Sleep Disorders: Sleep Disorders 1 |

Impact of Functional Nasal Obstruction on the Efficacy of Mandibular Advancement Therapy FREE TO VIEW

Sangita Trivedi, MBBS; Julie Johnson, APRN-BC; Julie Williams, PA-C; Alan Carr, DMD; Kevin Reid, DMD; Kannan Ramar, MBBS; John Park, MD
Author and Funding Information

Mayo Clinic, Rochester, MN

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1268A. doi:10.1016/j.chest.2016.08.1382
Text Size: A A A
Published online

SESSION TITLE: Sleep Disorders 1

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Functional nasal obstruction can increase frequency and severity of obstructive sleep apnea (OSA). Moreover, high nasal resistance is associated with mouth breathing, which could potentially limit the beneficial effect of mandibular repositioning appliances (MRA). Several studies have evaluated the effects of medical and surgical nasal interventions upon severity of OSA. However, there is a gap in understanding the impact of MRA in management of patients with OSA with nasal obstruction. We compared the efficacy of MRA in OSA patients with and without functional nasal obstruction.

METHODS: A retrospective, case-control analysis was performed on patients >18 years old with OSA referred for treatment with MRA between 2008 and 2012. Functional nasal obstruction included allergic and vasomotor rhinitis, turbinate hypertrophy, nasal polyp, septal deformity, and chronic sinusitis. OSA patients with these identified disorders were defined as cases, and those without functional nasal obstruction were defined as controls. Patients were excluded if they had MRA initiated or polysomnography (PSG) performed at a different institution, or if they did not have follow up oximetry or PSG after final adjustment of MRA. Clinical parameters of the patients were collected before and after commencing the treatment with MRA. The t-test was used to compare the means, and non-parametric Wilcoxon test was used to compare the medians.

RESULTS: Total number of patients with OSA was 123. Forty-one (33.3%) patients had documentation of functional nasal obstruction (cases). The mean age of the patients was 55.5±11.5 years, and 50% were males. There was no statistically significant difference for age and sex between the two groups. Body mass index (BMI) was significantly lower in cases (28±4.6 vs 30.4±5.3 kg/m2), and Epworth Sleepiness score (ESS) significantly higher (10±5 vs 8±4, p-value <0.05). There were no differences in the baseline results of overnight oximetry, PSG, continuous positive airway pressure (CPAP) intolerance, and pressure requirement between the 2 groups. Repeat PSG was performed in 7 cases and 9 controls while utilizing MRA. The overnight oximetry did not correlate with severity of residual disease on PSG. The cases had higher overall and supine apnea-hypopnea index, and respiratory disturbance index as compared to controls with median and interquartile range of 14(0-31) vs 3(0.75-8.5), 42(1-77) vs 7(0.5-28), and 18(7-30) vs 7(3.5-27) respectively. Statistically significant difference could not be derived due to small numbers of the patients in each group.

CONCLUSIONS: Our study suggests that concomitant presence of functional nasal obstruction in patients with OSA may not result in higher rate of intolerance to CPAP therapy or pressure requirement. Despite having a significantly lower BMI, cases had higher residual disease compared to controls on MRA. The results of overnight oximetry did not correlate with PSG findings.

CLINICAL IMPLICATIONS: Presence of functional nasal obstruction in patients with OSA may limit the usefulness of MRA. Overnight oximetry might underestimate the severity of residual disease in patients utilizing MRA. We would suggest PSG to assess the therapeutic response. Larger prospective studies are needed to confirm these findings.

DISCLOSURE: The following authors have nothing to disclose: Sangita Trivedi, Julie Johnson, Julie Williams, Alan Carr, Kevin Reid, Kannan Ramar, John Park

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
Mandibular Advancement Titration for Obstructive Sleep Apnea*: Optimization of the Procedure by Combining Clinical and Oximetric Parameters
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543