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Use of flow–volume curves to predict oral appliance treatment outcome in obstructive sleep apnea: a prospective validation study

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Abstract

Purpose

Flow–volume curves have been shown to relate to upper airway physiology during sleep and may be useful for predicting the response to treatment of obstructive sleep apnea (OSA) with mandibular advancement splints (MAS). The aim of this study was to prospectively assess the potential clinical utility of a previously derived prediction method using flow–volume curves performed during wakefulness.

Methods

Patients with newly diagnosed OSA interested in undertaking treatment with a custom-made MAS were approached to participate in the study. Response to treatment was defined by a 50% or greater reduction in the apnea–hypopnea index. Flow–volume curves were performed in the erect position prior to construction of the MAS.

Results

Flow–volume curves were performed in 35 patients. Of these, 25 patients were responders, and 10 patients were non-responders. A combined cut-off of an inspiratory flow rate at 50% of vital capacity (MIF50) less than 6.0 L/s and a ratio of the expiratory flow rate at 50% of vital capacity to MIF50 of greater than 0.7 correctly classified 48.6% of the patients. It had a sensitivity of 36.0%, specificity of 80.0%, positive predictive value of 81.8%, and negative predictive value of 33.3%.

Conclusions

These results suggest that the previously derived prediction model, using flow–volume curves performed during wakefulness, was not sufficient to reliably predict the response to treatment of OSA with MAS. A combination of a functional assessment using flow–volume curves and a structural evaluation of the upper airway with imaging modalities may result in a prediction model with better performance characteristics.

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Acknowledgements

The authors are grateful to Dr Biao Zeng and the sleep laboratory staff for their assistance.

Conflict of interest statement

PAC contributed to the development of the oral appliance used in this study, which is being commercialized by SomnoMed Ltd. He previously served as a consultant and medical advisory board member (2004–2006, AUD$5,000 per annum), and has a pecuniary interest in the company. His department receives equipment (oral appliances) and financial support (2009, AUD$60,000) for research studies from SomnoMed Ltd. PAC is a chief investigator in a CPAP clinical trial funded by ResMed Inc, and his department receives equipment support (CPAP machines) for investigator-initiated studies. He is a board member of the ResMed Foundation, a non-profit charitable organization. MAD’s travel and expenses to the German Dental and Medical Sleep Meeting in Regensburg, Germany were sponsored by SomnoMed Ltd in 2006. Support in-kind for this study (mandibular advancement splints) was provided by SomnoMed Ltd.

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Authors and Affiliations

  1. Centre for Sleep Health and Research, Department of Respiratory Medicine, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia

    Andrew S. L. Chan, Richard W. W. Lee & Peter A. Cistulli

  2. Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia

    Andrew S. L. Chan, Richard W. W. Lee & Peter A. Cistulli

  3. Department of Respiratory and Sleep Medicine, St George Hospital, University of New South Wales, Sydney, NSW, Australia

    Andrew S. L. Chan, Richard W. W. Lee & Peter A. Cistulli

  4. Department of Orthodontics, Faculty of Dentistry, Sydney Dental Hospital, University of Sydney, Sydney, NSW, Australia

    Vasantha K. Srinivasan & M. Ali Darendeliler

Authors
  1. Andrew S. L. Chan
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  2. Richard W. W. Lee
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  3. Vasantha K. Srinivasan
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  4. M. Ali Darendeliler
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  5. Peter A. Cistulli
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Corresponding author

Correspondence to Peter A. Cistulli.

Additional information

This study is supported by the National Health and Medical Research Council of Australia (Medical Postgraduate Scholarship No. 457155)

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Chan, A.S.L., Lee, R.W.W., Srinivasan, V.K. et al. Use of flow–volume curves to predict oral appliance treatment outcome in obstructive sleep apnea: a prospective validation study. Sleep Breath 15, 157–162 (2011). https://doi.org/10.1007/s11325-010-0395-7

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  • DOI: https://doi.org/10.1007/s11325-010-0395-7

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