First-line oral appliance therapy resolved OSA in third of patients
Click Here to Manage Email Alerts
Key takeaways:
- Achievement of an apnea-hypopnea index less than 10 events per hour signaled obstructive sleep apnea resolution.
- Obstructive sleep apnea endotypes differed based on oral appliance therapy response.
SAN DIEGO — A third of patients with obstructive sleep apnea had an apnea-hypopnea index less than 10 events per hour after oral appliance therapy, according to research presented at the American Thoracic Society International Conference.
Further, for those who still had OSA after 4-week oral appliance therapy, adding on another therapy other than CPAP resolved OSA for most patients, according to researchers.
“These findings pave the way for precision sleep medicine for sleep apnea,” Danny J. Eckert, PhD, director of the Adelaide Institute for Sleep Health at Flinders University, and Amal M. Osman, PhD, postdoctoral research associate at Flinders University, told Healio in a statement.
“Specifically, these initial exciting findings indicate that it is possible to resolve sleep apnea using a combination therapy approach that does not need to rely on CPAP, even for people with severe disease who have not traditionally been considered as candidates for non-CPAP therapies,” Eckert and Osman continued.
In this study, Eckert, Osman and colleagues evaluated 93 patients (22 women; median age, 55 years; median BMI, 29 kg/m2) with untreated OSA to see how many patients benefit from a flipped OSA treatment approach starting with oral appliance therapy (O2Vent Optima) rather than CPAP.
Patients could have previous CPAP failures, according to researchers.
Included patients had data for a minimum of three overnight in-laboratory studies so researchers could obtain different information.
The first night was a standard diagnostic study, whereas the second night was a physiology study. During this night, researchers collected measures of upper airway critical closing pressure, muscle responsiveness, arousal threshold and loop gain — all OSA endotypes — using various tools/devices.
The third night was used to assess OSA severity via apnea-hypopnea index (AHI) after at least 4 weeks of oral appliance therapy. Researchers continued to study patients who had OSA, or an AHI greater than 10 events per hour, on this third night until their AHI was less than 10 events per hour. These patients could receive an add-on therapy option (expiratory positive airway pressure valve, positional therapy, non-anatomical endotype targeted O2 and novel pharmacotherapy) to the oral appliance therapy, making a combination therapy.
The addition of CPAP to the mix was the last treatment option, researchers noted.
Prior to oral appliance monotherapy, the average AHI was 30 events per hour, but this significantly went down to 16 events per hour (P < .001) after a minimum oral appliance therapy use period of 4 weeks. Of the total cohort, around 33% had an AHI of less than 10 events per hour following monotherapy (responders).
After evaluation of baseline OSA endotypes, researchers found that responders significantly differed from non-responders across all four measures: “less collapsible upper airway, better pharyngeal muscle compensation, lower loop gain and a lower arousal threshold.”
Thirty-three patients who still had OSA after oral appliance monotherapy participated in at least one overnight study that evaluated AHI with combination therapy use. Achievement of an AHI of less than 10 events per hour with oral appliance therapy plus an add-on therapy occurred for “almost all” of these patients, according to researchers.
“While we had hope that this approach would work, we were encouraged and somewhat surprised at just how successful it was with only a handful of patients also requiring the addition of the conventional first line therapy, CPAP,” Eckert and Osman said.
“These novel findings offer considerable hope for the [more than] 50% of people with sleep apnea who are not able to use the first line therapy, CPAP,” they added.
According to Eckert and Osman, consideration of existing and emerging sleep apnea therapies is important when conducting additional research on this topic.
“Future studies should consider the use of other existing and emerging therapies for sleep apnea including pharmacotherapies that may yield similar levels of improvement and patient acceptance via a physiology-based, targeted combination therapy approach as employed in this study,” Eckert and Osman said.
“It will also be important to investigate potential long-term benefits beyond the single night approach investigated here,” they added.