IADR Abstract Archives
The role of hyoid bone positioning in response to a mandibular advancing appliance for obstructive sleep apnea
Objectives: The objective was to determine whether hyoid bone elevation induced by an anterior mandibular positioning device (AMP) plays a role in effectiveness for obstructive sleep apnea (OSA) intervention.
Methods: Fifteen patients (12 males and 3 females) underwent polysomnographs and lateral cephalograms before and after AMP use of at least 6 months. Measurements of sleep variables and upper airway morphology were compared between pre-AMP and with-AMP states using Student t-tests.
Results: The AMP appliance reduced apnea-hypopnea indices (AHI) approximately 53% (33.77 ± 3.29 vs. 15.85 ± 3.78, p = 0.0013). Cephalograms of the oropharyngeal airway showed that the hyoid bone moved superiorly toward the inferior mandibular border (Δ H-MP) approximately 5 mm (23.4 ± 1.44 vs. 18.27 ± 1.86, p = 0.0377), with the AMP device inserted; no cephalogram airway measurement other than hyoid bone position changed significantly. However, no significant correlations emerged between extent of AHI improvement (Δ AHI) and change (Δ H-MP) in hyoid bone position. Use of the AMP was not effective in all patients; in 3 of the 15 cases, OSA severity did not improve, as assessed by AHI. Δ H-MP measurements may be a useful marker to segregate patients with the tongue and hyoid muscles responsive to AMP from those not-so-responsive.
Conclusions:
Overall use of the AMP device is effective; however, that effectiveness appears to depend on differences in hyoid position, and reflects diverse responsiveness depending on distinct phenotypes of OSA patients with AMP use.
Methods: Fifteen patients (12 males and 3 females) underwent polysomnographs and lateral cephalograms before and after AMP use of at least 6 months. Measurements of sleep variables and upper airway morphology were compared between pre-AMP and with-AMP states using Student t-tests.
Results: The AMP appliance reduced apnea-hypopnea indices (AHI) approximately 53% (33.77 ± 3.29 vs. 15.85 ± 3.78, p = 0.0013). Cephalograms of the oropharyngeal airway showed that the hyoid bone moved superiorly toward the inferior mandibular border (Δ H-MP) approximately 5 mm (23.4 ± 1.44 vs. 18.27 ± 1.86, p = 0.0377), with the AMP device inserted; no cephalogram airway measurement other than hyoid bone position changed significantly. However, no significant correlations emerged between extent of AHI improvement (Δ AHI) and change (Δ H-MP) in hyoid bone position. Use of the AMP was not effective in all patients; in 3 of the 15 cases, OSA severity did not improve, as assessed by AHI. Δ H-MP measurements may be a useful marker to segregate patients with the tongue and hyoid muscles responsive to AMP from those not-so-responsive.
Conclusions:
Overall use of the AMP device is effective; however, that effectiveness appears to depend on differences in hyoid position, and reflects diverse responsiveness depending on distinct phenotypes of OSA patients with AMP use.