Dose-response relationship between mandibular advancement and OSA burden: Dissociated effects on supine and non-supine AHI
(2026) Sleep Medicine — Vol. 144, p. 108996 (2026)
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Martinot, Jean-Benoît 
- Abstract
- Background and objective: A key unresolved mechanistic question in obstructive sleep apnea (OSA) therapy with mandibular advancement devices (MAD) is how incremental advancement affects position-specific disease burden. This study aimed to evaluate the dynamic changes in apnea-hypopnea index (AHI) in different body positions in response to stepwise mandibular advancements, using the mandibular jaw movement (MJM)-based monitoring technology. Methods: A prospective cohort study was conducted in OSA patients eligible for MAD therapy with a standardized titration protocol. Home sleep tests with MJM analysis were performed at baseline, and three successive advancement levels (initial, intermediate, and maximal). Regression analysis with adjustments for time-varying confounding factors was applied to estimate the adjusted changes in residual AHI in supine and non-supine positions. Results: Ninety-six patients completed titration and follow-up. MAD titration did not significantly modify supine sleep time. Relative to baseline, early and significant improvements were observed for both supine and non-supine AHI at the initial advancement level (relative reduction of − 60.1% [95% CI: − 67.9; − 52.2] and − 55.0% [95% CI: − 61.1; − 48.9], respectively). Thereafter, AHI responses diverged: supine AHI continued a progressive reduction through to end of titration (mean cumulative change: − 78.4% [95% CI: − 82.7; − 74.2]), whereas non-supine AHI showed little additional change beyond the initial improvement (mean cumulative change: − 63.3% [95% CI: − 68.2; − 58.3]). Positional OSA prevalence was reduced from 38.5% at baseline to 18.3% at endpoint. Conclusions: These findings underscore the value of continuous, home-based monitoring of position-specific residual AHI during MAD titration, and support integrating MJM analysis into MAD therapy workflows.
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Citations
Martinot, J.-B., Le-Dong, N.-N., Cantero, C., Clause, D., De Almeida, F., Cistulli, P., & Pépin, J.-L. (2026). Dose-response relationship between mandibular advancement and OSA burden: Dissociated effects on supine and non-supine AHI. Sleep Medicine, 144, 108996. https://doi.org/10.1016/j.sleep.2026.108996 (Original work published 2026)