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Original Research: Sleep Disorders |

Oropharyngeal Crowding and Obesity as Predictors of Oral Appliance Treatment Response to Moderate Obstructive Sleep ApneaOral Appliance Treatment Response to Sleep Apnea

Satoru Tsuiki, DDS, PhD; Eiki Ito, PhD; Shiroh Isono, PhD; C. Frank Ryan, PhD; Yoko Komada, PhD; Masato Matsuura, PhD; Yuichi Inoue, PhD
Author and Funding Information

From the Japan Somnology Center (Drs Tsuiki, Ito, Komada, and Inoue), Neuropsychiatric Research Institute, Tokyo, Japan; the Yoyogi Sleep Disorder Center (Drs Tsuiki, Ito, and Inoue), Tokyo, Japan; the Department of Somnology (Drs Tsuiki, Ito, Komada, and Inoue), Tokyo Medical University, Tokyo, Japan; the Department of Anesthesiology (Dr Isono), Graduate School of Medicine, Chiba University, Chiba, Japan; the Division of Respiratory Medicine (Dr Ryan), Faculty of Medicine, The University of British, Columbia, Vancouver, BC, Canada; and the Department of Life Sciences and Bioinformatics (Dr Matsuura), Graduate School of Health, Sciences, Tokyo Medical and Dental University, Tokyo, Japan.

Correspondence to: Satoru Tsuiki, DDS, PhD, Division of Dental Sleep Medicine, Japan Somnology Center, Neuropsychiatric Research Institute, 1-24-10, Yoyogi, Shibuya-ku, Tokyo, Japan 151-0053; e-mail: tsuiki@somnology.com


Funding/Support: This study was supported in part by the Takata Foundation, Tokyo, Japan.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(2):558-563. doi:10.1378/chest.12-2609
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Background:  Oral appliances are increasingly prescribed for patients with moderate obstructive sleep apnea (OSA) instead of nasal CPAP. However, the efficacy of oral appliances varies greatly. We hypothesized that oral appliances were not efficacious in patients with moderate OSA who were obese with oropharyngeal crowding.

Methods:  Japanese patients with moderate OSA were prospectively and consecutively recruited. The Mallampati score (MS) was used as an estimate of oropharyngeal crowding. Follow-up polysomnography was performed with the adjusted oral appliance in place. Responders were defined as subjects who showed a follow-up apnea-hypopnea index (AHI) of < 5 with > 50% reduction in baseline AHI.

Results:  The mean baseline AHI was reduced with an oral appliance from 21 ± 4 to 9.8 ± 8 in 95 subjects. Thirty-five patients were regarded as responders. Logistic regression analyses revealed that both MS and BMI could individually predict the treatment outcome. When the cutoff value of BMI was determined to be 24 kg/m2 based on a receiver operating characteristic curve, 53 obese patients (ie, BMI > 24 kg/m2) with an MS of class 4 were indicative of treatment failure with a high negative predictive value (92) and a low negative likelihood ratio (0.28).

Conclusions:  We conclude that patients with moderate OSA who are obese with oropharyngeal crowding are unlikely to respond to oral appliance treatment. This simple prediction can be applied without the need for any cumbersome tools immediately after the diagnosis of OSA.

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