The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review

Chloé Kastoer; Marijke Dieltjens; Eline Oorts; Evert Hamans; Marc J Braem; Paul H Van de Heyning; Olivier M Vanderveken

doi:10.5664/jcsm.6202

The Use of Remotely Controlled Mandibular Positioner as a Predictive Screening Tool for Mandibular Advancement Device Therapy in Patients with Obstructive Sleep Apnea through Single-Night Progressive Titration of the Mandible: A Systematic Review

J Clin Sleep Med. 2016 Oct 15;12(10):1411-1421. doi: 10.5664/jcsm.6202.

Authors

Chloé Kastoer^{1

2}, Marijke Dieltjens^{1

3

2}, Eline Oorts¹, Evert Hamans², Marc J Braem^{3

2}, Paul H Van de Heyning^{1

4

2}, Olivier M Vanderveken^{1

4

2}

Affiliations

¹ Antwerp University Hospital, Department of ENT, Head and Neck Surgery, Edegem, Antwerp, Belgium.
² University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium.
³ Antwerp University Hospital, Department of Special Dentistry Care, Antwerp, Belgium.
⁴ Antwerp University Hospital, Multidisciplinary Sleep Disorders Centre, Antwerp, Belgium.

Abstract

Study objectives: To perform a review of the current evidence regarding the use of a remotely controlled mandibular positioner (RCMP) and to analyze the efficacy of RCMP as a predictive selection tool in the treatment of obstructive sleep apnea (OSA) with oral appliances that protrude the mandible (OAm), exclusively relying on single-night RCMP titration.

Methods: An extensive literature search is performed through PubMed.com, Thecochranelibrary.com (CENTRAL only), Embase.com, and recent conference meeting abstracts in the field.

Results: A total of 254 OSA patients from four full-text articles and 5 conference meeting abstracts contribute data to the review. Criteria for successful RCMP test and success with OAm differed between studies. Study populations were not fully comparable due to range-difference in baseline apneahypopnea index (AHI). However, in all studies elimination of airway obstruction events during sleep by RCMP titration predicted OAm therapy success by the determination of the most effective target protrusive position (ETPP). A statistically significant association is found between mean AHI predicted outcome with RCMP and treatment outcome with OAm on polysomnographic or portable sleep monitoring evaluation (p < 0.05).

Conclusions: The existing evidence regarding the use of RCMP in patients with OSA indicates that it might be possible to protrude the mandible progressively during sleep under poly(somno)graphic observation by RCMP until respiratory events are eliminated without disturbing sleep or arousing the patient. ETPP as measured by the use of RCMP was significantly associated with success of OAm therapy in the reported studies. RCMP might be a promising instrument for predicting OAm treatment outcome and targeting the degree of mandibular advancement needed.

Keywords: device; mandibular advancement; mandibular positioner; mandibular protrusion; obstructive sleep apnea; oral appliances; overnight; prediction; remotely controlled; single-night; titration.

Publication types

Review
Systematic Review

MeSH terms

Equipment Design
Humans
Mandible
Mandibular Advancement / instrumentation*
Mandibular Advancement / methods*
Polysomnography
Predictive Value of Tests
Sleep Apnea, Obstructive / therapy*
Treatment Outcome