Mandibular Jaw Movement Automated Analysis for Oral Appliance Monitoring in Obstructive Sleep Apnea: A Prospective Cohort Study.

RATIONALE:Oral appliances are second-line treatments options after continuous positive airway pressure for obstructive sleep apnea (OSA) management. However, the need for oral appliance titration limits their use due to monitoring challenges to assess the treatment effect. OBJECTIVES:To assess the validity of mandibular jaw movements (MJM) automated analysis compared to polysomnography/polygraphy (PSG/PG) in evaluating the effect of oral appliance treatment and the effectiveness of MJM monitoring for oral appliance titration at home in OSA patients. METHODS:This observational, prospective study included 135 OSA patients eligible for oral appliance therapy. The primary outcome was the apnea-hypopnea index (AHI), measured through in-laboratory PSG/PG and MJM-based technology. . Additionally, MJM monitoring at-home was conducted at regular intervals during the titration process. The agreement between PSG/PG and MJM automated analysis was evaluated using Bland-Altman analysis. Change in AHI during the home-based oral appliance titration process was evaluated using GLMM and GEE models. RESULTS:The automated MJM analysis demonstrated strong agreement with PG in assessing AHI during MAD treatment, with a median bias of 0.24/h (limits of agreement: -11.2 to 12.8/h). The improvement of AHI from baseline in response to oral appliance treatment was consistent across 3 evaluation conditions : in-lab PG (-59.6%; 59.8 to -59.5), in-lab MJM (-59.2%; -65.2 to -52.2) and at-home MJM analysis (-59.7% ; -67.4 to -50). CONCLUSIONS:Incorporating MJM automated analysis into the oral appliance titration process has the potential to optimize oral appliance therapy outcomes for OSA.