Grant Gruenspan (MHSc): Predicting the Effectiveness of Mandibular Advancement Devices and Maxillomandibular Advancement Surgery for the Treatment of Obstructive Sleep Apnea

January 31, 2018 @ 9:30 am – 10:00 am
Rosebrugh Building
Rosebrugh Bldg, Toronto, ON M5S 3G9

Room: RS 211



Obstructive sleep apnea (OSA) occurs due to the collapse of pharyngeal airway during sleep. The severity of OSA is assessed by the number of partial (hypopnea) or complete (apnea) collapses in the pharyngeal airway per hour of sleep (apnea-hypopnea index (AHI)). Mandibular advancement with oral appliances and maxillomandibular advancement (MMA) surgery are popular treatments for OSA which involves opening up the pharyngeal airway. However, these methods are not effective in all OSA patients, and there is no objective method to predict the effectiveness of these treatments. Previous studies have shown that structural changes to the pharyngeal airway can affect the craniofacial structure and generation of the snoring sounds and breathing sounds during wakefulness and sleep. Thus, we aim to investigate the feasibility of craniofacial and sound features to predict the effectiveness of mandibular advancement devices and MMA surgery. Method: In this study, 30 OSA patients who will undergo mandibular advancement or MMA surgery at the oral surgery clinic located at Toronto Rehabilitation Institute will be included. Before MMA surgery or applying a mandibular advancement device, all measurements will be completed. We will take photographs of the head and neck to analyse the craniofacial structure. Snoring sounds and breathing sounds during wakefulness and sleep will be recorded a microphone. Before and after the treatment, the AHI will be assessed using a wearable monitoring device. If the AHI doesn’t reduce after treatment, then the patient will be classified as a non-responder to the treatment. From the photographs and the recorded sounds, the craniofacial and acoustic features will be extracted, respectively. Based on the assessment, we will build a feature set and a prediction model for estimating the effectiveness of these treatments. 

Expected Results: Previous studies have shown that a low AHI, low BMI, and younger age to be found in responders to these treatments. We also expect that responders to these treatments to have a more posteriorly positioned mandible, and a smaller facial height. In addition, it is likely that the intensity of snoring to be lower in responders to these treatments because responders tend to have lower AHI, and thus it is expected to have lower snoring intensity.  

Significance: The screening technology will help physicians to determine the subgroup of OSA population who will respond significantly to the mandibular advancement and MMA treatment. This will significantly reduce the cost for the patient, and help them to get an optimum treatment.