Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea

Yoshitomo Nishio,Masayo Baku,Akifumi Furuhashi,Yoshiaki Kazaoka,Tetsuro Hoshino,Kenta Murotani,Ryujiro Sasanabe,Toshiaki Shiomi

doi:10.1007/s11325-019-01966-5

Yoshitomo Nishio, Masayo Baku + Show 6 more

Open Access

https://doi.org/10.1007/s11325-019-01966-5

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Abstract

PurposeOral appliances (OA) are used to treat patients with obstructive sleep apnea (OSA). The purpose of this study is to evaluate the efficacy of OA treatment in patients with rapid eye movement (REM)–related OSA.MethodsForty-six patients with REM-related OSA and 107 with non-stage-specific OSA were prescribed OA treatment after diagnosis by polysomnography (PSG) and a follow-up sleep test by PSG was conducted. Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline.ResultsSuccess rates according to criteria #1, #2, and #3 were 45.7%, 50.0%, and 50.0% in REM-related OSA and 36.4%, 52.3%, and 63.6% in non-stage-specific OSA, respectively. No significant differences in success rate were found between the two groups. In multivariate logistic regression analysis with each criterion as the response variable, only BMI was extracted as a significant predictor. The BMI cutoff values defined based on the maximum Youden index according to the three criteria were 26.2 kg/m2, 25.6 kg/m2, and 26.2 kg/m2, respectively.ConclusionsNo significant differences in success rate of OA treatment were found between REM-related OSA and non-stage-specific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA.

Highlights

Obstructive sleep apnea (OSA), characterized by repetitive respiratory events including apnea and hypopnea, is due to total or partial collapse of the upper airways during sleep, and affects 9 to 38% of the general adult population [1]
Efficacy and treatment outcome predictors were evaluated according to the following criteria for treatment success: #1, reduction of the apnea-hypopnea index (AHI) to less than 5 and > 50% compared with baseline; #2, AHI reduction to less than 10 and > 50% compared with baseline; and #3, > 50% AHI reduction compared with baseline
No significant differences in success rate of Oral appliances (OA) treatment were found between rapid eye movement (REM)-related obstructive sleep apnea (OSA) and non-stagespecific OSA

Summary

Introduction

Obstructive sleep apnea (OSA), characterized by repetitive respiratory events including apnea and hypopnea, is due to total or partial collapse of the upper airways during sleep, and affects 9 to 38% of the general adult population [1]. Rapid eye movement (REM)–related OSA, a highly prevalent subtype of OSA affecting 13 to 36%of patients, is characterized by apnea and hypopnea events predominantly or exclusively occurring during REM sleep [4, 5]. It is difficult to determine the appropriate course of management due to the lack of clinical data regarding the aforementioned treatment options for REM-related OSA. Two recent clinical studies have indicated that it is difficult for patients with REM-related OSA to achieve good adherence, and these patients are occasionally intolerant to continuous positive airway pressure (CPAP) therapy, which is the standard OSA treatment option [7, 8].

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