Nature and Science of Sleep (Sep 2022)
Differences in Predicted Therapeutic Outcome of Mandibular Advancement Determined by Remotely Controlled Mandibular Positioner in Canadian and Chinese Apneic Patients
Abstract
Wen-Yang Li,1 Jean-Francois Masse,2 Simon Gakwaya,3 Zhenjin Zhao,4 Wei Wang,1,* Frédéric Sériès3,* 1Institute of Respiratory and Critical Care, The First Hospital of China Medical University, Shenyang, People’s Republic of China; 2Faculté de Médecine Dentaire, Université Laval, Québec, QC, Canada; 3Unité de Recherche en Pneumologie, Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada; 4Institute of Orthodontics, The Stomatological Hospital of China Medical University, Shenyang, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Wang, Institute of Respiratory Disease, The First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, People’s Republic of China, Tel: +86 83282532, Email [email protected] Frédéric Sériès, Centre de recherche, IUCPQ, 2725 chemin Sainte-Foy, Québec, QC, G1V 4G5, Canada, Email [email protected]: In-lab mandibular protrusive titration using a remotely controlled mandibular positioner (RCMP) could predict the success rate of mandibular advancement device (MAD) and reliably determine the Optimal Protrusive Position (OPP) for obstructive sleep apnea (OSA) patients. The aim of this study was to compare MAD success rate using in-lab RCMP manual titration performed in Caucasian and Chinese OSA patients.Methods: Manual RCMP titration was performed during an in-lab sleep study using the same procedure that had been previously reported in untreated Caucasian and Chinese OSA patients. Success rate was determined according to classical success criteria or to those previously used for RCMP titration.Results: A total of 160 subjects were included in this study, and conclusive data were obtained from 141 (71 Chinese and 70 Caucasian OSA patients). Chinese patients were significantly younger, with lower BMI and more severe OSA disease than the Canadian counterparts. Among patients with predicted success, the OPP expressed in % of full protrusion position did not differ between the two ethnic groups. Chinese ethnicity, younger age and lower baseline AHI were significant determinants of RCMP success. In a multivariate analysis, only ethnicity and AHI were found to significantly account for success, the odds ratio for success in Chinese compared to Caucasians corrected for AHI being 3.7 and 4.6 depending on criteria used to define success.Conclusion: Although the OSA disease was more severe in Chinese patients, the predicted success rate of MAD according to RCMP titration was higher in Chinese than in Caucasians. This study was registered on ClinicalTrials.gov (NCT03231254).Keywords: obstructive sleep apnea, mandibular advancement device, remotely controlled mandibular positioner, optimal protrusive position
