In a recent study by the OrthoApnea research team, it is demonstrated that MAD is an effective and comfortable alternative for patients with sleep-disordered breathing. Specifically, this time the study is oriented to the analysis of phenotypes in the design and effectiveness of mandibular advancement devices.
In the study it is deduced that the phenotypes serve as a scale for detecting cases of success and failure and therefore, it functions as a forecasting tool focused on the final objective; to improve the capacity of the mandibular advancement devices (MAD) and to differentiate correctly the cases.
We share with you the details.
Phenotypes in the design and effectiveness of mandibular advancement devices.
Pedro Mayoral Sanz 1, Manuel Míguez Contreras 2, Javier Vila Martín3, Ramón Domínguez Mompell4, Silvia García Esteve4, Inés Durán Baamonde4, Javier de la Cruz Pérez4, Ramón Fernández Pujol5
1 Orthodontist. Hospital Rúber International, Madrid
2 Orthodontist. Clinical Director Eugnathos, Madrid
3 Otorhinolaryngologist, Hospital Val de Hebrón, Barcelona
4 Orthodontist. University Alfonso X el Sabio Madrid
5 Head of Radiology Area. University Rey Juan Carlos (URJC). Madrid
The upper airway is a complex, multifunctional and dynamic neuromechanical system. The anatomical and physiological characteristics of each individual, ie their phenotype, are determinant in the origin of respiratory problems and condition the treatment to be performed. Airway permeability during breathing requires neuronal and mechanical coordination that varies between subjects, which determines the ability to continually reestablish and coordinate the dilator muscles to counteract the forces acting to obstruct the airways.
The aim of the present study is to study the phenotypes of patients with positive and negative results treated with a mandibular advancement device using CBCT.
Prospective study performed on 20 patients treated with mandibular advancement device MAD of which 15 the AHI was reduced to less than 5 and 5 in which it was not reduced. CBCT is performed for diagnosis and control in all cases.
Four movement patterns were observed in patients treated with MAD, which were similar to those described in other studies: 8 patients in group 1 characterized by bidirectional movement, 5 patients in group 2 characterized by oropharyngeal movement, 2 patients in the group 3 characterized by uniform movement and finally 5 patients in group 4 characterized by absence of change.
MAD has been shown to be a very effective and convenient treatment alternative for patients with sleep-disordered breathing. The study of the phenotypes can help to determine the success and failure cases and therefore, be a tool of prediction of the result in order to improve the level of effectiveness of the MAD through the appropriate selection of the cases.
Bilston LE, Gandevia SC. Biomechanical properties of the upper human airway and its effect on its behavior during breathing and obstructive sleep apnea. J Appl Physiol 2014, 116: 314-24.
Different patterns of tongue movement observed during open respiration.
- The uniform dilation pattern is typical of healthy control subjects with overweight and obesity.
- The oropharyngeal movement is typical of thin subjects and young patients with mild OSAS
- The bidirectional movement pattern was observed more frequently in patients of low to moderate OSAS.
- The minimal movement pattern was more common in moderately severe tumors with severe OSAS.
However, considerable variability was observed, with some subjects showing different patterns of movements in different breaths within an imaging session.