Award Winning Abstracts from AADSM 2018


Clinical Excellence Award Winner


?Balina S1, Op de Beeck S2, Kastoer C2,4, Moorkens G3, Vanderveken O2,4,5, Braem M1,2 1 Department of Special Dentistry Care, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium; 2 Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Antwerp, Belgium; 3 Department of Internal Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium; 4 Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium; 5 Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Antwerp, Belgium

Introduction: Fatigue is an important health outcome parameter in public and occupational health care. Most patients with obstructive sleep apnea (OSA) report excessive daytime sleepiness and/or fatigue besides snoring. Mandibular advancement (MAD) treatment is associated withreduction of sleepiness using the Epworth Sleepiness Scale (ESS) questionnaire. However, somnolence and fatigue are often mixed-up. A clear distinction could be imperative in therapy decision-making. In this study we compared the discriminant ability of the Checklist Individual Strength (CIS) with ESS outcome in patients with OSA treated with MAD, related to reduction of apnea-hypopnea index (AHI).

Methods: The CIS (CIS_tot) measures 20 items (max score 140) in four dimensions of fatigue organized in subscales each to be scored from 1 to 7: fatigue severity (CIS_sc1 8 items max score 56), concentration problems (CIS_sc2 5 items max score 35), reduced motivation (CIS_sc3 4 items max score 28) and activity (CIS_sc4 3 items max score 21). On CIS_sc1, a score of ≥35/56 defines severe fatigue whereas an ESS score ≥11/24 indicates excessive sleepiness. All patients starting MAD-treatment filled out both the ESS and CIS questionnaires at baseline and at each recall. The scores for both questionnaires comparing 3-month versus baseline in a consecutive study population are reported (n=58).

Results: Complete datasets after 3 months of 41 patients were available.
Baseline results were (mean±SD):
AHI=28.6±17.2/hr; ESS=9±5; CIS_tot=82±34; CIS_sc1=37±15; CIS_sc2=21±11; CIS_sc3=13±7; CIS_sc4=11±5.
Results (mean±SD) after 3 months were:
AHI=9.9±11.5/hr; ESS=6±4; CIS_tot=63±31; CIS_sc1=27±14; CIS_sc2=15±9; CIS_sc3=12±6; CIS_sc4=9±5. Data were not normally distributed.Analysis was then performed in R using the Wilcoxon rank sum test for pairwise comparison and Spearman correlation for correlation analysis. 
Significances were: 
AHI p<0.000001; ESS p=0.000001; CIS_tot p=0.000015; CIS_sc1 p=0.000005; CIS_sc2 p=0.000040; CIS_sc3 p=0.074940; CIS_sc4 p=0.011960.

Conclusions: MAD treatment resulted in a significant decrease from baseline to 3-months in all parameters investigated, including the combined CIS_tot scale, except for CIS_sc3. A CIS_tot≥76/140 increases the risk for prolonged absence at work, putting the average OSA patient at risk with baseline CIS_tot=82/140, but not any more after MAD treatment with CIS_tot=63/140. At baseline the average CIS_sc1=37/56 revealed severe fatigue in the study population whereas the average ESS=9/24 failed to express this feature. The correlation analysis demonstrated a significant correlation between the changes in ESS en CIS_sc1 describing fatigue, while the ESS and CIS were not correlated on the three remaining subscales indicating concentration, motivation, and activity after three months of MAD treatment. The CIS questionnaire itself did however reveal statistically significant changes in the CIS subscales concentration, motivation and activity following MAD-treatment for 3 months.No correlation of a change in questionnaire outcome either ESS or CIS could be demonstrated regarding delta AHI.
In the present study the CIS questionnaire was a discriminant measure for the changes in fatigue during OSA treatment with MAD and offered additional information compared to ESS.

Student Excellence Award Winner


Dieltjens M1,2; Van Haesendonck G1,3; Kastoer C1,3; Shivalkar B1,4; Vrints C1,4; Van De Heyning C1,4; Braem M1,2; Vanderveken O1,3
1 University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk, Antwerp, Belgium;
2 Antwerp University Hospital, Department of Special Care Dentistry, Edegem, Antwerp, Belgium; 3 Antwerp University Hospital, Otolaryngology and Head and Neck Surgery, Edegem, Antwerp, Belgium; 4 Antwerp University Hospital, Cardiology, Edegem, Antwerp, Belgium

Introduction: The aim of this prospective clinical trial is to evaluate the cardiovascular effects of oral appliance therapy using a custom-made, titratable mandibular advancement device (MAD) in patients with obstructive sleep apnea (OSA).

Methods: Fifty patients with moderate to severe OSA were treated with MAD therapy (SomnoDent® Flex™, SomnoMed Ltd, Australia). After habituation, MAD titration was guided by subjective relief of cardinal symptoms like snoring and daytime sleepiness. At baseline and 6-month follow-up, participants underwent a type 3 home sleep test (HST; MediByte, Braebon Medical Corporation, Kanata, Ontario, Canada), 24-hour blood pressure (BP) monitoring, a comprehensive 2D Doppler and tissue Doppler echocardiography combined with speckle tracking, and objective compliance measurement. Responders are defined as patients with a reduction in AHI that was equal to or more than 50% compared to baseline.

Results: Up to this date, 31 out of 50 patients completed the 6-month follow-up (age: 46±12 years; 77% male; baseline AHI-HST: 13.1±10.2 events/hour; body mass index (BMI): 27±4 kg/m²; 24-hour systolic blood pressure (SBP): 128±12 mmHg, 24-hour diastolic blood pressure (DBP): 77±8 mmHg). Fourteen patients were lost to follow-up, mainly due to the time-consuming protocol, and in 5 patients the 6-month follow-up is being planned as a function of the individual timing when the MAD was fitted. After 6-month follow-up, a statistically significant decrease in AHI (p=0.001) to 6.9±6.9 events/hour of time in bed was observed on HST as compared to baseline. Eighteen patients (58%) were defined as responders.

Overall, systolic and diastolic blood pressure values, left ventricular ejection fraction (LVEF, Simpson method) and pulmonary arterial pressure (PAP) were within normal ranges and stayed normal under MAD therapy. However, in the responder group, a statistic significant improvement in LVEF could be observed, from 57±7 to 61±7% (p = 0.02) and a trend towards an improvement in PAP, from 27±10 to 25±11mmHg (p = 0.09).

Conclusions: The preliminary results of this ongoing clinical trial showed that MAD is efficacious in reducing OSA severity. Overall, the cardiac parameters were within normal ranges and stayed normal under MAD therapy, However, in the responder group, echocardiography showed a statistic significant improvement in LVEF and a trend towards improvement in PAP.