The Highlights of MATRx: A Dental Titration System for your Sleep Lab

John Remmers, MDChief Medical Officer, Zephyr Sleep Technologies

A New In-Lab Titration StudySelecting the Right Patients for Oral Appliance Therapy

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We start everyone on CPAP

Most patients hate it

Compliance problems

OSA TherapyWhat do we do now?

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The Alternative

Oral Appliance Therapy (OAT)

• Accounts for roughly 5% of the total OSA therapy

• Most OSA patients prefer oral appliance therapy; compliance is better

• So why are oral appliances under utilized?

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Inconsistent Efficacy

Only 50% of patients are efficaciously treated

Which ones?

Ferguson et al. SLEEP 2006; 29(2): 244-262

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Another Problem

The dentist

doesn’t know

where to set

the mandible

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Let’s sum it up

The sleep physician and

the dentist are both

operating in the dark.

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A polysomnographic mandibular titration device that:1. Selects patients for oral appliance therapy and

2. Determines an efficacious protrusive position

MATRx

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Interval 1NREM cycle; 30minsLateral PositionEffective Protrusion Mandibular position 11.0 –12.0mm

Interval 2REM cycle; 5minsLateral PositionIneffective Protrusion Mandibular position 12.4mm

Interval 3REM cycle; 25minsSupine PositionEffective Protrusion Mandibular position 13.9 –14.2mm

Interval 4REM cycle; 25minsSupine PositionEffective Protrusion Mandibular position 13.7 – 14.5mm

MATRx Study Results: PREDICTED SUCCESS; Target Protrusive Position = 14.5mmTherapeutic outcome study with oral appliance in place: AHI = 4.0

Case Study 1

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MATRx Clinical Trials

Remmers J, Charkhandeh S, Grosse J, Topor Z, Brant R, Santosham P, Bruehlmann S. Remotely controlled mandibular protrusion during sleep predicts therapeutic success with oral appliances in patients with obstructive sleep apnea. SLEEP 2013; 36 (10): 1517-1525.

3 prospective studies have validated MATRx

• Most recent clinical trial on 67 patients showed high predictive accuracy

See October’s issue, SLEEP

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Latest MATRx Clinical Trial

• Prospective evaluation of the predictive accuracy of MATRx

• All patients received a MATRx titration under polysomnographic monitoring

• All patients received oral appliance (SomnoDent) and were positioned at target within 3 weeks

• Sleep physician, dentist and patients blinded

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Inclusion Criteria

Broad spectrum of patients:

• Obstructive sleep apnea (AHI > 10 hr-1)

• Body mass index < 40 kg/m2

• Mean SpO2 > 90%

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Therapeutic Outcome

Success (58%) Failure

Baseline AHI(events•hr-1)

BMI (kg•m-2)

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Predicting Outcome- by Clinical Features

• Neither baseline AHI nor BMI predicted therapeutic outcome

• Adjusted neck circumference and age were weakly predictive

AHI (events•hr -1)

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Baseline | Therapy Baseline | Therapy

Predicting Outcome- by MATRx Results

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Predictive Accuracy

*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI

Predicted Success*

Therapeutic Failure

Predicted Failure

Therapeutic Success

FINAL PROTRUSION

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Predictive Accuracy

*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI

Predicted Success*

Therapeutic Failure

Predicted Failure

Therapeutic Success

FINAL PROTRUSION

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Predictive Accuracy

*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI

Predicted Success*

Therapeutic Failure

Predicted Failure

Therapeutic Success

FINAL PROTRUSION

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2

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*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI

Predicted Success*

Therapeutic Failure

Predicted Failure

Therapeutic Success

FINAL PROTRUSION

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Predictive Accuracy

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*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI

Predicted Success*

Therapeutic Failure

Predicted Failure

Therapeutic Success

FINAL PROTRUSION

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Predictive Accuracy

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*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI**PPV = 100% (with Therapeutic Success defined as: AHI < 10)

Predicted Success*

Therapeutic Failure

Predicted Failure

Therapeutic Success

FINAL PROTRUSION

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5Sensitivity

86%

Specificity92%

PPV = 94%** NPV = 83%

Predictive Accuracy

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PPV = 87%

Predicted Success*

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TARGET PROTRUSION

*Therapeutic Success defined as: AHI < 10 and 50% reduction from baseline AHI

Therapeutic Success

Therapeutic Failure

Predictive Accuracy

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Patient Acceptance

Readily accepted; overall much better tolerated than a CPAP titration

• Trays were comfortable

• No difficulty falling asleep

• Trays did not dislodge during the study

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How does MATRx change things?

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• Informs management decisions

• Increases confidence in the efficacy of oral appliance therapy

For the Physician

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• Improves treatment efficiency with oral appliances

• Increases percentage of therapeutic successes

For the Dentist

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• Provides a true alternative to CPAP

• Improves treatment compliance, quality of life and wellness

For the Patient

To learn more about MATRx, please contact Zephyr Sleep Technologies

[email protected]

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