Abstract
Purpose: There are subtypes of obstructive sleep apnea （OSA）: supine-predominant OSA, rapid eye movement （REM）-related OSA, and apnea-predominant OSA. Although continuous positive airway pressure （CPAP） is clearly a highly effective treatment option, various alternative treatment options exist, such as oral appliance （OA）, upper airway surgery, and hypoglossal nerve stimulation. Clinical guidelines recommend OA treatment for patients with mild to moderate OSA and those with severe OSA who are intolerant to CPAP therapy or refuse it. In recent years, differences in OA treatment efficacy depending on OSA subtype have been reported. It is necessary to understand the clinical features of different OSA subtypes. The aim of this study was to report the clinical features of REM-related OSA, supine-predominant OSA, and apnea-predominant OSA in patients requiring OA treatment.
Methods: A total of 553 patients were diagnosed with OSA by polysomnography （PSG） at the Department of Sleep Medicine of Aichi Medical University Hospital and were referred to the Department of Oral and Maxillofacial Surgery for prescription of OA. We examined clinical features such as sex, body mass index （BMI） and PSG findings for supine-predominant, REM-related OSA, and apnea-predominant OSA
Results: Supine-predominant OSA was observed in 226 （40.9％）, REM-related OSA in 128 （23.1％）, and apnea-predominant OSA in 53 （10.0%） patients. Patients with supine-predominant OSA were younger （50.6±14.9 vs. 55.5±13.9, p＝0.021） and had lower BMI （24.0±10.2 vs. 27.0±12.5, p＜0.001） than non-supine-predominant OSA. REM-related OSA was more prevalent in women than non-REM-related OSA （female ratio: 49.3％ vs. 25.6％, p＜0.001）. Patients with apnea-predominant OSA were older （61.2±13.7 vs. 55.0±14.7, p＝0.003） and had higher Epworth Sleepiness Scale scores （9.2±5.4 vs. 7.1±4.3, p＝0.014） than non-apnea-predominant OSA. Respiratory disorders in supine-predominant OSA and REM-related OSA were relatively mild to moderate and in apnea-predominant OSA tended to be severe.
Conclusions: Dentists should plan treatment strategies specific to each patient. They should sufficiently explain the justification and importance of OA treatment and the need to evaluate OA treatment using sleep tests and provide sleep dentistry through understanding of OSA subtypes. By understanding these subtypes, dentists can deepen their understanding of a patient’s specific pathology and provide high-quality sleep dentistry.
