American Journal of Orthodontics and Dentofacial Orthopedics
Original articleA comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea
Section snippets
Subject selection
In this retrospective study, we tracked the database of patients who had been treated with adjustable and titratable OAs at the Sleep Apnea Dental Clinic at the University of British Columbia or the orthodontic practice of Dr Alan A. Lowe. All patients had been diagnosed by overnight polysomnography (PSG) with the methodology previously described.14, 15, 16 They also met our patient selection criteria, including at least 10 healthy teeth in each arch, no evidence or past history of
Results
From the database, 9 of 134 patients were found to be nonresponders according to our criteria—5 moderate, 3 severe I, and 1 severe II. Table II shows demographic data, pretreatment and posttitration AHI, and improvement in AHI for each nonresponder-responder pair. All subjects were male. Their ages, pretreatment BMIs, posttitration BMIs, and pretreatment AHIs were not statistically significantly different in the 2 groups overall. The posttitration AHI and improvement in AHI were statistically
Discussion
The etiology of OSA is still controversial, but the interaction of anatomic and neuromuscular factors appears to determine pharyngeal patency.19, 20 Many anatomic alterations in OSA patients have been previously reported with lateral cephalometric analyses. Lowe et al,16 with a principal component analysis, documented several alterations including posteriorly positioned maxilla and mandible, steep occlusal plane, overerupted maxillary and mandibular teeth, proclined incisors, steep mandibular
Conclusions
A comparison of responders and nonresponders showed that nonresponders had wider upper airways and an average increase of 2.9% in BMI during treatment. These results suggest that practitioners should be cautious when treating patients with an OA if they have a wide anteroposterior airway and a weight change during treatment.
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Cited by (0)
The Klearway appliance was invented by Alan A. Lowe at the University of British Columbia, which has obtained international patents, and specific licensees have been assigned the rights to manufacture and distribute the appliance worldwide. Royalties from the sale of the Klearway appliance are paid to the University of British Columbia.