%0 Journal Article
%~ PubMed
%A Zhao, Moyin
%A Barber, Tracie
%A Cistulli, Peter
%A Sutherland, Kate
%A Rosengarten, Gary
%T Computational fluid dynamics for the assessment of upper airway response to oral appliance treatment in obstructive sleep apnea.
%B Journal of Biomechanics
%D 2013
%C United Kingdom
%I Pergamon
%V 46
%N 1
%P 142-150
%@ 1873-2380
%X 
%Z FOR Codes: 110399 90304 110506


%0 Journal Article
%~ PubMed
%A Ng, Andrew Tze Ming
%A Darendeliler, M Ali
%A Petocz, Peter
%A Cistulli, Peter A
%T Cephalometry and prediction of oral appliance treatment outcome.
%B Sleep & Breathing
%D 2012
%C Germany
%I Springer
%V 16
%N 1
%P 47-58
%@ 1522-1709
%X RATIONALE: Predicting which patients with obstructive sleep apnea (OSA) will be successfully treated with mandibular advancement splints (MAS) remains elusive. Developing simple daytime measurements and tests to predict treatment outcome would enhance MAS treatment. OBJECTIVE: The purpose of this study was to assess the clinical utility of anthropomorphic measurements and cephalometric X-rays in the prediction of MAS treatment outcome in OSA. METHODS: Anthropomorphic measurements and cephalometric X-rays from 72 OSA patients who had presented to a tertiary referral sleep clinic were analyzed retrospectively. RESULTS: Treatment response was defined as ???50% reduction in Apnea/Hypopnea Index (AHI; criterion 1); ???50% reduction and residual AHI less than 20/h (criterion 2); ???50% reduction in AHI and residual AHI less than 10/h (criterion 3); and ???50% reduction in AHI and residual AHI less than 5/h (criterion 4). This was done to reflect the differences in the clinical definition of treatment success in the literature. A good response occurred in 56% (40 patients) according to criterion 1; 54% (39 patients) according to criterion 2; 46% (33 patients) according to criterion 3; or 39% (28 patients) according to criterion 4. Age and gender were found to be significant predictors for criteria 1 and 2. Age and soft palate length were found to be significant predictors for criteria 3 and 4. Equations to predict MAS treatment response were derived as equations were to predict final AHI. CONCLUSIONS: Certain cephalometric and anthropomorphic measurements impact on MAS treatment outcome. This study adds to the current literature and implies that MAS success is (to some degree) related to anatomical characteristics.
%Z FOR Codes: 110399 1105


%0 Journal Article
%~ PubMed
%A Le Guen, M C
%A Cistulli, P A
%A Berlowitz, D J
%T Continuous positive airway pressure requirements in patients with tetraplegia and obstructive sleep apnoea.
%B Spinal Cord
%D 2012
%C United Kingdom
%I Nature Publishing Group
%V 50
%N 11
%P 832-835
%@ 1476-5624
%X Study design:Clinic-based retrospective case-control study.Objectives:To compare continuous positive airway pressure (CPAP) requirements between patients with tetraplegia and able-bodied patients with obstructive sleep apnoea (OSA).Setting:Melbourne, Australia.Methods:Diagnostic and CPAP titration polysomnograms of 219 able-bodied, and 25 patients with tetraplegia and OSA were compared for apnoea hypopnoea index (AHI) and CPAP levels required to effectively treat OSA. Demographics and body mass index (BMI) were obtained for each patient. ASIA score and injury date were obtained for patients with tetraplegia.Results:There was no significant difference in AHI (P=0.102) between the two groups; however, able-bodied patients were significantly older (P=0.003), required significantly higher levels of CPAP to control their OSA (P<0.001) and had higher BMIs (P=0.009) than patients with tetraplegia. In the tetraplegia group, there was no significant correlation between AHI and effective CPAP (r=0.022, P=0.92) or between AHI and BMI (r=-0.196, P=0.35). There was a significant correlation between effective CPAP and BMI (r=0.411, P=0.041). Among able-bodied patients, over two-thirds (68.8%) required 10-16?cm H(2)0 to control their OSA and nearly one-third required over 16?cm H(2)0. In contrast, over two-thirds (68.8%) in the tetraplegia group required less than 10?cm H(2)0 of CPAP to control their OSA.Conclusion:This retrospective study suggests that OSA patients with tetraplegia require significantly less CPAP to treat their OSA at any given AHI than those who are able-bodied. This suggests that additional unknown factors may contribute to the high prevalence of OSA in tetraplegia.Spinal Cord advance online publication, 22 May 2012; doi:10.1038/sc.2012.57.
%Z FOR Codes: 110399


%0 Book Section
%A Cistulli, Peter
%A Sutherland, Kate
%A Chan, Andrew
%T Obstructive Sleep Apnea: Oral Appliances
%B Essentials of Sleep Medicine: An approach for Clinical Pulmonology
%D 2012
%C United States
%I Springer Science+Business Media,
%V 
%N 
%P 155-175
%@ 9781607617358
%E Badr, M. Safwan
%E Badr, M. Safwan
%E Badr, M. Safwan
%E Badr, M. Safwan
%X 
%Z FOR Codes: 100499


%0 Journal Article
%A Palnitkar, G
%A Zimmermann, S C
%A Cistulli, Peter
%T Obstructive sleep apnoea in adults: Identifying risk factors and tailoring therapy
%B Medicine Today
%D 2012
%C Australia
%I Medicine Today Pty. Ltd.
%V 13
%N 8
%P 14-23
%@ 1443-430X
%X 
%Z FOR Codes: 110203


%0 Book Section
%A Cistulli, Peter
%A Darendeliler, Ali
%T Oral Appliance Therapy for Snoring and Sleep Apnea
%B Sleep Apnea: Pathogenesis, Diagnosis and Treatment(2nd Ed)
%D 2012
%C United Kingdom
%I Informa Healthcare
%V 
%N 
%P 501-514
%@ 9780849396977
%E Pack, Allan I
%E Pack, Allan I
%E Pack, Allan I
%E Pack, Allan I
%X 
%Z FOR Codes: 110506


%0 Journal Article
%~ PubMed
%A Raynes-Greenow, Camille H
%A Hadfield, Ruth M
%A Cistulli, Peter A
%A Bowen, Jenny
%A Allen, Hugh
%A Roberts, Christine L
%T Sleep apnea in early childhood associated with preterm birth but not small for gestational age: a population-based record linkage study.
%B Sleep
%D 2012
%C United States
%I The American Academy of Sleep Medicine
%V 35
%N 11
%P 1475-1480
%@ 0161-8105
%X 
%Z FOR Codes: 111706 111403


%0 Journal Article
%~ PubMed
%A Barratt, D J
%A Harvey, L A
%A Cistulli, P A
%A Nier, L
%A Denis, S
%T The use of bronchodilators in people with recently acquired tetraplegia: a randomised cross-over trial.
%B Spinal Cord
%D 2012
%C United Kingdom
%I Nature Publishing Group
%V 50
%N 11
%P 836-839
%@ 1476-5624
%X Study design:A within-participant, double-blind, cross-over, randomised control trial.Objectives:To determine the short-term effects of bronchodilator therapy on respiratory function in people with recently acquired motor complete tetraplegia.Setting:Hospital, Australia.Methods:A total of 12 people with recently acquired tetraplegia were randomised to receive either a one-off dose of a bronchodilator followed by an equivalent dose of a placebo propellant between 1 day and 1 week later or visa versa. The three outcomes were forced expiratory volume in 1???s (FEV1), peak expiratory flow rate (PEF) and forced vital capacity (FVC). These were measured while supine by a blinded assessor 10 and 30???min after treatment. Data were analysed on 11 participants and reported as percentage of predicted.Results:The FEV1, FVC and PEF mean between-group differences (95% confidence interval) at 10???min post treatment were 7.3% (2.7-11.9%; P=0.003), 5.5% (1.6-9.4%; P=0.008) and 20.1% (1.1-40.4%; P=0.039). Similar effects were observed at 30???min for FVC and FEV1 but not for PEF.Conclusion:Bronchodilator therapy has a beneficial effect on FEV1, FVC and PEF in participants with recently acquired tetraplegia.Spinal Cord advance online publication, 29 May 2012; doi:10.1038/sc.2012.62.
%Z FOR Codes: 1103


%0 Journal Article
%~ PubMed
%A Sutherland, Kate
%A Deane, Sheryn A
%A Chan, Andrew S L
%A Schwab, Richard J
%A Ng, Andrew T
%A Darendeliler, M Ali
%A Cistulli, Peter A
%T Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea.
%B Sleep
%D 2011
%C United States
%I The American Academy of Sleep Medicine
%V 34
%N 4
%P 469-77
%@ 0161-8105
%X Oral appliances are increasingly being used for treatment of obstructive sleep apnea (OSA). Mandibular advancement splint (MAS) mechanically protrudes the mandible, while the tongue stabilizing device (TSD) protrudes and holds the tongue using suction. Although both appliances can significantly improve or ameliorate OSA, their comparative effects on upper airway structure have not been investigated.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Sutherland, Kate
%A Lee, Richard W W
%A Phillips, Craig L
%A Dungan, George
%A Yee, Brendon J
%A Magnussen, John S
%A Grunstein, Ronald R
%A Cistulli, Peter A
%T Effect of weight loss on upper airway size and facial fat in men with obstructive sleep apnoea.
%B Thorax
%D 2011
%C United Kingdom
%I BMJ Group
%V 66
%N 9
%P 797-803
%@ 0040-6376
%X Obstructive sleep apnoea (OSA) is commonly associated with obesity and can be improved by weight loss. Changes in upper airway size related to regional fat loss may mediate the improvement in OSA. This study aimed to assess changes in upper airway size and regional facial and abdominal fat with weight loss and their association with OSA improvement.
%Z FOR Codes: 111712 110203


%0 Journal Article
%~ PubMed
%A Mostafiz, Whitney
%A Dalci, Oyku
%A Sutherland, Kate
%A Malhotra, Atul
%A Srinivasan, Vasanth
%A Darendeliler, M Ali
%A Cistulli, Peter A
%T Influence of Oral and Craniofacial Dimensions on Mandibular Advancement Splint Treatment Outcome in Obstructive Sleep Apnea.
%B Chest
%D 2011
%C United States
%I American College of Chest Physicians
%V 139
%N 6
%P 1331-9
%@ 0012-3692
%X Mandibular advancement splints (MASs) can effectively treat obstructive sleep apnea (OSA); however, no validated and reliable prediction method for treatment outcome currently exists. The efficacy of MAS may relate to anatomic factors, including craniofacial size and upper-airway soft-tissue volume and anatomic balance between them. We aimed to assess whether craniofacial and oral measurements are associated with MAS treatment outcome.
%Z FOR Codes: 110399 1105


%0 Journal Article
%~ PubMed
%A Sutherland, K
%A Cistulli, P
%T Mandibular advancement splints for the treatment of sleep apnea syndrome.
%B Swiss Medical Weekly
%D 2011
%C Switzerland
%I E M H Schweizerischer Aerzteverlag AG
%V 141
%N 
%P w13276
%@ 1424-3997
%X Oral devices, in particular Mandibular Advancement Splints (MAS), which hold the mandible in a protruded position during sleep, are increasingly used for the treatment of Obstructive Sleep Apnoea (OSA). These devices can be effective in treating OSA across a range of severity. Complete resolution of OSA (Apnoea-Hypopnoea Index [AHI] reduced <5/hr) with use of an MAS occurs in around 40% of patients. Overall two thirds of patients experience some clinical benefit (?50% AHI reduction AHI) however others will not objectively respond to this form of treatment, despite improvement in symptoms. Although MAS are less efficacious in reducing polysomnographic indices of OSA than the standard treatment, Continuous Positive Airway Pressure (CPAP), improvements in health outcomes appear to be comparable. Therefore, the superiority of CPAP in improving oxygen desaturations and reducing AHI may be extenuated by its low compliance, resulting in both treatments having similar effectiveness in clinical practice. MAS are now recommended as a first line treatment for mild to moderate OSA, as well as in more severe patients who are unable to tolerate or refuse CPAP. Success with MAS treatment has been associated with factors such as female gender, younger age, supine-dependent OSA, lower BMI, smaller neck circumference and craniofacial factors, however a reliable, validated method for prediction in the clinical setting has yet to be established. MAS are well tolerated, however short-term side effects are common although generally minor and transient. Long-term dental changes are for the most part subclinical, but can be problematic for a minority of patients. MAS are a dental-based treatment for a medical sleep disorder and, as such, an interdisciplinary care model is considered important for the attainment of optimal patient outcomes.
%Z FOR Codes: 110399 1105


%0 Journal Article
%~ PubMed
%A Sutherland, Kate
%A Lee, Richard W W
%A Cistulli, Peter A
%T Obesity And Craniofacial Structure As Risk Factors For Obstructive Sleep Apnea - Impact Of Ethnicity.
%B Respirology (Carlton, Vic.)
%D 2011
%C Australia
%I Wiley-Blackwell Publishing Asia
%V 17
%N 2
%P 213-22
%@ 1440-1843
%X OSA is the result of structural and functional abnormalities that promote the repetitive collapse of the upper airway during sleep. This common disorder is estimated to occur in approximately 4% of men and 2% of women, with prevalence studies from North America, Australia, Europe and Asia indicating that occurrence is relatively similar across the globe. Anatomical factors, such as obesity and craniofacial morphology, are key determinants of the predisposition to airway collapse; however, their relative importance for OSA risk likely varies between ethnicities. Direct inter-ethnic studies comparing craniofacial phenotypes in OSA are limited. However, available data suggest that Asian OSA populations primarily display features of craniofacial skeletal restriction, African Americans display more obesity and enlarged upper airway soft tissues, while Caucasians show evidence of both bony and soft tissue abnormalities. Our recent comparison of Chinese and Caucasian OSA patients found for the same degree of OSA severity. Caucasians were more obese, and Chinese had more skeletal restriction. However, the ratio of obesity to craniofacial bony size (or anatomical balance, an important determinant of upper airway volume and OSA risk) was similar between Caucasians and Chinese OSA patients. Ethnicity appears to influence OSA craniofacial phenotype but furthermore the relative contribution of the anatomical factors underlying OSA risk. The skeletal restriction craniofacial phenotype may be particularly vulnerable to increasing obesity rates. Better understanding of craniofacial phenotypes encompassing ethnicity may help improve OSA recognition and treatment; however, further studies are needed to elucidate ethnic differences in OSA anatomical risk factors.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Elliott, Rosalind
%A McKinley, Sharon
%A Cistulli, Peter
%T The quality and duration of sleep in the intensive care setting: An integrative review.
%B International journal of nursing studies
%D 2011
%C United Kingdom
%I Pergamon
%V 
%N 3
%P 
%@ 1873-491X
%X BACKGROUND: Sleep is essential for well-being and recovery from illness. The critically ill are in significant need of sleep but at increased risk of sleep loss and disruption. OBJECTIVES: To determine the quality and duration of sleep experienced by adults who are patients in intensive care units and factors affecting their sleep. DESIGN: An integrative approach was used for this literature review in order to explore the available evidence on this topic, which has yet to be fully investigated. DATA SOURCES: PubMed, CINAHL, Psychinfo, the Australian Digital Theses Program and ProQuest Dissertations and Theses (Interdisciplinary) databases were searched for studies conducted about sleep in adult intensive care units. Manual searches of papers identified from this search were performed to find additional studies. REVIEW METHODS: Data related to the quality and duration of sleep along with study design, sample size and intensive care context were extracted, evaluated and summarised. RESULTS: Total sleep time is normal or reduced with significant fragmentation. Light sleep is prolonged and deep and rapid eye movement sleep are reduced. The most likely factors affecting sleep quality are high sound levels, frequent interventions and medications. Data obtained from polysomnography are supported by patient self reports. Considerable variation in data exists between patients and studies affecting generalizability. Existing criteria for staging sleep may be inadequate for quantifying sleep in intensive care patients. CONCLUSIONS: There is evidence that intensive care patients'' sleep is significantly disrupted. Alternative methods of quantifying sleep for intensive care patients may be required. Few large observational or interventional studies have used polysomnography and simultaneous recordings of intrinsic and extrinsic disruptive factors. These studies are required in order to improve sleep for intensive care patients.
%Z FOR Codes: 110310 110999


%0 Journal Article
%A Lee, Richard
%A Sutherland, Kate
%A Cistulli, Peter
%T Craniofacial Morphology in Obstructive Sleep Apnea: A Review
%B Clinical Pulmonary Medicine
%D 2010
%C United States
%I Lippincott Williams & Wilkins
%V 17
%N 4
%P 189-195
%@ 1068-0640
%X 
%Z FOR Codes: 110315


%0 Journal Article
%~ PubMed
%A Lee, Richard W W
%A Vasudavan, Sivabalan
%A Hui, David S
%A Prvan, Tania
%A Petocz, Peter
%A Darendeliler, M Ali
%A Cistulli, Peter A
%T Differences in craniofacial structures and obesity in Caucasian and Chinese patients with obstructive sleep apnea.
%B Sleep
%D 2010
%C United States
%I Associated Professional Sleep Societies, Llc
%V 33
%N 8
%P 1075-1080
%@ 0161-8105
%X STUDY OBJECTIVES: To explore differences in craniofacial structures and obesity between Caucasian and Chinese patients with obstructive sleep apnea (OSA). DESIGN: Inter-ethnic comparison study. SETTING: Two sleep disorder clinics in Australia and Hong Kong. PATIENTS: 150 patients with OSA (74 Caucasian, 76 Chinese). INTERVENTIONS: Anthropometry, cephalometry, and polysomnography were performed and compared. Subgroup analyses after matching for: (1) body mass index (BMI); (2) OSA severity. MEASUREMENTS AND RESULTS: The mean age and BMI were similar between the ethnic groups. Chinese patients had more severe OSA (AHI 35.3 vs 25.2 events/h, P = 0.005). They also had more craniofacial bony restriction, including a shorter cranial base (63.6 +/- 3.3 vs 77.5 +/- 6.7 mm, P < 0.001), maxilla (50.7 +/- 3.7 vs 58.8 +/- 4.3 mm, P < 0.001) and mandible length (65.4 +/- 4.2 vs 77.9 +/- 9.4 mm, P < 0.001). These findings remained after correction for differences in body height. Similar results were shown in the BMI-matched analysis (n = 66). When matched for OSA severity (n = 52), Chinese patients had more craniofacial bony restriction, but Caucasian patients were more overweight (BMI 30.7 vs 28.4 kg/m2, P = 0.03) and had a larger neck circumference (40.8 vs 39.1 cm, P = 0.004); however, the ratios of BMI to the mandible or maxilla size were similar. CONCLUSIONS: Craniofacial factors and obesity contribute differentially to OSA in Caucasian and Chinese patients. For the same degree of OSA severity, Caucasians were more overweight, whereas Chinese exhibited more craniofacial bony restriction.
%Z FOR Codes: 110506


%0 Journal Article
%~ PubMed
%A Cistulli, Peter A
%A Phillips, Craig L
%T Expanding the Clinical Spectrum of OSA – An Association with Pulmonary
Embolism?
%B Sleep
%D 2010
%C United States
%I The American Academy of Sleep Medicine
%V 33
%N 8
%P 1009-1010
%@ 0161-8105
%X 
%Z FOR Codes: 1102 1103


%0 Journal Article
%~ PubMed
%A Chan, A S L
%A Phillips, C L
%A Cistulli, P A
%T Obstructive sleep apnoea--an update.
%B Internal Medicine Journal
%D 2010
%C Australia, United Kingdom, Netherlands, United States
%I Wiley-Blackwell Publishing Asia
%V 40
%N 2
%P 102-6
%@ 1445-5994
%X Obstructive sleep apnoea (OSA) is a common disorder characterized by the repetitive complete or partial collapse of the upper airway during sleep. It results in intermittent hypoxaemia and hypercapnia, cortical arousals and surges of sympathetic activity. The occurrence of OSA has also been linked to serious long-term adverse health consequences; such as hypertension, metabolic dysfunction, cardiovascular disease, neurocognitive deficits and motor vehicle accidents. There have been several advances in the field of particular clinical importance: (i) the development of portable monitoring as part of a simplified clinical algorithm for the diagnosis of OSA in selected patients; (ii) growing awareness of the cardio-metabolic health consequences of OSA and (iii) emerging evidence to support a range of non-continuous positive airway pressure (CPAP) treatment modalities, such as oral appliances.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Lee, Richard W W
%A Sutherland, Kate
%A Chan, Andrew S L
%A Zeng, Biao
%A Grunstein, Ronald R
%A Darendeliler, M Ali
%A Schwab, Richard J
%A Cistulli, Peter A
%T Relationship between surface facial dimensions and upper airway structures in obstructive sleep apnea.
%B Sleep
%D 2010
%C United States
%I The American Academy of Sleep Medicine
%V 33
%N 9
%P 1249-1254
%@ 0161-8105
%X STUDY OBJECTIVES: We hypothesized that the facial phenotype is closely linked to upper airway anatomy. The aim of this study was to investigate the relationship between surface facial dimensions and upper airway structures using magnetic resonance imaging (MRI) in subjects with obstructive sleep apnea (OSA). DESIGN: Cohort study. SETTING: Sleep investigation unit. PATIENTS: Sixty-nine patients (apnea-hypopnea index > or = 10/h) underwent MRI as part of a study of upper airway anatomy in oral appliance therapy. INTERVENTIONS: Measurements of a range of surface facial dimensions and upper airway soft tissue volumes were performed on the MR images using image-analysis software. Pearson correlation analyses were performed. MEASUREMENTS AND RESULTS: Significant correlations were identified between a number of surface facial dimensions and neck circumference. Significant positive correlations were demonstrated between surface facial dimensions (including facial widths, facial heights, nose width, interocular and intercanthal widths) and upper airway structures. The strongest associations were between the tongue volume and the midface width (r = 0.70, P < 0.001), and lower-face width (r = 0.60, P <0.001). Surface facial dimensions in combination were also strong determinants for tongue volume (r2 = 0.69). Correlations between surface soft tissue thickness and upper airway soft tissue volumes occurred at the level of the midface but not at the level of the lower face. CONCLUSIONS: This study demonstrates that there is a relationship between surface facial dimensions and upper airway structures in subjects with OSA. These findings support the potential role of surface facial measurements in anatomic phenotyping for OSA.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Chan, Andrew S L
%A Sutherland, Kate
%A Schwab, Richard J
%A Zeng, Biao
%A Petocz, Peter
%A Lee, Richard W W
%A Darendeliler, M Ali
%A Cistulli, Peter A
%T The effect of mandibular advancement on upper airway structure in obstructive sleep apnoea.
%B Thorax
%D 2010
%C United Kingdom
%I BMJ Group
%V 65
%N 8
%P 726-732
%@ 0040-6376
%X Background The mechanisms by which mandibular advancement splints (MAS) improve obstructive sleep apnoea (OSA) are not well understood. This study aimed to evaluate the mechanism of action of MAS by assessing their effect on upper airway structure in patients with OSA. Methods Patients were recruited from a sleep disorders clinic for treatment with a custom-made MAS. MRI of the upper airway was performed during wakefulness in the supine position, with and without the MAS. Results Sixty-nine patients with OSA were recruited. Treatment with the MAS reduced the apnoea-hypopnoea index (AHI) from 27.0+/-14.7 events/h to 12.2+/-12.5 events/h (p<0.001). There was an increase in the total airway volume with mandibular advancement (16.5+/-0.7 cm(3) vs 18.1+/-0.8 cm(3); p<0.01) that occurred predominantly because of an increase in the volume of the velopharynx (5.7+/-0.3 cm(3) vs 6.5+/-0.3 cm(3); p<0.001). This increase in airway calibre was associated with an increase in the lower anterior facial height (6.8+/-0.1 cm vs 7.5+/-0.1 cm; p<0.001), reduction in the distance between the hyoid and posterior nasal spine (7.4+/-0.1 cm vs 7.2+/-0.1 cm; p<0.001), lateral displacement of the parapharyngeal fat pads away from the airway (right parapharyngeal fat pad 0.17+/-0.02 cm; left parapharyngeal fat pad 0.22+/-0.02 cm) and anterior movement of the tongue base muscles (0.33+/-0.03 cm). Subanalyses in responders and non-responders to MAS treatment showed that the increase in upper airway calibre with mandibular advancement occurred only in responders. Conclusion These results suggest that the mechanism of action of MAS is to increase the volume of the upper airway, predominantly by increasing the volume of the velopharynx, and this increased volume is associated with changes in the surrounding bony and soft tissue structures.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Chan, Andrew S L
%A Lee, Richard W W
%A Srinivasan, Vasantha K
%A Darendeliler, M Ali
%A Cistulli, Peter A
%T Use of flow-volume curves to predict oral appliance treatment outcome in obstructive sleep apnea: a prospective validation study.
%B Sleep & breathing = Schlaf & Atmung
%D 2010
%C Germany
%I Springer
%V 15
%N 
%P 157-62
%@ 1522-1709
%X Flow-volume curves have been shown to relate to upper airway physiology during sleep and may be useful for predicting the response to treatment of obstructive sleep apnea (OSA) with mandibular advancement splints (MAS). The aim of this study was to prospectively assess the potential clinical utility of a previously derived prediction method using flow-volume curves performed during wakefulness.
%Z FOR Codes: 110399


%0 Book Section
%A Lavigne, Gilles J
%A Heinzer, Raphael C
%A Cistulli, Peter
%A Smith, Michael T
%T Classification of sleep disorders
%B Sleep Medicine for Dentists. A Practical Overview
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 21-31
%@ 9780867154870
%E Lavigne, Gilles J
%E Cistulli, Peter A
%E Smith, Michael T
%X 
%Z FOR Codes: 110399


%0 Book Section
%A Lee, Richard W W
%A Chan, Andrew S L
%A Cistulli, Peter
%T Clinical approach to diagnosis of obstructive sleep apnea
%B Sleep Medicine for Dentists. A Practical Overview
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 53-59
%@ 9780867154870
%E Lavigne, Gilles J
%E Cistulli, Peter A
%E Smith, Michael T
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Deane, Sheryn A
%A Cistulli, Peter A
%A Ng, Andrew T
%A Zeng, Biao
%A Petocz, Peter
%A Darendeliler, M Ali
%T Comparison of mandibular advancement splint and tongue stabilizing device in obstructive sleep apnea: a randomized controlled trial.
%B Sleep
%D 2009
%C United States
%I The American Academy of Sleep Medicine
%V 32
%N 5
%P 648-653
%@ 0161-8105
%X STUDY OBJECTIVES: To compare the efficacy of a mandibular advancement splint (MAS) and a novel tongue stabilizing device (TSD) in the treatment of obstructive sleep apnea (OSA). DESIGN: A randomized crossover design was used. PATIENTS: Twenty-seven patients (20 male, 7 female), recruited from a tertiary hospital sleep clinic. MEASUREMENTS AND RESULTS: The apnea-hypopnea index (AHI) was reduced with MAS (11.68 +/- 8.94, P = 0.000) and TSD (13.15 +/- 10.77, P = 0.002) compared with baseline (26.96 +/- 17.17). The arousal index decreased for MAS (21.09 +/- 9.27, P = 0.004) and TSD (21.9 +/- 10.56, P = 0.001) compared with baseline (33.23 +/- 16.41). Sixty-eight percent of patients achieved a complete or partial response with MAS, compared with 45% with TSD. The Epworth Sleepiness Scale (ESS) score was decreased with MAS (P = < 0.001) and TSD (P = 0.002). Subjective improvements in snoring and quality of sleep were reported, with a better response for MAS than TSD. Compliance was poorer for TSD, and the side effect profiles of the 2 modalities were different. All patients were satisfied with MAS compared to TSD, and 91% of patients preferred the MAS. CONCLUSION: Objective testing showed the MAS and TSD had similar efficacy in terms of AHI reduction. Patients reported improvements with both devices; however, better compliance and a clear preference for MAS was apparent when both devices were offered. Longer term studies are needed to clarify the role of TSD.
%Z FOR Codes: 110399 110599 111699


%0 Journal Article
%~ PubMed
%A Lee, Richard W W
%A Chan, Andrew S L
%A Grunstein, Ronald R
%A Cistulli, Peter A
%T Craniofacial phenotyping in obstructive sleep apnea--a novel quantitative photographic approach.
%B Sleep
%D 2009
%C United States
%I The American Academy of Sleep Medicine
%V 32
%N 1
%P 37-45
%@ 0161-8105
%X STUDY OBJECTIVES: To compare the craniofacial morphological phenotype of subjects with and without obstructive sleep apnea (OSA) using a quantitative photographic analysis technique. DESIGN: Case-control study; subgroup matched for body mass index (BMI) and sex. SETTING: Sleep investigation unit in a university teaching hospital. PATIENTS: 114 subjects (93% Caucasian) with OSA (apnea-hypopnea index [AHI] > or = 10/h) and 66 controls (AHI < 10/h). INTERVENTIONS: Standardized frontal-profile craniofacial photographic imaging performed prior to polysomnography. Photographs were analyzed for the computation of linear, angular, area and polyhedral volume measurements representing dimensions and relationships of the various craniofacial regions. MEASUREMENTS AND RESULTS: Photographic craniofacial phenotypic differences were demonstrated between OSA and control subjects, including a range of measurements of the face, mandible, maxilla, eyes, nose, head and neck. After 1-for-1 subgroup matching for BMI and sex (51 subjects in each group), mandibular length 1 (6.21 +/- 0.08 [mean +/- SEM] vs. 6.58 +/- 0.08 cm, P = 0.006), mandibular-nasion angle 1 (35.0 +/- 0.48 vs. 36.7 +/- 0.37 degrees, P = 0.006) and anterior neck space area (10.2 +/- 0.53 vs. 12.2 +/- 0.52 cm2, P = 0.01) remained smaller in the OSA group. Mandibular width-length angle (88.0 +/- 0.75 vs. 85.3 +/- 0.54 degrees, P = 0.005) and face width-midface depth angle (72.3 +/- 0.44 vs. 70.7 +/- 0.39 degrees, P = 0.01) remained larger in the OSA group, whereas mandibular triangular area (39.2 +/- 0.63 vs. 41.7 +/- 0.74 cm2, P = 0.01) was smaller. CONCLUSIONS: Craniofacial phenotypic differences in OSA in Caucasian subjects can be demonstrated using a photographic analysis technique.
%Z FOR Codes: 110399


%0 Book Section
%A Darendeliler, M Ali
%A Cheng, Lam L
%A Pirelli, Paolo
%A Cistulli, Peter
%T Dentofacial orthopedics
%B Sleep Medicine for Dentists. A Practical Overview
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 85-91
%@ 9780867154870
%E Lavigne, Gilles J
%E Cistulli, Peter A
%E Smith, Michael T
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Chan, A S L
%A Lee, R W W
%A Srinivasan, V K
%A Darendeliler, M A
%A Grunstein, R R
%A Cistulli, P A
%T Nasopharyngoscopic evaluation of oral appliance therapy for obstructive sleep apnoea.
%B The European respiratory journal : official journal of the European Society for Clinical Respiratory Physiology
%D 2009
%C Switzerland
%I European Respiratory Society
%V 35
%N 4
%P 836-42
%@ 1399-3003
%X This study aimed to explore the effect of mandibular advancement splints (MAS) on upper airway anatomy during wakefulness in obstructive sleep apnoea (OSA). Patients commencing treatment for OSA with MAS were recruited. Response to treatment was defined by a >or=50% reduction in the apnoea/hypopnoea index. Nasopharyngoscopy was performed in the supine position. Nasopharyngoscopy was performed in 18 responders and 17 nonresponders. Mandibular advancement caused an increase in the calibre of the velopharynx (mean+/- sem +40+/-10%), with relatively minor changes occurring in the oropharynx and hypopharynx. An increase in cross-sectional area of the velopharynx with mandibular advancement occurred to a greater extent in responders than nonresponders (+56+/-16% versus +22+/-13%; p<0.05). Upper airway collapse during the M??ller manoeuvre, relative to the baseline cross-sectional area, was greater in nonresponders than responders in the velopharynx (-94+/-4% versus -69+/-9%; p<0.01) and oropharynx (-37+/-6% versus -16+/-3%; p<0.01). When the M??ller manoeuvre was performed with mandibular advancement, airway collapse was greater in nonresponders than responders in the velopharynx (-80+/-11% versus +9+/-37%; p<0.001), oropharynx (-36+/-6% versus -20+/-5%; p<0.05) and hypopharynx (-64+/-6% versus -42+/-6%; p<0.05). These results indicate that velopharyngeal calibre is modified by MAS treatment and this may be useful for predicting treatment response.
%Z FOR Codes: 110506 110315


%0 Journal Article
%~ PubMed
%A Gunaratnam, Kogulan
%A Taylor, Barbara
%A Curtis, Bradley
%A Cistulli, Peter
%T Obstructive sleep apnoea and periodontitis: a novel association?
%B Sleep and Breathing
%D 2009
%C Germany
%I Springer
%V 13
%N 3
%P 233-239
%@ 1522-1709
%X PURPOSE: Since both obstructive sleep apnoea (OSA) and periodontitis are associated with systemic inflammation and cardiovascular morbidity, we questioned whether there may be an association between these two disorders. MATERIALS AND METHODS: A standard periodontal examination was undertaken in a group of 66 (54 men and 12 women) treatment-na??ve patients diagnosed with OSA [apnoea-hypopnoea index (AHI) >5/h] to derive a number of quantitative variables which could then be used to determine the prevalence of periodontitis in a group of patients. RESULTS: The prevalence of periodontitis in our study group was 77-79%, depending on the definition used. This was almost four times that of historical controls derived from a recent national survey. When sleep-related variables were compared against periodontal variables, significant correlations were found between periodontal clinical attachment level and total sleep time. CONCLUSION: Our pilot study suggests that OSA is associated with periodontitis. Further research is needed to elucidate the nature of this association.
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Chan, Andrew
%A Cistulli, Peter
%T Oral appliance treatment of obstructive sleep apnea: an update.
%B Current Opinion in Pulmonary Medicine
%D 2009
%C United States
%I Lippincott Williams & Wilkins
%V 15
%N 6
%P 591-596
%@ 1531-6971
%X PURPOSE OF REVIEW: Oral appliances are an alternative to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA). Although CPAP is a highly efficacious treatment, there is a need for other treatment options because the clinical effectiveness of CPAP is often limited by poor patient acceptance and tolerance, and suboptimal compliance. RECENT FINDINGS: There has been an expansion of the research evidence to support the use of oral appliances in clinical practice. Recent work has focused on the following clinically relevant areas: the effect of device design on efficacy and patient compliance, the role of different modalities for assessing the upper airway in the prediction of treatment outcome, the assessment of the impact of treatment on a range of health outcomes and the evaluation of long-term adverse effects. SUMMARY: There is robust evidence of the efficacy of oral appliances for improving polysomnographic indices and modifying the health risk associated with OSA. The current evidence suggests a similar impact on health outcomes as CPAP. However, further research is required to address a number of unresolved issues, including the influence of device design, titration procedures, prediction of treatment outcome and the clinical effectiveness of oral appliances for modifying the adverse health consequences of OSA.
%Z FOR Codes: 110399 110506


%0 Book Section
%A Marklund, Marie
%A Cistulli, Peter
%T Oral appliances
%B Sleep Medicine for Dentists. A Practical Overview
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 77-84
%@ 9780867154870
%E Lavigne, Gilles J
%E Cistulli, Peter A
%E Smith, Michael T
%X 
%Z FOR Codes: 110399


%0 Book Section
%A Chan, Andrew S L
%A Lee, Richard W W
%A Lavigne, Gilles J
%A Cistulli, Peter
%T Pathophysiology of obstructive sleep apnea
%B Sleep Medicine for Dentists. A Practical Overview
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 41-46
%@ 9780867154870
%E Lavigne, Gilles J
%E Cistulli, Peter A
%E Smith, Michael T
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Lee, Richard W W
%A Petocz, Peter
%A Prvan, Tania
%A Chan, Andrew S L
%A Grunstein, Ronald R
%A Cistulli, Peter A
%T Prediction of obstructive sleep apnea with craniofacial photographic analysis.
%B Sleep
%D 2009
%C United States
%I The American Academy of Sleep Medicine
%V 32
%N 1
%P 46-52
%@ 0161-8105
%X STUDY OBJECTIVES: To develop models based on craniofacial photographic analysis for the prediction of obstructive sleep apnea (OSA). DESIGN: Prospective cohort study. SETTING: Sleep investigation unit in a university teaching hospital. PATIENTS: One hundred eighty subjects (95.6% Caucasian) referred for the initial investigation of OSA were recruited consecutively. INTERVENTIONS: Clinical assessment and frontal-profile craniofacial photographic analyses were performed prior to polysomnography. Prediction models for determining the presence of OSA (apnea-hypopnea index [AHI] > or =10) were developed using logistic regression analysis and classification and regression trees (CART). MEASUREMENTS AND RESULTS: Obstructive sleep apnea was present in 63.3% of subjects. Using logistic regression, a model with 4 photographic measurements (face width, eye width, cervicomental angle, and mandibular length 1) correctly classified 76.1% of subjects with and without OSA (sensitivity 86.0%, specificity 59.1%, area under the receiver operating characteristics curve [AUC] 0.82). Combination of photographic and other clinical data improved the prediction (AUC 0.87), whereas prediction based on clinical assessment alone was lower (AUC 0.78). The optimal CART model provided a similar overall classification accuracy of 76.7%. Based on this model, 59.4% of the subjects were classified as either high or low risk with positive predictive value of 90.9% and negative predictive value of 94.7%, respectively. The remaining 40.6% of subjects have intermediate risk of OSA. CONCLUSIONS: Craniofacial photographic analysis provides detailed anatomical data useful in the prediction of OSA. This method allows OSA risk stratification by craniofacial morphological phenotypes.
%Z FOR Codes: 110399


%0 Book
%A Lavigne, Gilles J
%A Cistulli, Peter
%A Smtih, Michael T
%T Sleep Medicine for Dentists. A Practical Overview
%B 
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 
%@ 9780867154870
%X 
%Z FOR Codes: 110399


%0 Book Section
%A Chan, Andrew S L
%A Lee, Richard W W
%A Cistulli, Peter
%T Sleep-related breathing disorders
%B Sleep Medicine for Dentists. A Practical Overview
%D 2009
%C United States
%I Quintessence
%V 
%N 
%P 35-40
%@ 9780867154870
%E Lavigne, Gilles J
%E Cistulli, Peter A
%E Smith, Michael T
%X 
%Z FOR Codes: 110399


%0 Journal Article
%~ PubMed
%A Zeng, Biao
%A Ng, Andrew T
%A Qian, Jin
%A Petocz, Peter
%A Darendeliler, M Ali
%A Cistulli, Peter A
%T Influence of nasal resistance on oral appliance treatment outcome in obstructive sleep apnea.
%B Sleep
%D 2008
%C United States
%I American Academy Sleep Medicine
%V 31
%N 4
%P 543-547
%@ 0161-8105
%X It has been recognized that nasal airway resistance (NAR) is elevated in patients with OSA. However, little is known regarding the influence of nasal resistance on mandibular advancement splint (MAS) treatment outcome in OSA patient. We hypothesized that nasal resistance differs between MAS responders and nonresponders and therefore may influence treatment outcome. Thirty-eight patients with known OSA underwent polysomnography while wearing a custom-made MAS. Treatment outcome was defined as follows: Responders (R) > or =50% reduction in AHI, and Nonresponders (NR) as <50% reduction in AHI. NAR was measured using posterior rhinomanometry in both sitting and supine positions, with and without MAS. The mean AHI in 26 responders was significantly reduced from 29.0 +/- 2.9/h to 6.7 +/- 1.2/h; P < 0.01). In 12 nonresponders there was no significant change in AHI (23.9 +/- 3.0/h vs 22.0 +/- 4.3/h; P=ns). Baseline NAR was significantly lower in responders in the sitting position compared to nonresponders (6.5 +/- 0.5 vs 9.4 +/- 1.0 cm H2O; P < 0.01). There was no significant change in NAR (from baseline) with MAS in either response group while in the sitting position, but in the supine position NAR increased significantly with MAS in the nonresponder group (11.8 +/- 1.5 vs. 13.8 +/- 1.6 cm H2O/L/s; P < 0.01). Logistic regression analysis revealed that NAR and BMI were the most important predictive factors for MAS treatment outcome. These data suggest that higher levels of NAR may negatively impact on treatment outcome with MAS.
%Z FOR Codes: 110399 110315 110506


%0 Journal Article
%~ PubMed
%A Chan, Andrew S L
%A Lee, Richard W W
%A Cistulli, Peter A
%T Non-positive airway pressure modalities: mandibular advancement devices/positional therapy.
%B Proceedings of the American Thoracic Society
%D 2008
%C United States
%I American Thoracic Society
%V 5
%N 2
%P 179-184
%@ 1546-3222
%X Although positive airway pressure is the most efficacious treatment for obstructive sleep apnea (OSA), its clinical effectiveness is limited by its obtrusive interface. Two alternative treatment modalities used in clinical practice are mandibular advancement devices (MADs) and positional therapy. The goals in treatment of OSA are to prevent obstructive apneas and hypopneas, to improve symptoms, and to modify the increased cardiovascular risk. MADs achieve this by mechanically protruding the mandible, thereby increasing the dimensions of the upper airway and reducing its collapsibility. By avoiding supine sleep, positional therapy improves the patency of the upper airway in those with positional OSA. There is now a relatively strong evidence base to support the use of MADs in clinical practice, with research studies assessing the impact of treatment on a range of health outcomes. The revised clinical practice parameters of the American Academy of Sleep Medicine recommend their use for mild to moderate OSA; or for patients with severe OSA who are unable to tolerate or refuse treatment with positive airway pressure. The evidence base for positional therapy is emerging, but is less well developed. A better understanding of the range of OSA phenotypes and predictors of response to different treatment modalities is required to allow physicians to tailor the choice of treatment to the individual patient.
%Z FOR Codes: 110399 110506


%0 Journal Article
%~ PubMed
%A Gunaratnam, Kogulan
%A Taylor, Barbara
%A Cistulli, Peter
%A Curtis, Bradley
%T Periodontitis and sleep apnoea.
%B Annals of the Royal Australasian College of Dental Surgeons
%D 2008
%C Australia
%I Royal Australasian College of Dental Surgeons Inc.
%V 19
%N 
%P 48-49
%@ 0158-1570
%X 
%Z FOR Codes: 110508


%0 Journal Article
%~ PubMed
%A Hammond, Roger J
%A Gotsopoulos, Helen
%A Shen, Gang
%A Petocz, Peter
%A Cistulli, Peter A
%A Darendeliler, M Ali
%T A follow-up study of dental and skeletal changes associated with mandibular advancement splint use in obstructive sleep apnea.
%B American journal of orthodontics and dentofacial orthopedics : official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics
%D 2007
%C United States
%I Mosby, Inc
%V 132
%N 6
%P 806-814
%@ 1097-6752
%X INTRODUCTION: Mandibular advancement splints (MAS) are a recognized therapeutic option in the treatment of obstructive sleep apnea (OSA). This study aimed to investigate side effects and possible changes in the dentofacial complex associated with long term use of MAS. METHODS: The sample included 64 patients with OSA who had been using MAS on average for 25.1 +/- 11.8 months (range, 10.7-64.5 months). A specifically designed questionnaire was used to investigate the patients'' self-assessment of the side effects of wearing MAS; cephalometric analyses and dental cast measurements were conducted to identify objectively dental and skeletal changes caused by MAS over time. RESULTS: The most commonly reported side effects were jaw discomfort, tooth tenderness, excessive salivation, and dry mouth. Subjectively, snoring improved in 56 patients (88%), and daytime sleepiness (Epworth sleepiness scale) scores significantly decreased from pretreatment to follow-up (11.4-7.1, P <.001). Small subjective occlusal changes were experienced by 8 patients (12.5%). Reductions in overbite (-0.3 +/- 0.08 mm, P <.01) and overjet (-0.2 +/- 0.06 mm, P <.05) were found, and cephalometric analysis showed statistically significant but clinically insignificant changes limited to anterior movement of the mandibular incisors (0.5 +/- 0.12 mm, P <.001). CONCLUSIONS: Side effects of MAS use over long periods are common but mild and well tolerated by most patients, and dentofacial changes are negligible.
%Z FOR Codes: 110203 110599


%0 Journal Article
%~ PubMed
%A Chan, Andrew S L
%A Lee, Richard W W
%A Cistulli, Peter A
%T Dental appliance treatment for obstructive sleep apnea.
%B Chest
%D 2007
%C United States
%I American College of Chest Physicians
%V 132
%N 2
%P 693-699
%@ 0012-3692
%X Oral appliances for the treatment of obstructive sleep apnea (OSA) are worn during sleep to maintain the patency of the upper airway by increasing its dimensions and reducing its collapsibility. Oral appliances are a simpler alternative to continuous positive airway pressure (CPAP). Over the last decade, there has been a significant expansion of the evidence base to support the use of oral appliances, with robust studies demonstrating their efficacy. This work has been underpinned by the recognition of the importance of upper airway anatomy in the pathophysiology of OSA. The updated practice parameters of the American Academy of Sleep Medicine now recommend their use for mild-to-moderate OSA, or for patients with severe OSA who are unable to tolerate CPAP or refuse treatment with CPAP. Oral appliances have been shown to have a beneficial impact on a number of important clinical end points, including the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, BP, aspects of neuropsychological functioning, and quality of life. Elucidation of the mechanism of action of oral appliances has provided insight into the factors that predict treatment response and may improve the selection of patients for this treatment modality. Longitudinal studies to characterize the long-term adverse effects of oral appliance use are now beginning to emerge. Although less efficacious than CPAP for improving the polysomnographic indexes of OSA, oral appliances are generally preferred by patients. This has the potential to translate to better patient adherence and may provide an equivalent health outcome.
%Z FOR Codes: 110399


%0 Book Section
%A Cistulli, Peter
%A Darendeliler, Ali
%T Oral Appliances
%B Obstructive Sleep Apnea: Diagnosis, and Treatment
%D 2007
%C United States
%I Informa Healthcare
%V 
%N 
%P 217-232
%@ 9780849391828
%E Kushida, Clete A
%X 
%Z FOR Codes: 110501


%0 Journal Article
%~ PubMed
%A Zeng, Biao
%A Ng, Andrew T
%A Darendeliler, M Ali
%A Petocz, Peter
%A Cistulli, Peter A
%T Use of flow-volume curves to predict oral appliance treatment outcome in obstructive sleep apnea.
%B American journal of respiratory and critical care medicine
%D 2007
%C 1740 Broadway, New Y
%I Amer Thoracic Soc
%V 175
%N 7
%P 726-730
%@ 1535-4970
%X BACKGROUND: It has been recognized that mandibular advancement splint (MAS) treatment is effective in some, but not all, patients with obstructive sleep apnea (OSA). Hence there is a need for a simple and reliable clinical tool to assist in the differentiation of treatment responses. We hypothesized that abnormalities of flow-volume curves, together with other clinical variables, may have clinical utility in the prediction of MAS treatment outcome. METHODS: Fifty-four patients with known OSA underwent MAS treatment. Expiratory and inspiratory flow-volume curves were measured in the erect and supine positions to derive midinspiratory flow (MIF(50)) and the ratio of expiratory to inspiratory flow at 50% of vital capacity (MEF(50):MIF(50)). Multivariable logistic regression was performed to identify additional significant clinical variables in the prediction of treatment outcome. RESULTS: The mean (+/- SD) apnea-hypopnea index (AHI) in 35 responders was significantly reduced from 28.9 +/- 13.7 to 6.7 +/- 5.8/hour (p<0.001). In 19 nonresponders there was no significant change in AHI. MIF(50) was lower (6.04 +/- 1.80 vs. 6.88 +/- 1.08 L/second; p=0.035) and the MEF(50):MIF(50) ratio was higher (0.82 +/- 0.23 vs. 0.61 +/- 0.15; p=0.001) in responders than nonresponders. Logistic regression analysis revealed that the MEF(50):MIF(50) ratio was the most important predictive factor for MAS treatment outcome, but that body mass index, age, and baseline AHI were also contributory. CONCLUSIONS: These data suggest that flow-volume curves, in combination with other factors such as body mass index, age, and baseline AHI, may have a useful clinical role in the prediction of treatment outcome with MAS.
%Z FOR Codes: 110203 110599 111699