Evaluation of sleep position shifts in patients with obstructive sleep apnea syndrome with the use of the mandibular advancement device

Domenico Ciavarella ¹ Donatella Ferrara ^1* Carlotta Fanelli ¹ Graziano Montaruli ¹ Giuseppe Burlon ¹ Michele Laurenziello ¹ Lucio Lo Russo ¹ Fariba Esperouz ¹ Michele Tepedino ² MAURO LORUSSO ¹

• ¹ University of Foggia, Foggia, Italy
• ² University of L'Aquila, L'Aquila, Abruzzo, Italy

Background: The aim of the study was to evaluate position shifts during sleep of patients with obstructive sleep apnea syndrome both with and without the use of the mandibular advancement device (MAD). Methods: Seventy-three adult Caucasian patients diagnosed with obstructive sleep apnea syndrome confirmed by polysomnography were retrospectively enrolled. Inclusion criteria were as follows: age >20 years, body mass index < 34kg/m2, polysomnographic diagnosis of OSA, nonsmoker, absence of comorbidities at diagnosis, treatment with MAD. Two polysomnographic monitoring were performed: one at the time of diagnosis (T0) and another after three months of treatment. The parameters evaluated were apnea-hypopnea index (AHI), oxygen desaturation index (ODI), total number of position shifts and position shift index (number of shifts per hour). Since variables failed the normality test, a Wilcoxon test was performed to analyze the correlation between the mean of polysomnographic parameters at T0 and T1. The differences (T1-T0) of each variable were evaluated using the Spearman's rho correlation test. Statistical significance was set at p < 0.05. Results and conclusions: All parameters, including both respiratory and positional measures, showed a significant reduction, after the use of MAD compared to the beginning. Spearman correlation test revealed a relationship between the total number of sleep position shifts and sleep position shifts index with the oxygen desaturation index. However, no significant correlation was observed between the apnea-hypopnea index and positional values.