Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular

Introduction: Obstructive sleep apnea (OSA) is a common disorder characterized by episodes of upper airway obstruction, leading to oxygen desaturation, disrupted sleep, and systemic complications. Although continuous positive airway pressure (CPAP) is the standard treatment for OSA, mandibular advan...

Descripción completa

Detalles Bibliográficos
Autor: Camañes-Gonzalvo, Sara
Tipo de recurso: tesis doctoral
Fecha de publicación:2025
País:España
Institución:Universitat de València
Repositorio:RODERIC. Repositorio Institucional de la Universitat de València
OAI Identifier:oai:dnet:roderic_____::06174feae702a207e10f7c130cf3e979
Acceso en línea:https://hdl.handle.net/10550/111048
Access Level:acceso abierto
Palabra clave:obstructive sleep apnea
apnea obstructiva sueño
mandibular advancement devices
dispositivos de avance mandibular
UNESCO::CIENCIAS MÉDICAS
id ES_7357116d3be3ef6b1a0605f5679b939c
oai_identifier_str oai:dnet:roderic_____::06174feae702a207e10f7c130cf3e979
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
title Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
spellingShingle Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
Camañes-Gonzalvo, Sara
obstructive sleep apnea
apnea obstructiva sueño
mandibular advancement devices
dispositivos de avance mandibular
UNESCO::CIENCIAS MÉDICAS
title_short Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
title_full Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
title_fullStr Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
title_full_unstemmed Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
title_sort Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibular
dc.creator.none.fl_str_mv Camañes-Gonzalvo, Sara
author Camañes-Gonzalvo, Sara
author_facet Camañes-Gonzalvo, Sara
author_role author
dc.contributor.none.fl_str_mv Bellot Arcís , Carlos
Marco Pitarch , Rocío
García Selva , Marina
Departament d'Estomatologia
dc.subject.none.fl_str_mv obstructive sleep apnea
apnea obstructiva sueño
mandibular advancement devices
dispositivos de avance mandibular
UNESCO::CIENCIAS MÉDICAS
topic obstructive sleep apnea
apnea obstructiva sueño
mandibular advancement devices
dispositivos de avance mandibular
UNESCO::CIENCIAS MÉDICAS
description Introduction: Obstructive sleep apnea (OSA) is a common disorder characterized by episodes of upper airway obstruction, leading to oxygen desaturation, disrupted sleep, and systemic complications. Although continuous positive airway pressure (CPAP) is the standard treatment for OSA, mandibular advancement devices (MADs) present an effective alternative for patients who cannot tolerate CPAP or reject surgery. However, the effectiveness of MADs varies, with a success rate of 60-70%. Identifying phenotypic predictors is crucial for optimizing patient selection and improving therapeutic outcomes. This thesis aims to establish predictive factors to guide clinical decision-making in MAD treatment for OSA. Objectives: The goal of this research is to analyze the phenotypic characteristics that differentiate responders to MAD treatment from non-responders in OSA through four studies: 1. Systematic review and meta-analysis of predictors of MAD efficacy. 2. Analysis of polysomnographic phenotypes and their integration into predictive models. 3. Evaluation of anatomical and physiological characteristics of the airway. 4. Classification of OSA subgroups and assessment of the impact of facial morphology on MAD efficacy. Materials and Methods: - Study 1: A systematic review and meta-analysis were conducted, including studies on MAD efficacy. Clinical, anatomical, and polysomnographic predictors were analyzed, and the quality was assessed using Newcastle-Ottawa, Cochrane, and GRADE tools. - Studies 2 and 3: A prospective analysis of patients treated with MAD over six years was carried out. Logistic regression and CHAID analysis were used to define predictive models based on clinical, anatomical, and polysomnographic variables. - Study 4: A retrospective analysis classified OSA subgroups using K-means clustering. Results: - Study 1: Of 99 studies, 60 were included in the meta-analysis. Responders were younger, with lower BMI, cervical circumference, facial height, hyoid-C3 distance, and minimal cross-sectional area of the airway (CSAmin), along with higher minimum oxygen saturation. Responders also required lower CPAP pressures. - Study 2: In 112 patients, the response rate was higher in positional OSA and lower in REM-dependent OSA or OSA with predominant apneas. Key predictors included T90% and positional OSA in the first definition of response, BMI and apnea-predominant phenotype in the second. CHAID analysis established clinically relevant cutoff values. - Study 3: Predictive models were based on airway length, anterior facial height, and basal T90% (first definition of response); Jarabak index, gonion angle, CSAmin, basal BMI, and basal AHI (second definition). - Study 4: Two subgroups were identified. Subgroup 1, with more severe OSA (higher BMI, T90%, and AHI), vertical facial pattern, and narrower airways, exhibited lower therapeutic success. Facial morphology influenced response, with dolichofacial pattern patients showing the lowest success rate. Conclusions: This thesis identified phenotypic factors that influence the efficacy of MAD treatment in OSA. Predictive models could enhance patient selection and optimize therapeutic outcomes. Future research should validate these models in prospective studies.
publishDate 2025
dc.date.none.fl_str_mv 2025
2025
2025
2025
dc.type.none.fl_str_mv doctoral thesis
info:eu-repo/semantics/doctoralThesis
format doctoralThesis
dc.identifier.none.fl_str_mv https://hdl.handle.net/10550/111048
url https://hdl.handle.net/10550/111048
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
open access
info:eu-repo/semantics/openAccess
rights_invalid_str_mv Attribution-NonCommercial-NoDerivatives 4.0 International
http://creativecommons.org/licenses/by-nc-nd/4.0/
open access
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv 299 p.
application/pdf
dc.source.none.fl_str_mv reponame:RODERIC. Repositorio Institucional de la Universitat de València
instname:Universitat de València
instname_str Universitat de València
reponame_str RODERIC. Repositorio Institucional de la Universitat de València
collection RODERIC. Repositorio Institucional de la Universitat de València
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1844184132401233920
spelling Fenotipos de los pacientes respondedores al tratamiento de la apnea obstructiva del sueño mediante los dispositivos de avance mandibularCamañes-Gonzalvo, Saraobstructive sleep apneaapnea obstructiva sueñomandibular advancement devicesdispositivos de avance mandibularUNESCO::CIENCIAS MÉDICASIntroduction: Obstructive sleep apnea (OSA) is a common disorder characterized by episodes of upper airway obstruction, leading to oxygen desaturation, disrupted sleep, and systemic complications. Although continuous positive airway pressure (CPAP) is the standard treatment for OSA, mandibular advancement devices (MADs) present an effective alternative for patients who cannot tolerate CPAP or reject surgery. However, the effectiveness of MADs varies, with a success rate of 60-70%. Identifying phenotypic predictors is crucial for optimizing patient selection and improving therapeutic outcomes. This thesis aims to establish predictive factors to guide clinical decision-making in MAD treatment for OSA. Objectives: The goal of this research is to analyze the phenotypic characteristics that differentiate responders to MAD treatment from non-responders in OSA through four studies: 1. Systematic review and meta-analysis of predictors of MAD efficacy. 2. Analysis of polysomnographic phenotypes and their integration into predictive models. 3. Evaluation of anatomical and physiological characteristics of the airway. 4. Classification of OSA subgroups and assessment of the impact of facial morphology on MAD efficacy. Materials and Methods: - Study 1: A systematic review and meta-analysis were conducted, including studies on MAD efficacy. Clinical, anatomical, and polysomnographic predictors were analyzed, and the quality was assessed using Newcastle-Ottawa, Cochrane, and GRADE tools. - Studies 2 and 3: A prospective analysis of patients treated with MAD over six years was carried out. Logistic regression and CHAID analysis were used to define predictive models based on clinical, anatomical, and polysomnographic variables. - Study 4: A retrospective analysis classified OSA subgroups using K-means clustering. Results: - Study 1: Of 99 studies, 60 were included in the meta-analysis. Responders were younger, with lower BMI, cervical circumference, facial height, hyoid-C3 distance, and minimal cross-sectional area of the airway (CSAmin), along with higher minimum oxygen saturation. Responders also required lower CPAP pressures. - Study 2: In 112 patients, the response rate was higher in positional OSA and lower in REM-dependent OSA or OSA with predominant apneas. Key predictors included T90% and positional OSA in the first definition of response, BMI and apnea-predominant phenotype in the second. CHAID analysis established clinically relevant cutoff values. - Study 3: Predictive models were based on airway length, anterior facial height, and basal T90% (first definition of response); Jarabak index, gonion angle, CSAmin, basal BMI, and basal AHI (second definition). - Study 4: Two subgroups were identified. Subgroup 1, with more severe OSA (higher BMI, T90%, and AHI), vertical facial pattern, and narrower airways, exhibited lower therapeutic success. Facial morphology influenced response, with dolichofacial pattern patients showing the lowest success rate. Conclusions: This thesis identified phenotypic factors that influence the efficacy of MAD treatment in OSA. Predictive models could enhance patient selection and optimize therapeutic outcomes. Future research should validate these models in prospective studies.3 - Salut i Benestar3 - Salut i Benestar::3.6 - Per a 2020, reduir a la meitat el nombre mundial de morts i lesions causats per accidents de trànsit3 - Salut i Benestar::3.4 - Per a 2030, reduir en un terç la mortalitat prematura per malalties no transmissibles, mitjançant la prevenció i el tractament, i promoure la salut mental i el benestarBellot Arcís , CarlosMarco Pitarch , RocíoGarcía Selva , MarinaDepartament d'Estomatologia2025202520252025doctoral thesisinfo:eu-repo/semantics/doctoralThesis299 p.application/pdfhttps://hdl.handle.net/10550/111048reponame:RODERIC. Repositorio Institucional de la Universitat de Valènciainstname:Universitat de ValènciaInglésAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/open accessinfo:eu-repo/semantics/openAccessoai:dnet:roderic_____::06174feae702a207e10f7c130cf3e9792025-07-15T12:44:01Z
score 15,638193

Similares en LA Referencia