Prediction of non-responders to oral appliance treatment of obstructive sleep apnea: a pilot study

Ulrik Leidland Opsahl; Morten Berge; Sverre Lehmann; Bjørn Bjorvatn; Anders Johansson

doi:10.1007/s11325-025-03315-1

Prediction of non-responders to oral appliance treatment of obstructive sleep apnea: a pilot study

Sleep Breath. 2025 Apr 15;29(2):159. doi: 10.1007/s11325-025-03315-1.

Authors

Ulrik Leidland Opsahl^{1

2

3}, Morten Berge^{4

5}, Sverre Lehmann^{5

6}, Bjørn Bjorvatn^{7

8}, Anders Johansson^{4

5}

Affiliations

¹ Department of Clinical Dentistry, Faculty of Medicine, Center for Translational Oral Research (TOR), University of Bergen, Bergen, Norway. ulrik.opsahl@uib.no.
² Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway. ulrik.opsahl@uib.no.
³ Department of Clinical Dentistry - Prosthodontics, Faculty of Medicine, University of Bergen, Post Box 7800, Bergen, 5009, Norway. ulrik.opsahl@uib.no.
⁴ Department of Clinical Dentistry, Faculty of Medicine, Center for Translational Oral Research (TOR), University of Bergen, Bergen, Norway.
⁵ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
⁶ Department of Clinical Science, University of Bergen, Bergen, Norway.
⁷ Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
⁸ Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

Abstract

Purpose: Several clinically available variables have been identified as predictors of non-response to oral appliance (OA) treatment, including endotypical traits such as severe upper airway collapsibility, unstable ventilatory control, and low arousal threshold. This study aimed to identify potential predictors of non-response to OA treatment in patients with OSA non-adherent to treatment with positive airway pressure.

Methods: Patients in this study were initially treated with OAs with and without elastic bands in a crossover design. Subsequently, each patient selected their preferred treatment modality for continued therapy based on subjective preferences. The chosen OA treatment. The chosen OA treatment modality was titrated optimally based on reduction of REI. Patients not reaching > 50% reduction of REI from baseline were classified as non-responders. Statistical analyses were conducted using Student's t-test and Pearson's chi-squared test to assess differences in baseline variables between responders and non-responders, and logistic regression analyses were performed to investigate variables associated with not responding to OA treatment.

Results: Overall, 63.2% (n = 36) of the patients were responders to OA treatment following titration. Smaller distance from habitual bite position to maximal retruded position (Odds ratio: 0.28, p = 0.016), positional OSA (Odds ratio: 0.94, p = 0.024) and a higher number of the endotypical OSA traits severe collapsibility, high loop gain and low arousal threshold (Odds ratio: 7.41, p = 0.038), were found to predict non-response to OA treatment.

Conclusion: These novel findings suggest that severe upper airway collapsibility, high loop gain and low arousal threshold, identified through clinically available variables, appear to be important predictors of non-response to OA treatment, along with short distance from habitual bite position to maximal retruded position and positional OSA.

Trial registration number: NCT05987618 (clinicaltrials.gov).

Keywords: Endotypical traits; Obstructive sleep apnea; Oral appliance; Prediction.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Continuous Positive Airway Pressure*
Cross-Over Studies
Female
Humans
Male
Middle Aged
Occlusal Splints*
Patient Compliance*
Pilot Projects
Polysomnography
Sleep Apnea, Obstructive* / therapy
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT05987618