Efficacy of a novel oral appliance and the role of posture on nasal resistance in obstructive sleep apnea

Benjamin K Tong; Carolin Tran; Andrea Ricciardiello; Alan Chiang; Michelle Donegan; Nick Murray; Irene Szollosi; Jason Amatoury; Jayne C Carberry; Danny J Eckert

doi:10.5664/jcsm.8244

Efficacy of a novel oral appliance and the role of posture on nasal resistance in obstructive sleep apnea

J Clin Sleep Med. 2020 Apr 15;16(4):483-492. doi: 10.5664/jcsm.8244.

Authors

Benjamin K Tong^{1

2}, Carolin Tran¹, Andrea Ricciardiello¹, Alan Chiang¹, Michelle Donegan¹, Nick Murray³, Irene Szollosi⁴, Jason Amatoury^{1

2

5}, Jayne C Carberry^{1

2

6}, Danny J Eckert^{1

2

6}

Affiliations

¹ Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.
² School of Medical Sciences, University of New South Wales, Sydney, New South Wales, Australia.
³ Prince of Wales Hospital, Sydney, New South Wales, Australia.
⁴ The Prince Charles Hospital, Brisbane, Queensland, Australia.
⁵ Biomedical Engineering Program, American University of Beirut, Beirut, Lebanon.
⁶ Adelaide Institute for Sleep Health, Flinders University, Adelaide, South Australia, Australia.

Abstract

Study objectives: High nasal resistance is associated with oral appliance treatment failure in obstructive sleep apnea (OSA). A novel oral appliance with a built-in oral airway has been shown to reduce pharyngeal pressure swings during sleep and may be efficacious in those with high nasal resistance. The role of posture and mandibular advancement on nasal resistance in OSA remains unclear. This study aimed to determine (1) the effects of posture and mandibular advancement on nasal resistance in OSA and (2) the efficacy of a new oral appliance device including in patients with high nasal resistance.

Methods: A total of 39 people with OSA (7 females, apnea-hypopnea index (AHI) (mean ± standard deviation) = 29 ± 21 events/h) completed split-night polysomnography with and without oral appliance (order randomized). Prior to sleep, participants were instrumented with a nasal mask, pneumotachograph, and a choanal pressure catheter for gold standard nasal resistance quantification seated, supine and lateral (with and without oral appliance, order randomized).

Results: Awake nasal resistance increased from seated, to supine, to lateral posture (median [interquartile range] = 1.8 [1.4, 2.7], 2.7 [1.7, 3.5], 3.4 [1.9, 4.6] cm H₂O/L/s, P < .001). Corresponding measures of nasal resistance did not change with mandibular advancement (2.3 [1.4, 3.5], 2.5 [1.8, 3.6], 3.5 [1.9, 4.8] cm H₂O/L/s, P = .388). The median AHI reduced by 47% with oral appliance therapy (29 ± 21 versus 18 ± 15 events/h, P = .002). Participants with high nasal resistance (> 3 cm H₂O/L/s) had similar reductions in AHI versus those with normal nasal resistance (61 [-8, 82] versus 40 [-5, 62] %, P = .244).

Conclusions: Nasal resistance changes with posture in people with OSA. A novel oral appliance with a built-in oral airway reduces OSA severity in people with OSA, including in those with high nasal resistance.

Clinical trial registration: Registry: ANZCTR; Title: Combination therapy for obstructive sleep apnoea; Identifier: ACTRN12617000492358; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372279.

Keywords: lung; mandibular advancement therapy; sleep-disordered breathing; upper airway physiology.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Continuous Positive Airway Pressure
Female
Humans
Mandibular Advancement*
Polysomnography
Posture
Sleep Apnea, Obstructive* / therapy
Treatment Outcome

Associated data

ANZCTR/ACTRN12617000492358