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Introduction Mandibular advancement device (MAD) is designed to pull the mandible and the tongue forward anteriorly to increase the cross-sectional airway dimension and thus possibly reduce airway obstructions during sleep. The effectiveness of a MAD may be affected by the pre-treatment OSA severity, BMI, and degree of changes in pharyngeal dimensions resulting from the device in situ. In this study, 3D submental ultrasound imaging is applied to evaluate the difference in the tongue and airway configurations between the responders and non-responders of the MAD treatment. Methods In this retrospective study, 31 subjects (25 males, median age/BMI/baseline AHI of 56/24.5/25.3) diagnosed with sleep apnea and underwent tongue-backing-MAD (t-MAD) treatment were consented from the Department of dentistry of National Taiwan University Hospital between April and December 2022 (IRB 202108078RIPD). Changes in the severity of OSA were assessed with polysomnographic studies. Success of t-MAD treatment was defined by an AHI of less than 10 events/hour and at least 50% decrease in AHI from baseline. There were no significant differences in age, BMI, gender and baseline AHI between responders (17) and non-responders (14). While awake and lying in supine position, the tongue and airway configurations at retropalatal and retroglossal regions without and with t-MAD in situ were assessed with standardized 3D submental ultrasound imaging (AmCAD BioMed Corp., Taiwan). Statistical comparisons were performed using t-tests, chi-square tests and nonparametric Mann-Whitney tests. Results The anteroposterior location of the tongue-airway interface at retroglossal region, relative to the superior-inferior location of the soft-palate-airway interface, was found significantly reduced in responders when t-MAD is in situ (p = 0.0078). 13 responders (76.5%) and 9 non-responders (64.3%) were observed with airway width increase in the retroglossal region with t-MAD in situ. However, the difference in airway width changes between responders and non-responders was not statistically significant possibly due to the limited sample size. Conclusion With the real-time visualization and quantitative characterization of the tongue and airway configurations, the 3D submental ultrasound with standardized imaging protocol is able to differentiate the responders from non-responders of the t-MAD treatment and could be a potential tool for treatment response evaluation. Support (if any)

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)

Introduction Mandibular advancement device (MAD) responder phenotype are not well understood in patients with obstructive sleep apnea (OSA). Recent studies have reported the association between MAD treatment response and polysomnographic phenotypes using positional and sleep stage dependency, but with inconsistent findings. Thus, the study aims to investigate the relationship between the two phenotypes and MAD response. Methods This retrospective study recruited patients with OSA (apnea-hypopnea index [AHI] >10/h), who were 20 to 80 years old, treatment naïve, and received MAD treatment for more than three months from 2009 to 2017. AHIsupine/AHInon-supine ≥2 and 50% reduction; criterion 2: residual AHI 50% reduction; criterion 3: reduction >50%). The association between the two phenotypes and the three treatment criteria was identified using multivariable logistic regression. Results A total of 218 patients with a median age of 52.5 years, body mass index (BMI) of 25.4 kg/m2, and AHI of 28.2/h were recruited. Supine-p OSA had lower waist circumferences than non-positional OSA. The REM-p group had lower AHI and more female than the NREM-p and SI group. Supine-p OSA had better response than non-positional OSA (criterion 1: 43.2% vs 34.1%; criterion 2: 63.6% vs 34.1%; criterion 3: 77.3% vs 51.2%). NREM-p OSA had lower response across all three criteria (REM-p vs NREM-p vs SI: criterion 1: 57.6% vs 0% vs 42.0%; criterion 2: 75.8% vs 16.7% vs 56.5%; criterion 3: 75.8% vs 33.3% vs 77.1%). The odds of MAD response for supine-p OSA was 3.78 (95% CI = 1.44–9.93) to 3.98 (95% CI = 1.58–9.99)-fold than non-positional OSA while the odds for NREM-p OSA were 0.06 (95% CI = 0.01–0.58) to 0.15 (95% CI = 0.03–0.67)-fold than SI OSA after adjusting demographics and clinical features affecting MAD response. Conclusion Positional and sleep stage dependency were associated with MAD response and could be indicators for personal-tailored OSA treatment. Support (if any) The Ministry of Science and Technology, Taiwan (MOST 109-2314-B-002-252)