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Original Research: SLEEP DISORDERS |

Influence of Oral and Craniofacial Dimensions on Mandibular Advancement Splint Treatment Outcome in Patients With Obstructive Sleep Apnea

Whitney Mostafiz, ScB; Oyku Dalci, PhD; Kate Sutherland, PhD; Atul Malhotra, MD, FCCP; Vasanth Srinivasan, MDSc; M. Ali Darendeliler, PhD; Peter A. Cistulli, MD, PhD, FCCP
Author and Funding Information

From the Department of Orthodontics (Ms Mostafiz and Drs Dalci, Srinivasan, and Darendeliler), Faculty of Dentistry, University of Sydney, Sydney Dental Hospital; Woolcock Institute of Medical Research (Drs Sutherland and Cistulli), University of Sydney; and Centre for Sleep Health and Research (Drs Sutherland and Cistulli), Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, NSW, Australia; and Harvard School of Dental Medicine (Ms Mostafiz) and Brigham and Women’s Hospital and Harvard Medical School (Dr Malhotra), Boston, MA.

Correspondence to: Peter A. Cistulli, MD, PhD, FCCP, Centre for Sleep Health and Research, Department of Respiratory Medicine, Level 8, Main Block, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW 2065, Australia; e-mail: peter.cistulli@sydney.edu.au


Funding/Support: This study was supported by the National Health and Medical Research Council of Australia [Project Grant 457557]. SomnoMed Ltd provided the oral appliances for this study. Ms Mostafiz was supported by a Harvard Medical School Office of Enrichment Program grant and an American Association of Dental Research Student Research Fellowship.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(6):1331-1339. doi:10.1378/chest.10-2224
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Background:  Mandibular advancement splints (MASs) can effectively treat obstructive sleep apnea (OSA); however, no validated and reliable prediction method for treatment outcome currently exists. The efficacy of MAS may relate to anatomic factors, including craniofacial size and upper-airway soft-tissue volume and anatomic balance between them. We aimed to assess whether craniofacial and oral measurements are associated with MAS treatment outcome.

Methods:  Dental impressions and lateral cephalometric radiographs were obtained from patients with OSA prior to commencing MAS treatment. Intertooth distances and palatal depths were measured on dental casts, and standard cephalometric analysis was performed with the addition of cross-sectional area (CSA) of the tongue and bony oral enclosure. Treatment outcome was determined by polysomnography.

Results:  Of 53 patients, 25 were complete responders (posttreatment apnea-hypopnea index [AHI] < 5/h), 17 were partial responders (≥ 50% AHI reduction), and 11 were nonresponders (< 50% AHI reduction). Cephalometric analyses did not reveal any significant differences between responders and nonresponders. Oral cavity measurements or CSA did not differ with treatment outcome; however, there was a trend toward a larger tongue CSA in complete vs partial and nonresponders (39.5 ± 1.3 cm2 vs 35.5 ± 0.5 cm2, P = .09). Tongue/oral enclosure CSA ratio, indicating a larger tongue for a given oral cavity size, was greater in complete responders (P = .012, n = 30).

Conclusions:  Oral dimensions do not appear to differ between patients who respond and those who do not respond to MAS treatment. However, the larger tongue for a given oral cavity size in responders suggests that MAS may help to correct anatomic imbalance. Further research to assess whether the ratio between tongue and bony oral enclosure size may be useful in selecting patients for MAS treatment is warranted.

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