Mandibular jaw movement analysis ‘convenient approach’ in OSA oral appliance titration

Key takeaways:

• In-laboratory polygraphy and at-home automated mandibular jaw movement analysis showed similar decreases in apnea-hypopnea index at end of titration.
• There are many probable benefits with the automated approach.

Among adults with obstructive sleep apnea receiving oral appliance therapy, mandibular jaw movement automated analysis plus monitoring may help with titration, according to results published in Annals of the American Thoracic Society.

“The findings suggest that a cost-effective digital medicine solution, requiring minimal technical and human resources, enabling multi-night home monitoring and collecting patient-reported outcome measures could offer a convenient approach for oral appliance titration in clinical practice and research,” Jean-Benoît Martinot, MD, head of the Sleep and Vigilance Center at Centre Hospitalier Universitaire Université Catholique de Louvain Namur (Sainte-Elisabeth site), told Healio.

“It could streamline health care operations, providing results within minutes and reducing the need for extensive in-person visits,” Martinot continued. “It could help address sleep lab capacity issues, particularly exacerbated by the COVID-19 pandemic, and benefit those in remote areas with limited access to in-lab polysomnography (PSG) services.”

In an observational, prospective study, Martinot and colleagues assessed 135 adults (median age, 48.8 years; 74% men; median BMI, 27.4 kg/m²) with OSA eligible for oral appliance therapy to find out if mandibular jaw movement (MJM) automated analysis by machine learning performs similarly to PSG/polygraphy (PG) when measuring apnea-hypopnea index (AHI) changes between baseline and the end of titration.

Researchers also specifically looked at MJM monitoring for oral appliance titration in an at-home setting.

Within the total cohort, 30 adults had been lost to follow-up (mean duration, 5.23 months), and 93 adults fully completed home monitoring questionnaires.

Through Bland-Altman analysis, researchers observed “strong agreement” between MJM automated analysis and PG or PSG during AHI measurement at the end of mandibular advancement device titration (median bias, 0.24 events per hour).

From baseline, there was a similar decrease in AHI at the end of titration reported by in-laboratory PG (–59.6%; 95% CI, –59.8% to –59.5%), in-laboratory automated MJM analysis (–59.2%; 95% CI, –65.2% to –52.2%) and at-home automated MJM analysis (–59.7%; 95% CI, –67.4% to –50.2%) in the cohort of 93 adults.

Notably, with each rise in protrusion level during titration (initial, intermediate and final), researchers found larger AHI declines from baseline in the assessment of at-home MJM-based monitoring, signaling improvement.

Similar to the above finding, the proportion of adults with an AHI improvement of 50% or more from baseline went up as the level of protrusion went up (initial, 50.5%; intermediate, 64.5%; final, 65.6%).

“Personalized titration through remote monitoring using MJM enables prescribing the minimal level of mandibular advancement needed to sufficiently reduce AHI,” Martinot told Healio. “This approach minimizes side effects, reduces discomfort and enhances treatment compliance, thereby improving overall patient management.”

In addition to AHI improvement, sleep quality, snoring, morning fatigue, headache, dry mouth and daytime sleepiness each improved with mandibular advancement device use, according to researchers.

Martinot told Healio findings from this study were not unexpected because they were similar to previous findings in CHEST and consistent with expectations in a signal review in Journal of Clinical Sleep Medicine.

“Other studies will demonstrate that another metric specific to the Sunrise device, REMOV, which measures the percentage of time spent in increased respiratory effort, assists clinicians in evaluating the efficacy of oral appliances,” Martinot told Healio.