0473 Multi-outcome of mandibular advancement device in Obstructive Sleep Apnea with different polysomnographic phenotype

Abstract

Abstract Introduction The association of mandibular advancement device (MAD) treatment response and polysomnographic phenotype in patients with obstructive sleep apnea (OSA) has not been fully elucidated. We hypothesized MAD response would be associated with two polysomnographic phenotypes, including sleep stage and positional dependency in treatment-naïve patients with moderate-severe obstructive OSA. Methods This retrospective study recruited OSA patients with AHI ≥15/h, aged 20 to 80, treatment naïve, and received MAD treatment for more than three months. Positional phenotype included supine predominant (supine-p) and non-positional OSA. Sleep stage phenotype included REM-predominant (REM-p), NREM-predominant (NREM-p), and stage-independent (SI) OSA. MAD response was defined as criterion 1: residual AHI< 5/h with >50% reduction, and criterion 2: residual AHI< 10/h with >50% reduction. Outcomes included the change in PSG parameters, habitual latency of sleep onset and sleep hour, Epworth sleepiness scale, excessive daytime sleepiness, depression, physical, vitality and mental health domain of SF-36, and in-lab bedtime and wake blood pressure (BP). Results 379 patients with median age of 52.2 years, BMI of 26 kg/m2, 78.1% of men, and AHI of 28.2/h were recruited. Supine-p and REM-p OSA had lower baseline AHI and desaturation. The overall response rate were 34.7% (criterion 1 ) and 56% (Criterion 2). Supine-p OSA had higher response rate than non-positional OSA (criterion 1: 42.2% vs. 20.3%; criterion 2: 64.3% vs. 32.5%), while NREM-p OSA had lower response rate than REM-p and SI (REM-p vs. NREM-p vs. SI: criterion 1: 43.9% vs. 9.7% vs. 34.2%; criterion 2: 54.5% vs. 41.9% vs. 53.3%). Despite the more reduction in AHI, desaturaiotn, and arousal in responders, there was no differences in change of ESS, EDS, sleep pattern, depression, SF 36 domain, and BP between responders and non-responders which remained unchanged after stratified with sleep stage and position phenotypes. Conclusion Non-positional and NREM-predominant OSA had lower responses rate to MAD treatment. There were no differences in non-breathing outcomes between responders and nonresponders regardless of sleep stage and positional phenotype. Support (if any) The work was supported by grants from the National Science and Technology Council, Taiwan (NSTC 111-2314-B-002-293); Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-252); National Taiwan University Hospital (NTUH 107-19, 111-X0033, 111-S0298)