Predictive Accuracy of MATRx Plus in Identifying Favorable Candidates for Oral Appliance Therapy

NCT03217383 | Completed DMC

• 1 other identifier: ZCP201703
• Study Type: interventional
• Target: 75
• Locations: 1 country
• Sites: 1

Brief Summary

Obstructive sleep apnea (OSA) is a common disease that is largely un-diagnosed and untreated. Standard treatment for obstructive sleep apnea, nasal continuous positive airway pressure (CPAP), entails use of a nose mask to deliver positive pressure which dilates the pharynx and eliminates obstruction. This therapy is highly efficacious and benign but is associated with low adherence, particularly in non-sleepy apneics with disease of mild and moderate severity. The principal alternative to CPAP therapy is oral appliance (OA) therapy in which a custom made mandibular advancement splint (MAS) is used to protrude the mandible during sleep, thereby opening the pharyngeal airway. OA therapy, while preferred and well accepted by most participants, is not uniformly efficacious. Additionally, uncertainty regarding the patient's response to OAT and the effective target mandibular position can lead to a significant time span between diagnosis and initiation of effective treatment. Furthermore, knowledge of the effective target mandibular position supports the use of new OA design and manufacturing processes that can further reduce the time and cost in delivering the therapy. Zephyr Sleep Technologies (the Sponsor) has developed a method of identifying OAT responsive participants and their efficacious mandibular protrusion. Recently, Zephyr Sleep Technologies developed a portable device that avoids this requirement and can be used in a multi-night test in the home. Using a feedback controlled mandibular positioner (FCMP), the device measures and analyzes respiratory airflow and oxygen saturation and makes decisions in real-time about moving the mandible. The FCMP device was tested in a blinded, bi-phase clinical study in which participants with mild-to-severe sleep apnea (n=202) underwent two full-night studies in the home. Data from phase 1 were used to develop a predictive method, and data from phase 2 were used to prospectively test the accuracy of the predictive method. An efficacious mandibular position was also predicted, and each participant was treated with a custom oral appliance set to that position. Data from both phases were used to evaluate the feasibility of use of the device in the home. A random forest machine learning system was used to develop and test the predictive method. The overall oral appliance success rate was 76% for phase 1 and 71% for phase 2. The overall predictive accuracy was 88%. Values for sensitivity and specificity were 85% and 93%, respectively. Positive and negative predictive values were 97% and 72%, respectively. The effective target protrusive position was identified in 86% of cases. The studies were conducted independently by the participants in their homes, though due to limitations in the early prototype design, a clinical coordinator visited the home to set up the equipment prior to each night of study. No significant problems were encountered, and no significant risks were identified. The results of the clinical trial show that the auto-titrating mandibular positioner is suitable for use in the home and accurately predicts OAT outcome as well as target protrusive position. Based on the results of this study, Zephyr developed a commercially available device which has been approved for sale in Canada (Health Canada device license #97614). The device, branded MATRx plus, functions as both a sleep recorder as well as a home-based system to select patients for oral appliance therapy. This commercially available device is currently being used in three separate usability trials to quantify the usability of the device and the benefits of an improved workflow through adoption of the new technology in a dental practice. Evidence has recently appeared to indicate that the change in pharyngeal volume caused by protrusion of the mandible, measured while awake, correlates with the change in apnea-hypopnea index (AHI) achieved by OAT, measured while asleep. This is the first convincing evidence that an awake measurement of the pharyngeal airway correlates with the improvement in respiratory status during sleep induced by an oral appliance. The implication is that a simple conebeam CT of the pharynx can predict outcome with OAT. Accordingly, we shall carry out conebeam CTs in the research protocol, both at rest position of the mandible and at 90% of maximal protrusion. The purpose of this study is to test whether the predictive accuracy of the FCMP in the home environment is improved by the commercial design and whether patients predicted to be suitable for oral appliance therapy have long term adherence.

Conditions

Sleep Apnea; Sleep Apnea, Obstructive; Sleep Disordered Breathing

Keywords

Oral appliance therapy; mandibular protrusion

Outcome Measures

Primary Outcomes (2)

• Sensitivity

  The hypothesis that sensitivity is greater than 0.50 (50%) when the MATRx plus device is used independently by patients in the home will be tested.

  6 weeks

• Oral appliance compliance

  The long-term use of the oral appliance in patients selected for oral appliance therapy by the MATRx plus device will be documented.

  12 months

Secondary Outcomes (1)

• Usability

  3 days

Study Arms (1)

MATRx plus test

EXPERIMENTAL

All study participants will receive the same test protocol. All participants will complete the MATRx plus theragnostic test and receive a prediction of oral appliance outcome. All participants will then receive a custom oral appliance set to the predicted protrusive position or a sham position, and outcome home sleep tests will be performed with the custom oral appliance in place to determine if the test prediction was correct.

Device: MATRx plus

Interventions

MATRx plus DEVICE

The MATRx plus test is a 2- or 3-night home sleep test that uses temporary titration trays to move the lower jaw in response to respiratory events. The purpose of the test is to predict oral appliance therapy outcome, and to provide a protrusive position for individuals predicted to experience therapeutic success.

MATRx plus test

Eligibility Criteria

• Age: 21 Years - 80 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Aged between 21 and 80 years
• Obstructive sleep apnea (ODI and AHI \> 10hr-1)
• Body mass index less than 45 kg/m2
• Neck circumference less than 50 cm
• Absence of severe oxyhemoglobin desaturation during sleep as indicated by a mean value of oxygen saturation (SaO2) greater than 87 percent
• Mandibular range of motion greater than 5 mm
• Adequate dentition (10 upper and 10 lower teeth)
• Ability to understand and provide informed consent
• Ability and willingness to meet the required schedule

You may not qualify if:

• Inability to breathe comfortably through the nose
• Central Sleep Apnea (\>50% of apneas are central)
• Anticipated change in medical therapy that could alter the severity of OSA during the protocol
• Anticipated change in body weight (5% or more) during the protocol
• Symptomatic, non-respiratory sleep disorder, e.g., restless leg syndrome or chronic insomnia
• Severe respiratory disorder(s) other than sleep disordered breathing
• Loose teeth, faulty restorations, or advanced periodontal disease
• Participation in other studies that could interfere with study protocol
• Pregnant or nursing
• Patients with heart failure
• Cerebral vascular incident within the last 12 months
• Use of pacemaker or other life supporting device
• Regular use of CPAP or oral appliance therapy within the last 1 month

Sponsors & Collaborators

• Zephyr Sleep Technologies: lead

Study Sites (1)

Zephyr Sleep Technologies

Calgary, Alberta, T2H2J6, Canada

Location

Related Publications (2)

• Mosca EV, Grosse J, Remmers JE. Oral appliance therapy is highly efficacious at reducing sleep apnea-specific hypoxic burden, a metric predictive of cardiovascular morbidity and mortality. J Clin Sleep Med. 2025 Jul 1;21(7):1185-1190. doi: 10.5664/jcsm.11622.

  PMID: 40123555 DERIVED

• Mosca EV, Bruehlmann S, Zouboules SM, Chiew AE, Westersund C, Hambrook DA, Jahromi SAZ, Grosse J, Topor ZL, Charkhandeh S, Remmers JE. In-home mandibular repositioning during sleep using MATRx plus predicts outcome and efficacious positioning for oral appliance treatment of obstructive sleep apnea. J Clin Sleep Med. 2022 Mar 1;18(3):911-919. doi: 10.5664/jcsm.9758.

  PMID: 34747691 DERIVED

MeSH Terms

Conditions

Sleep Apnea Syndromes; Sleep Apnea, Obstructive

Condition Hierarchy (Ancestors)

Apnea; Respiration Disorders; Respiratory Tract Diseases; Sleep Disorders, Intrinsic; Dyssomnias; Sleep Wake Disorders; Nervous System Diseases

Study Officials

• John Remmers, MD

  Zephyr Sleep Technologies

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Masking Details: Though the study only has one study arm, the participant, medical PI, dental PI will be blinded to the test prediction.
• Purpose: OTHER
• Intervention Model: SINGLE GROUP
• Sponsor Type: INDUSTRY
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: July 12, 2017
• First Posted: July 14, 2017
• Study Start: July 10, 2017
• Primary Completion: March 30, 2019
• Study Completion: July 3, 2019
• Last Updated: March 8, 2021

Record last verified: 2021-03

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)