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• W4387267475 abstract "SESSION TITLE: OSA: New Therapeutic Targets SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/09/2023 12:00 pm - 12:45 pm PURPOSE: Apnea-hypopnea index (AHI) is a frequency-based index used to define the severity of obstructive sleep apnea (OSA). However, the existing evidence does not support the hypothesis that AHI is a valid surrogate for long-term health outcomes as it is not predictive of OSA-related risk. Conversely, sleep apnea-specific hypoxic burden (SASHB) appears to be more predictive of OSA-related risk than AHI. While SASHB has been studied in cohorts of untreated individuals, it has not been studied in relation to OSA therapy. This is the first assessment of the ability of precision oral appliance therapy (OAT) to reduce SASHB and the first use of SASHB in defining therapeutic efficacy. METHODS: Data previously obtained from two clinical studies that investigated the prediction of response to precision OAT in OSA were analyzed. Data from 109 participants with OSA (n = 36 mild, n = 35 moderate, and n = 38 severe) completed two-night type 3 home sleep tests before and after receiving an oral appliance (ProSomnus Sleep Technologies, Pleasanton, CA). Apnea-hypopnea index and SASHB were calculated. For SASHB, a cut-off of 53 %min/h was used based on data indicating that values above this limit are associated with OSA-related risk; for AHI, cut-offs of < 10 h-1 and < 15 h-1 were used because of their prevalence in clinical practice. RESULTS: Of the participants with mild OSA at baseline, none had a baseline SASHB ≥ 53 %min/h, whereas 54% of participants with moderate and 97% of participants with severe OSA had a baseline SASHB ≥ 53 %min/h. Precision oral appliance therapy reduced AHI from 29.1 ± 20.3 h-1 to 10.5 ± 14.6 h-1 (p < 0.001) and SASHB from 81.8 ± 79.4 %min/h to 27.3 ± 63.2 %min/h (p < 0.001). Using an AHI-based definition of therapeutic efficacy, 85% (for AHI < 15 h-1) and 76% (for AHI < 10 h-1) of participants achieved efficacy with precision OAT. However, when the risk-based SASHB definition of therapeutic efficacy (SASHB < 53 %min/h) was used, precision OAT efficacy increased to 91%. When assessed by severity, 89% of moderate and 68% of severe participants achieved an AHI < 15 h-1 and 77% of moderate and 55% of severe participants achieved an AHI < 10 h-1. When SASHB < 53 %min/h was used to define therapeutic efficacy, efficacy increased to 94% for moderate and 79% for severe OSA. CONCLUSIONS: In the studied population, precision OAT significantly improved SASHB, reducing OSA-related risk in 91% of participants. The use of AHI, a frequency-based index of OSA, appears to misclassify some individuals as therapeutic non-responders to precision OAT despite their having an SASHB in the low-risk range. Sleep apnea-specific hypoxic burden likely provides a more meaningful assessment of OSA treatment efficacy than AHI as it accounts for the risk associated with the disease. CLINICAL IMPLICATIONS: Efficacy of precision OAT should be reevaluated in light of the data indicating that use of SASHB to define therapeutic success could result in more patients being treated and better patient outcomes. DISCLOSURES: No relevant relationships by Joshua Grosse Employee relationship with ProSomnus Sleep Technologies Please note: Ongoing Added 11/24/2022 by Erin Mosca, source=Web Response, value=Salary No relevant relationships by John Remmers Employee relationship with Zephyr Sleep Technologies Please note: 9/2012 - 5/2021 Added 01/30/2023 by Seyed Abdolali Zareian Jahromi, source=Web Response, value=Salary" @default.
• W4387267475 created "2023-10-03" @default.
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• W4387267475 date "2023-10-01" @default.
• W4387267475 modified "2023-10-03" @default.
• W4387267475 title "A COMPARISON OF FREQUENCY- AND RISK-BASED INDICES IN THE ASSESSMENT OF PRECISION ORAL APPLIANCE EFFICACY IN TREATING OBSTRUCTIVE SLEEP APNEA" @default.
• W4387267475 doi "https://doi.org/10.1016/j.chest.2023.07.4035" @default.
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