Banca de DEFESA: DANIELA SAMPAIO CARVALHO CLARK

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
STUDENT : DANIELA SAMPAIO CARVALHO CLARK
DATE: 24/03/2025
TIME: 09:00
LOCAL: Sala de Reunião 5 - FS
TITLE:

Effìcacy of Mandibular Advancement Devices: Assessment and Outcome Prediction in the Treatment of Obstructive Sleep Apnea 

KEY WORDS:

obstructive sleep apnoea; mandibular advancement device; prediction; treatment efficacy; polysomnography; ultrasound

PAGES: 100
BIG AREA: Ciências da Saúde
AREA: Odontologia
SUMMARY:

“The mandibular advancement device (MAD) is an effective alternative to CPAP for treating obstructive sleep apnea (OSA). However, patient responses vary significantly, making it challenging to predict their efficacy. A critical issue with mandibular advancement devices is the lack of robust data on factors that might predict treatment response, and understanding the mechanisms influencing this variability is essential.

Objective: To compare the efficacy of a personalized mandibular advancement device using alternative polysomnographic metrics to the apnea-hypopnea index (AHI) - oxygen desaturation index (ODI), hypoxic burden, minimum oxygen saturation (SpO2 min), and time spent with saturation below 90% (T90) - across different periods. Additionally, to correlate demographic, anthropometric, and anatomical variables with treatment efficacy and the severity of the disease. 

Methods: Twenty participants (70% male, 30% female; mean age: 54.9 + 8.72 years; BMI: 27.6 3.24 kg/m*; neck circumference: 40.9 a 4.37 cm) with a prior diagnosis of obstructive sleep apnea via type I polysomnography participated. Participants had either struggled to adapt to CPAP or were seeking an alternative treatment. They were treated with a custom-made mandibular advancement device. The protocol included gradual adjustments of the MAD, efficacy monitoring using type IV polysomnography (wireless high-resolution oximeter with a built-in accelerometer linked to a smartphone with automated cloud analysis), and lmaging with ultrasound of anatomical structures in the upper airway and tongue. Treatment response was defined as a >50% reduction in the oxygen desaturation index (ODI).

Results: 70.6% of participants responded positively to the treatment, showing an average 71% reduction in ODI, while non-responders showed an average reduction of 14.3%. The MAD significantly improved all assessed polysomnographic metrics, and efficacy was maintained throughout the evaluation period (p<0.05). Gender, age, neck circumference, BMI, and Mallampati score were not predictors of treatment efficacy; significant correlations were observed with the width of the tongue base and the length of the upper airway. Predictors of OSA severity included BMI, neck circumference, and upper airway length.

Conclusions:  The  use  of mandibular  advancement  devices  effectively  improved  the evaluated metrics, confirming them as a safe and viable treatment option. However, demographic, anthropometric, and anatomical variables were weakly correlated with treatment efficacy when analyzed individually. Continued research is necessary to elucidate how these variables interrelate and to develop alternative objective prediction methods that allow for more effective and personalized therapeutic approaches.”

 

COMMITTEE MEMBERS:
Externo à Instituição - ALESSANDRO LOURENÇO JANUÁRIO - ARIA
Interna - 2867208 - ELIANA MITSUE TAKESHITA NAKAGAWA
Externa ao Programa - 3155042 - JANINE DELLA VALLE ARAKI - nullPresidente - ***.983.411-** - JORGE DO NASCIMENTO FABER - UnB