Skip to main content

Advertisement

SpringerLink
Log in

Cephalometry and prediction of oral appliance treatment outcome

  • Original Article
  • Published:
Sleep and Breathing Aims and scope Submit manuscript

Abstract

Rationale

Predicting which patients with obstructive sleep apnea (OSA) will be successfully treated with mandibular advancement splints (MAS) remains elusive. Developing simple daytime measurements and tests to predict treatment outcome would enhance MAS treatment.

Objective

The purpose of this study was to assess the clinical utility of anthropomorphic measurements and cephalometric X-rays in the prediction of MAS treatment outcome in OSA.

Methods

Anthropomorphic measurements and cephalometric X-rays from 72 OSA patients who had presented to a tertiary referral sleep clinic were analyzed retrospectively.

Results

Treatment response was defined as ≥50% reduction in Apnea/Hypopnea Index (AHI; criterion 1); ≥50% reduction and residual AHI less than 20/h (criterion 2); ≥50% reduction in AHI and residual AHI less than 10/h (criterion 3); and ≥50% reduction in AHI and residual AHI less than 5/h (criterion 4). This was done to reflect the differences in the clinical definition of treatment success in the literature. A good response occurred in 56% (40 patients) according to criterion 1; 54% (39 patients) according to criterion 2; 46% (33 patients) according to criterion 3; or 39% (28 patients) according to criterion 4. Age and gender were found to be significant predictors for criteria 1 and 2. Age and soft palate length were found to be significant predictors for criteria 3 and 4. Equations to predict MAS treatment response were derived as equations were to predict final AHI.

Conclusions

Certain cephalometric and anthropomorphic measurements impact on MAS treatment outcome. This study adds to the current literature and implies that MAS success is (to some degree) related to anatomical characteristics.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Riley R, Guilleminault C, Herran J, Powell N (1983) Cephalometric analyses and flow volume loops in obstructive sleep apnea patients. Sleep 6:304–317

    Google Scholar 

  2. Haponik EF, Smith PL, Bohlman ME, Allen RP, Goldman SM, Bleecker ER (1983) Computerized tomography in obstructive sleep apnea: correlation of airway size with physiology during sleep and wakefulness. Am Rev Respir Dis 127:221–226

    PubMed  CAS  Google Scholar 

  3. Crumley RL, Stein M, Gamsu G, Golden J, Dermon S (1987) Determination of obstructive site in obstructive sleep apnea. Laryngoscope 97:301–308

    Article  PubMed  CAS  Google Scholar 

  4. Abbey NC, Block AJ, Green D, Mancuso A, Hellard DW (1989) Measurement of pharyngeal volume by digitized magnetic resonance imaging. Effect of nasal continuous positive airway pressure. Am Rev Respir Dis 140:717–723

    PubMed  CAS  Google Scholar 

  5. Chan AS, Sutherland K, Schwab RJ, Zeng B, Petocz P, Lee RWW, Darendeliler MA, Cistulli PA (2010) The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea. Thorax 65:726–732

    Article  PubMed  Google Scholar 

  6. Suratt PM, Dee R, Atkinson RL, Armstrong P, Wilhoit SC (1983) Fluoroscopic and computed tomographic features of the pharyngeal airway in obstructive sleep apnea. Am Rev Respir Dis 127:487–492

    PubMed  CAS  Google Scholar 

  7. Rivlin J, Hoffstein V, Kalbfleisch J, McNicholas W, Zamel N, Bryan AC (1984) Upper airway morphology in patients with idiopathic obstructive sleep apnea. Am Rev Respir Dis 129:355–360

    PubMed  CAS  Google Scholar 

  8. Millman RP, Carlisle CC, Rosenberg C, Kahn D, McRae R, Kramer NR (2000) Simple predictors of uvulopalatopharyngoplasty in the treatment of obstructive sleep apnea. Chest 118:1025–1030

    Article  PubMed  CAS  Google Scholar 

  9. Mehta A, Qian J, Petocz P, Darendeliler MA, Cistulli PA (2001) A randomized, controlled study of a mandibular advancement splint for obstructive sleep apnea. Am J Respir Crit Care Med 163:1457–1461

    PubMed  CAS  Google Scholar 

  10. Eveloff SE, Rosenberg CL, Carlisle CC, Millman RP (1994) Efficacy of a Herbst mandibular advancement device in obstructive sleep apnea. Am J Respir Crit Care Med 149:905–909

    PubMed  CAS  Google Scholar 

  11. Mayer G, Meier-Ewert K (1995) Cephalometric predictors for orthopaedic mandibular advancement in obstructive sleep apnoea. Eur J Orthod 17:35–43

    PubMed  CAS  Google Scholar 

  12. Gotsopoulos H, Chen C, Qian J, Cistulli PA (2002) Oral appliance therapy improves symptoms in obstructive sleep apnea. Am J Respir Crit Care Med 166:743–748

    Article  PubMed  Google Scholar 

  13. Naismith S, Winter V, Gotsopoulos H, Hickie I, Cistulli PA (2004) Neurobehavioral functioning in obstructive sleep apnea: differential effects of sleep quality, hypoxemia and subjective sleepiness. J Clin Exp Neuropsychol 26:43–54

    Article  PubMed  CAS  Google Scholar 

  14. Chan AS, Cistulli PA (2009) Oral appliance treatment of obstructive sleep apnea: an update. Curr Opin Pulm Med Aug 25 (in press)

  15. Guilleminault C, Riley R, Powell N (1984) Obstructive sleep apnea and abnormal cephalometric measurements. Chest 86:793–794

    Article  PubMed  CAS  Google Scholar 

  16. Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA (1986) Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 9:469–477

    PubMed  CAS  Google Scholar 

  17. Houston WJ (1983) The analysis of errors in orthodontic measurements. Am J Orthod 83:382–390

    Article  PubMed  CAS  Google Scholar 

  18. Zeng B, Ng AT, Darendeliler MA, Petocz P, Cistulli PA (2007) Use of flow-volume curves to predict oral appliance treatment outcome in obstructive sleep apnea. Am J Respir Crit Care Med 175:726–730

    Article  PubMed  Google Scholar 

  19. Marklund M, Franklin KA, Stenlund H, Persson M (1998) Mandibular morphology and the efficacy of a mandibular advancement device in patients with sleep apnoea. Eur J Oral Sci 106:914–921

    Article  PubMed  CAS  Google Scholar 

  20. Liu Y, Zeng X, Fu M, Huang X, Lowe AA (2000) Effects of a mandibular repositioner on obstructive sleep apnea. Am J Orthod Dentofacial Orthop 118:248–256

    Article  PubMed  CAS  Google Scholar 

  21. Linder-Aronson S (1970) Adenoids, their effects on mode of breathing and nasal airflow and their relationship to characteristics of their facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol 265:1–132

    CAS  Google Scholar 

  22. Solow B, Siersbaek-Nielson S, Greve E (1984) Airway adequacy, head posture, and craniofacial morphology. Am J Orthod 86:214–223

    Article  PubMed  CAS  Google Scholar 

  23. Tomes CS (1873) The bearing of the development of the jaws on irregularities. Dent Cosmos 115:292–296

    Google Scholar 

  24. Linder-Aronson S (1985) The physiologic basis of functional appliances: the role of respiration. In: Grabe TM (ed) Physiologic principles of fundamental appliances. CV Mosby Co, St Louis, pp 5–11

    Google Scholar 

  25. Guilleminault C, Partinen M, Praud JP, Saby MA, Chambille B, Dehan M, Gaultier C (1989) Morphometric facial changes and obstructive sleep apnea in adolescents. J Pediatr 114:997–999

    Article  PubMed  CAS  Google Scholar 

  26. Vargervik K, Harvold EP (1987) Experiments on the interaction between orofacial function and morphology. Ear Nose Throat J 66:201–208

    PubMed  CAS  Google Scholar 

  27. Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS (1984) Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod 85:115–124

    Article  PubMed  CAS  Google Scholar 

  28. Liu Y, Lowe AA, Fleetham JA, Park YC (2001) Cephalometric and physiological predictors of the efficacy of an adjustable oral appliance for treating obstructive sleep apnea. Am J Orthod Dentofacial Orthop 120:639–647

    Article  PubMed  CAS  Google Scholar 

  29. Cistulli PA, Gotsopoulos H, Marklund M, Lowe AA (2004) Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances. Sleep Med Rev 8:443–457

    Article  PubMed  Google Scholar 

  30. Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W (2006) Oral appliances for snoring and obstructive sleep apnea: a review. Sleep 29:244–262

    PubMed  Google Scholar 

  31. Marklund M, Stenlund H, Franklin KA (2004) Mandibular advancement devices in 630 men and women with obstructive sleep apnea and snoring: tolerability and predictors of treatment success. Chest 125:1270–1278

    Article  PubMed  Google Scholar 

  32. O'Sullivan RA, Hillman DR, Mateljan R, Pantin C, Finucane KE (1995) Mandibular advancement splint: an appliance to treat snoring and obstructive sleep apnea. Am J Respir Crit Care Med 151:194–198

    PubMed  Google Scholar 

  33. Schmidt-Nowara WW, Lowe A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S (1995) Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 18:501–510

    PubMed  CAS  Google Scholar 

  34. Lowe AA (2000) Oral appliances for sleep breathing disorders. In: Kryger MH, Roth T, Dement WC (eds) Principles and practice of sleep medicine, 3rd edn. WB Saunders Co, Philadelphia, pp 929–939

    Google Scholar 

  35. Clark GT, Arand D, Chung E, Tong D (1993) Effect of anterior mandibular positioning on obstructive sleep apnoea. Am Rev Respir Dis 147:624–629

    PubMed  CAS  Google Scholar 

Download references

Acknowledgment

We wish to thank Dr Jin Qian, sleep laboratory manager of the Centre for Sleep Disorders and Respiratory Failure at St. George Hospital, for his assistance with sleep studies and data processing.

Conflict of interest

PAC contributed to the development of the oral appliance used on this study, which is being commercialized by SomnoMed Ltd, and was a consultant for the company 2004–2006. His department has received in-kind and/or financial support for sleep apnea research from SomonMed Ltd., ResMed Inc, and ExploraMed Inc.

Author information

Authors and Affiliations

  1. Centre for Sleep Disorders and Respiratory Failure, St. George Hospital, Sydney, Australia

    Andrew Tze Ming Ng

  2. Faculty of Dentistry, University of Sydney, Sydney, Australia

    M. Ali Darendeliler

  3. Department of Statistics, Macquarie University, Sydney, Australia

    Peter Petocz

  4. Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, Sydney, Australia

    Peter A. Cistulli

Authors
  1. Andrew Tze Ming Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Ali Darendeliler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Petocz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Peter A. Cistulli
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Andrew Tze Ming Ng.

Appendices

Appendix A

Table 4 Individual cephalometric measurements
Full size table

Appendix B

Table 5 Individual cephalometric measurements
Full size table

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ng, A.T.M., Darendeliler, M.A., Petocz, P. et al. Cephalometry and prediction of oral appliance treatment outcome. Sleep Breath 16, 47–58 (2012). https://doi.org/10.1007/s11325-011-0484-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11325-011-0484-2

Keywords

Search

Navigation