Ulrik Leidland Opsahl, Morten Berge, Sverre Lehmann, Bjørn Bjorvatn, Anders Johansson
{"title":"预测对口腔器械治疗阻塞性睡眠呼吸暂停无反应：一项初步研究。","authors":"Ulrik Leidland Opsahl, Morten Berge, Sverre Lehmann, Bjørn Bjorvatn, Anders Johansson","doi":"10.1007/s11325-025-03315-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Several clinically available variables have been identified as predictors of non-response to oral appliance (OA) treatment, including endotypical traits such as severe upper airway collapsibility, unstable ventilatory control, and low arousal threshold. This study aimed to identify potential predictors of non-response to OA treatment in patients with OSA non-adherent to treatment with positive airway pressure.</p><p><strong>Methods: </strong>Patients in this study were initially treated with OAs with and without elastic bands in a crossover design. Subsequently, each patient selected their preferred treatment modality for continued therapy based on subjective preferences. The chosen OA treatment. The chosen OA treatment modality was titrated optimally based on reduction of REI. Patients not reaching > 50% reduction of REI from baseline were classified as non-responders. Statistical analyses were conducted using Student's t-test and Pearson's chi-squared test to assess differences in baseline variables between responders and non-responders, and logistic regression analyses were performed to investigate variables associated with not responding to OA treatment.</p><p><strong>Results: </strong>Overall, 63.2% (n = 36) of the patients were responders to OA treatment following titration. Smaller distance from habitual bite position to maximal retruded position (Odds ratio: 0.28, p = 0.016), positional OSA (Odds ratio: 0.94, p = 0.024) and a higher number of the endotypical OSA traits severe collapsibility, high loop gain and low arousal threshold (Odds ratio: 7.41, p = 0.038), were found to predict non-response to OA treatment.</p><p><strong>Conclusion: </strong>These novel findings suggest that severe upper airway collapsibility, high loop gain and low arousal threshold, identified through clinically available variables, appear to be important predictors of non-response to OA treatment, along with short distance from habitual bite position to maximal retruded position and positional OSA.</p><p><strong>Trial registration number: </strong>NCT05987618 (clinicaltrials.gov).</p>","PeriodicalId":21862,"journal":{"name":"Sleep and Breathing","volume":"29 2","pages":"159"},"PeriodicalIF":2.0000,"publicationDate":"2025-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000117/pdf/","citationCount":"0","resultStr":"{\"title\":\"Prediction of non-responders to oral appliance treatment of obstructive sleep apnea: a pilot study.\",\"authors\":\"Ulrik Leidland Opsahl, Morten Berge, Sverre Lehmann, Bjørn Bjorvatn, Anders Johansson\",\"doi\":\"10.1007/s11325-025-03315-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Several clinically available variables have been identified as predictors of non-response to oral appliance (OA) treatment, including endotypical traits such as severe upper airway collapsibility, unstable ventilatory control, and low arousal threshold. This study aimed to identify potential predictors of non-response to OA treatment in patients with OSA non-adherent to treatment with positive airway pressure.</p><p><strong>Methods: </strong>Patients in this study were initially treated with OAs with and without elastic bands in a crossover design. Subsequently, each patient selected their preferred treatment modality for continued therapy based on subjective preferences. The chosen OA treatment. The chosen OA treatment modality was titrated optimally based on reduction of REI. Patients not reaching > 50% reduction of REI from baseline were classified as non-responders. Statistical analyses were conducted using Student's t-test and Pearson's chi-squared test to assess differences in baseline variables between responders and non-responders, and logistic regression analyses were performed to investigate variables associated with not responding to OA treatment.</p><p><strong>Results: </strong>Overall, 63.2% (n = 36) of the patients were responders to OA treatment following titration. Smaller distance from habitual bite position to maximal retruded position (Odds ratio: 0.28, p = 0.016), positional OSA (Odds ratio: 0.94, p = 0.024) and a higher number of the endotypical OSA traits severe collapsibility, high loop gain and low arousal threshold (Odds ratio: 7.41, p = 0.038), were found to predict non-response to OA treatment.</p><p><strong>Conclusion: </strong>These novel findings suggest that severe upper airway collapsibility, high loop gain and low arousal threshold, identified through clinically available variables, appear to be important predictors of non-response to OA treatment, along with short distance from habitual bite position to maximal retruded position and positional OSA.</p><p><strong>Trial registration number: </strong>NCT05987618 (clinicaltrials.gov).</p>\",\"PeriodicalId\":21862,\"journal\":{\"name\":\"Sleep and Breathing\",\"volume\":\"29 2\",\"pages\":\"159\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2025-04-15\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12000117/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Sleep and Breathing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s11325-025-03315-1\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Sleep and Breathing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s11325-025-03315-1","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Prediction of non-responders to oral appliance treatment of obstructive sleep apnea: a pilot study.
Purpose: Several clinically available variables have been identified as predictors of non-response to oral appliance (OA) treatment, including endotypical traits such as severe upper airway collapsibility, unstable ventilatory control, and low arousal threshold. This study aimed to identify potential predictors of non-response to OA treatment in patients with OSA non-adherent to treatment with positive airway pressure.
Methods: Patients in this study were initially treated with OAs with and without elastic bands in a crossover design. Subsequently, each patient selected their preferred treatment modality for continued therapy based on subjective preferences. The chosen OA treatment. The chosen OA treatment modality was titrated optimally based on reduction of REI. Patients not reaching > 50% reduction of REI from baseline were classified as non-responders. Statistical analyses were conducted using Student's t-test and Pearson's chi-squared test to assess differences in baseline variables between responders and non-responders, and logistic regression analyses were performed to investigate variables associated with not responding to OA treatment.
Results: Overall, 63.2% (n = 36) of the patients were responders to OA treatment following titration. Smaller distance from habitual bite position to maximal retruded position (Odds ratio: 0.28, p = 0.016), positional OSA (Odds ratio: 0.94, p = 0.024) and a higher number of the endotypical OSA traits severe collapsibility, high loop gain and low arousal threshold (Odds ratio: 7.41, p = 0.038), were found to predict non-response to OA treatment.
Conclusion: These novel findings suggest that severe upper airway collapsibility, high loop gain and low arousal threshold, identified through clinically available variables, appear to be important predictors of non-response to OA treatment, along with short distance from habitual bite position to maximal retruded position and positional OSA.
期刊介绍：
The journal Sleep and Breathing aims to reflect the state of the art in the international science and practice of sleep medicine. The journal is based on the recognition that management of sleep disorders requires a multi-disciplinary approach and diverse perspectives. The initial focus of Sleep and Breathing is on timely and original studies that collect, intervene, or otherwise inform all clinicians and scientists in medicine, dentistry and oral surgery, otolaryngology, and epidemiology on the management of the upper airway during sleep.
Furthermore, Sleep and Breathing endeavors to bring readers cutting edge information about all evolving aspects of common sleep disorders or disruptions, such as insomnia and shift work. The journal includes not only patient studies, but also studies that emphasize the principles of physiology and pathophysiology or illustrate potentially novel approaches to diagnosis and treatment. In addition, the journal features articles that describe patient-oriented and cost-benefit health outcomes research. Thus, with peer review by an international Editorial Board and prompt English-language publication, Sleep and Breathing provides rapid dissemination of clinical and clinically related scientific information. But it also does more: it is dedicated to making the most important developments in sleep disordered breathing easily accessible to clinicians who are treating sleep apnea by presenting well-chosen, well-written, and highly organized information that is useful for patient care.
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