Mandibular movement monitoring may help improve oral sleep apnea devices

Tracking jaw movements is a useful tool for measuring the efficacy of oral appliances, according to a new study in the journal CHEST®


Glenview, IL, November 6, 2018

While continuous positive airway pressure (CPAP) continues to be the gold standard for treatment of sleep apnea, the cumbersome machines are often not well tolerated by patients. Because of this, less obtrusive oral appliances that thrust the jaw forward during sleep are becoming more popular. Mandibular protrusion enlarges the pharynx and stabilizes the upper airway. A new study in CHEST® demonstrates that mandibular movements (MM) monitoring can be used to assess the efficacy of these oral appliances.

MM during sleep are accurate reporters for increased respiratory effort and microarousals found in people with sleep apnea. In this sleep study, 56 patients with obstructive sleep apnea (OSA) were fitted with a custom mandibular advancement splint (OAT) and had their midsagittal mandibular movement tracked. Patients were evaluated at the end of the titration procedure. During the titration procedure different degrees of advancement are trialed up and down to find the single best amount to control apnea events for that patient.

"The novelty of the study is related to tracking sleep MM in order to assess the effectiveness of oral appliance therapy," explained lead investigator Jean-Benoit Martinot, MD, Sleep Laboratory, CHU UCL Namur Site Sainte-Elisabeth, Namur, Belgium. "Our study suggested for the first time that MM monitoring represents a powerful tool for assessing the efficacy of OAT treatment."

Investigators found that by the end of titration, all indications of OSA decreased compared with baseline. Overall, patients showed a reduction of vertical respiratory MM and sleep respiratory effort, as well as a dramatic decrease in obstructive hypopnea. Scores from the apnea-hypopnea index and oxygen desaturation index also dropped.

"Using MM measurements in the oral appliance titration procedure has the potential to optimize the benefit/risk ratio of oral appliances," said Dr. Martinot. "There is a high interindividual variability in response to the oral appliances, and it is difficult to predict the range of responses without proper measurement."


A chart showing the changes from baseline found in subjects during the study.
A chart showing the changes from baseline found in subjects during the study.

Researchers also found that MM monitoring helped to reveal the presence of central apneas. They found in a subgroup of subjects a decrease in respiratory effort, but no improvement or an increase in sharp and sudden MM of high amplitude, which indicates persistent sleep fragmentation. This is highly suggestive of emergent central apneas and may shed light on a possible predictor for poor response to OAT.

With new technology on the horizon, MM monitoring could potentially represent a cost-effective and easy-to-implement tool for sleep clinics to use when titrating oral appliances. "MM monitoring during sleep is practical and informative for measuring indices of residual respiratory events when OSA is treated by oral appliances," concluded Dr. Martinot. "Given the growing use of this treatment as the primary alternative to CPAP, these data are relevant for sleep clinicians.

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Notes for editors
The article is “Mandibular Movement Analysis to Assess Efficacy of Oral Appliance Therapy in OSA,” by Jean-Benoit Martinot, MD; Nam N. Le-Dong, MD, PhD; Etienne Crespeigne, MSc; Philip E. Silkoff, MD; Valérie Cuthbert, MSc; Stéphane Denison, MSc; Jean-Christian Borel, PhD; and Jean-Louis Pépin, MD, PhD (https://doi.org/10.1016/j.chest.2018.08.1027). It will appear in the journal CHEST®, volume 154, issue 6 (December 2018) published by Elsevier.

This innovative monitoring of mandibular movements is linked with the LIFE project led by Jean-Louis Pépin and supported by a research grant from the French National Research Agency (ANR-12-TECS-0010), and in the framework of the "Investissements d'avenir" program (ANR-15-IDEX-02).

Full text of this article and interviews with the authors are available to credentialed journalists upon request; contact Andrea Camino, American College of Chest Physicians, at +1 224 521 9513 or acamino@chestnet.org.

About the journal CHEST®
The journal CHEST®, the official publication of the American College of Chest Physicians, features the best in peer-reviewed, cutting-edge original research in the multidisciplinary specialties of chest medicine: pulmonary, critical care, and sleep medicine; thoracic surgery; cardiorespiratory interactions; and related disciplines. Published since 1935, it is home to the highly regarded clinical practice guidelines and consensus statements. Readers find the latest research posted in the Online First section each week and access series that provide insight into relevant clinical areas, such as Recent Advances in Chest Medicine; Topics in Practice Management; Pulmonary, Critical Care and Sleep Pearls; Ultrasound Corner; Chest Imaging and Pathology for Clinicians; and Contemporary Reviews. Point/Counterpoint Editorials and the CHEST Podcasts address controversial issues, fostering discussion among physicians. journal.chestnet.org

About American College of Chest Physicians® (CHEST)
CHEST is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research and team-based care. Its mission is to champion the prevention, diagnosis and treatment of chest diseases through education, communication and research. It serves as an essential connection to clinical knowledge and resources for its 19,000 members from around the world who provide patient care in pulmonary, critical care and sleep medicine. For information about the American College of Chest Physicians and its flagship journal CHEST®, visit chestnet.org.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers. www.elsevier.com

Media contact
Andrea Camino
American College of Chest Physicians (CHEST)
+1 224 521 9513
acamino@chestnet.org