with the latest International Consensus Statement on OSA severity were established. Logistic regression and CHAID models integrated baseline clinical, anthropometric, cephalometric anatomical, soft tissue characteristics and physiological upper airway variables.

Results

A total of 112 patients completed the study: 64 responders and 48 non-responders according to response definition 1, and 81 responders and 31 non-responders according to response definition 2. Responders to MAD treatment had lower body mass index (BMI), neck and waist circumference, Epworth Sleepiness Scale scores, apnoea–hypopnea index (AHI), snoring intensity on the Visual Analog Scale, CPAP pressure, and higher T90% and minSaO₂. Patients exhibiting greater anatomical imbalance, smaller airway volume, smaller minimum cross-sectional area (CSAmin) and longer airway length demonstrated a poorer response to treatment.

Conclusions

Airway length, initial T90% and anterior facial height collectively formed a highly predictive logistic regression model for response definition 1. Jarabak's ratio, gonial angle, CSAmin, airway length, initial BMI and baseline AHI constituted a highly predictive model for the second response definition. Furthermore, the CHAID regression tree established cutoff values for the variables that form the predictive models.

查看原文本刊更多论文

阻塞性睡眠呼吸暂停的个体化治疗：下颌推进装置反应的预测模型和解剖表型。

目的：这项非随机临床研究旨在确定区分应答者和无应答者的表型特征。此外，它试图基于分析的表型特征，建立一个使用下颌推进装置（MAD）治疗阻塞性睡眠呼吸暂停（OSA）的预测模型。材料和方法：本研究注册编号为NCT05596825，根据标准化方案使用两件式可调节器具前瞻性分析了6年以上的MAD治疗。建立了与最新的OSA严重程度国际共识声明一致的两种反应定义。Logistic回归和CHAID模型综合了基线临床、人体测量、头测解剖学、软组织特征和生理上呼吸道变量。结果：共有112例患者完成研究：根据反应定义1,64例有反应，48例无反应；根据反应定义2,81例有反应，31例无反应。MAD治疗的应答者体重指数（BMI）、颈腰围、Epworth嗜睡量表评分、呼吸暂停低通气指数（AHI）、视觉模拟量表上的打鼾强度、CPAP压、T90%和minSaO2较高。解剖失衡较大、气道体积较小、最小横截面积（CSAmin）较小、气道长度较长的患者对治疗的反应较差。结论：气道长度、初始T90%和前脸高度共同构成了反应定义的高预测性logistic回归模型1。Jarabak比值、角状角、CSAmin、气道长度、初始BMI和基线AHI构成了第二反应定义的高度预测模型。此外，CHAID回归树为构成预测模型的变量建立了截止值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Orthodontics & Craniofacial Research 医学-牙科与口腔外科

CiteScore

5.30

自引率

3.20%

发文量

审稿时长

>12 weeks

期刊介绍： Orthodontics & Craniofacial Research - Genes, Growth and Development is published to serve its readers as an international forum for the presentation and critical discussion of issues pertinent to the advancement of the specialty of orthodontics and the evidence-based knowledge of craniofacial growth and development. This forum is based on scientifically supported information, but also includes minority and conflicting opinions. The objective of the journal is to facilitate effective communication between the research community and practicing clinicians. Original papers of high scientific quality that report the findings of clinical trials, clinical epidemiology, and novel therapeutic or diagnostic approaches are appropriate submissions. Similarly, we welcome papers in genetics, developmental biology, syndromology, surgery, speech and hearing, and other biomedical disciplines related to clinical orthodontics and normal and abnormal craniofacial growth and development. In addition to original and basic research, the journal publishes concise reviews, case reports of substantial value, invited essays, letters, and announcements. The journal is published quarterly. The review of submitted papers will be coordinated by the editor and members of the editorial board. It is policy to review manuscripts within 3 to 4 weeks of receipt and to publish within 3 to 6 months of acceptance.