Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea
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SLEEP BREATHING PHYSIOLOGY AND DISORDERS • ORIGINAL ARTICLE
Treatment outcome of oral appliance in patients with REM-related obstructive sleep apnea Yoshitomo Nishio 1 & Tetsuro Hoshino 2 Yoshiaki Kazaoka 1 & Toshiaki Shiomi 2
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& Kenta Murotani & Akifumi Furuhashi & Masayo Baku & Ryujiro Sasanabe &
Received: 8 September 2019 / Revised: 4 October 2019 / Accepted: 22 October 2019 # The Author(s) 2019
Abstract Purpose Oral 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. Methods Forty-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. Results Success 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. Conclusions No significant differences in success rate of OA treatment were found between REM-related OSA and non-stagespecific OSA. BMI has greater impact on treatment outcome of OA in patients with REM-related OSA. Keywords Obstructive sleep apnea . REM-related obstructive sleep apnea . Oral appliance . Body mass index
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]. Untreated OSA is associated with daytime symptoms, various * Tetsuro Hoshino [email protected] 1
Department of Oral and Maxillofacial Surgery, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 4801195, Japan
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Department of Sleep Medicine and Sleep Disorders Center, Aichi Medical University Hospital, 1-1 Yazakokarimata, Nagakute, Aichi 4801195, Japan
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Biostatistics Center, Graduate School of Medicine, Kurume University, 67 Asahimachi, Kurume, Fukuoka 8300011, Japan
comorbidities, and mortality [2]. Although continuous positive airway pressure (CPAP) is clearly a highly effective treatment option, various alternative treatment options are available, such as oral appliances, upper airway surgery, and hypo
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