Systems and methods for providing an automated titration for oral appliance therapy

Abstract

Provided herein are systems, methods and devices for performing one or more titrations for oral appliance therapy. For example, a method for evaluating an outcome of oral appliance therapy in a subject is discussed herein. The method can include positioning an adjustable mandibular displacement device in an oral cavity of a subject and implementing an automatic titration protocol. The protocol can include controlling a protrusion level of the adjustable mandibular displacement device during a test period, monitoring physiological information from the subject during the test period, and analyzing the physiological information to evaluate the outcome of oral appliance therapy.

1 . (canceled) 
     
     
         2 . A system for performing a titration for oral appliance therapy based on data collected at a plurality of protrusion levels, comprising:
 an adjustable mandibular displacement device configured to be positioned in an oral cavity of a subject; and   a processing unit and a memory operatively coupled to the processing unit, the memory having computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to:   receive data related to at least two protrusion levels of the adjustable mandibular displacement device and a respective amount of time that the adjustable mandibular displacement device spends at each of the at least two protrusion levels; and   evaluate an outcome of oral appliance therapy with a mandibular repositioning appliance based on the data related to the at least two protrusion levels of the adjustable mandibular displacement device and the respective amount of time that the adjustable mandibular displacement device spends at each of the at least two protrusion levels.   
     
     
         3 . The system of  claim 2 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to:
 receive physiological data collected from a subject during a test period; and   detect one or more respiratory events using the physiological data.   
     
     
         4 . The system of  claim 2 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises predicting an effective protrusion level of the adjustable mandibular displacement device. 
     
     
         5 . The system of  claim 2 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises predicting whether the subject is a favorable candidate for oral appliance therapy with the mandibular repositioning appliance. 
     
     
         6 . The system of  claim 3 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises comparing a frequency of occurrence of the one or more respiratory events at different protrusion levels. 
     
     
         7 . The system of  claim 6 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to determine that the subject is a candidate for oral appliance therapy with the mandibular repositioning appliance if the frequency occurrence of the one or more respiratory events decreases between successively greater protrusion levels. 
     
     
         8 . The system of  claim 3 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises determining whether a frequency of respiratory events at or above a given protrusion level during the test period is less than a predefined value. 
     
     
         9 . The system of  claim 8 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises determining whether a percentage of time at or below the given protrusion level is greater than or equal to a predefined percentage of the test period. 
     
     
         10 . The system of  claim 9 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to determine that an effective protrusion level for oral appliance therapy with the mandibular repositioning appliance is a smallest protrusion level where the frequency of respiratory events at or above the given protrusion level during the test period is less than the predefined value and the percentage of time at or below the given protrusion level is greater than or equal to the predefined percentage of the test period. 
     
     
         11 . The system of  claim 3 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to calculate a frequency of respiratory events at a plurality of protrusion levels by:
 determining a number of respiratory events at or above each of the plurality of protrusion levels; and   dividing each of the number of respiratory events by an amount of time at or above each of the plurality of protrusion levels, and wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to identify one or more of the plurality of protrusion levels where the frequency of respiratory events is less than a predefined value.   
     
     
         12 . The system of  claim 11 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises determining whether a percentage of time at or below each of the one or more of the plurality of protrusion levels is greater than or equal to a predefined percentage of the test period. 
     
     
         13 . The system of  claim 12 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to determine that an effective protrusion level for oral appliance therapy with the mandibular repositioning appliance is a smallest protrusion level where the frequency of respiratory events at the one or more of the plurality of protrusion levels during the test period is less than the predefined value and the percentage of time at or below the one or more of the plurality of protrusion levels is greater than or equal to the predefined percentage of the test period. 
     
     
         14 . The system of  claim 3 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to determine a percentage of time the adjustable mandibular displacement device spends at or below each of the at least two protrusion levels. 
     
     
         15 . The system of  claim 14 , wherein the evaluation is based on a frequency of respiratory events at or above each of the at least two protrusion levels and the percentage of time the adjustable mandibular displacement device spends at or below each of the at least two protrusion levels. 
     
     
         16 . The system of  claim 3 , wherein the physiological data from the subject comprises at least one of oxygen saturation, respiratory airflow, acoustic energy, or vibration generated by the subject. 
     
     
         17 . The system of  claim 3 , wherein the physiological data from the subject comprises oxygen saturation. 
     
     
         18 . The system of  claim 2 , wherein the data related to one of the at least two protrusion levels of the adjustable mandibular displacement device is evaluated during a non-event period. 
     
     
         19 . The system of  claim 18 , wherein the non-event period comprises a portion of a test period wherein a frequency of one or more respiratory events is less than a predetermined threshold. 
     
     
         20 . The system of  claim 2 , further comprising a mandibular displacement device controller or a computing device, wherein the mandibular displacement device controller or the computing device comprises the processing unit and the memory. 
     
     
         21 . The system of  claim 20 , further comprising the mandibular displacement device controller and the computing device. 
     
     
         22 . The system of  claim 21 , wherein the mandibular displacement device controller is located at the subject's bedside, and wherein the computing device is located at the subject's bedside or remotely from the subject. 
     
     
         23 . A non-transitory computer-readable medium having computer-executable instructions stored thereon for performing a titration for oral appliance therapy that, when executed by a processing unit, cause the processing unit to:
 receive data related to at least two protrusion levels of an adjustable mandibular displacement device and a respective amount of time that the adjustable mandibular displacement device spends at each of the at least two protrusion levels, wherein the adjustable mandibular displacement device is positioned in an oral cavity of a subject during the titration; and   evaluate an outcome of oral appliance therapy with a mandibular repositioning appliance based on the data related to the at least two protrusion levels of the adjustable mandibular displacement device and the respective amount of time that the adjustable mandibular displacement device spends at each of the at least two protrusion levels.   
     
     
         24 . A system for performing a titration for oral appliance therapy, comprising:
 an adjustable mandibular displacement device configured to be positioned in an oral cavity of a subject;   a monitoring unit configured to sense physiological information from the subject during a test period; and   a processing unit and a memory operatively coupled to the processing unit, the memory having computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to:   control a protrusion level of the adjustable mandibular displacement device during the test period;   monitor changes in the protrusion level of the adjustable mandibular displacement device during the test period; and   evaluate an outcome of oral appliance therapy with a mandibular repositioning appliance based on a history of movement of the adjustable mandibular displacement device and the physiological information during the test period, wherein the changes in the protrusion level of the adjustable mandibular displacement device define the history of movement of the adjustable mandibular displacement device.   
     
     
         25 . The system of  claim 24 , wherein the history of movement of the adjustable mandibular displacement device comprises movement between at least two protrusion levels. 
     
     
         26 . The system of  claim 24 , wherein the history of movement includes an amount of time the adjustable mandibular displacement device spends at each of at least two protrusion levels. 
     
     
         27 . The system of  claim 24 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to:
 receive one or more physiological inputs from the monitoring unit during the test period; and   detect one or more respiratory events during the test period using the one or more physiological inputs.   
     
     
         28 . The system of  claim 27 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to analyze the history of movement to determine a percentage of time the adjustable mandibular displacement device spends at or below each of at least two protrusion levels. 
     
     
         29 . The system of  claim 28 , wherein the evaluation is based on a frequency of respiratory events at or above each of the at least two protrusion levels and the percentage of time the adjustable mandibular displacement device spends at or below each of the at least two protrusion levels. 
     
     
         30 . The system of  claim 24 , wherein controlling a protrusion level of the adjustable mandibular displacement device during the test period is performed automatically. 
     
     
         31 . The system of  claim 24 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises predicting whether the subject is a favorable candidate for oral appliance therapy with the mandibular repositioning appliance. 
     
     
         32 . The system of  claim 24 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises predicting an effective protrusion level of the adjustable mandibular displacement device. 
     
     
         33 . The system of  claim 27 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises determining whether a frequency of respiratory events at or above a given protrusion level during the test period is less than a predefined value. 
     
     
         34 . The system of  claim 33 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises determining whether a percentage of time at or below the given protrusion level is greater than or equal to a predefined percentage of the test period. 
     
     
         35 . The system of  claim 34 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to determine that an effective protrusion level for oral appliance therapy with the mandibular repositioning appliance is a smallest protrusion level where the frequency of respiratory events at or above the given protrusion level during the test period is less than the predefined value and the percentage of time at or below the given protrusion level is greater than or equal to the predefined percentage of the test period. 
     
     
         36 . The system of  claim 27 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to calculate a frequency of respiratory events at a plurality of protrusion levels by:
 determining a number of respiratory events at or above each of the plurality of protrusion levels; and   dividing each of the number of respiratory events by an amount of time at or above each of the plurality of protrusion levels, and wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to identify one or more of the plurality of protrusion levels where the frequency of respiratory events is less than a predefined value.   
     
     
         37 . The system of  claim 36 , wherein evaluating an outcome of oral appliance therapy with the mandibular repositioning appliance further comprises determining whether a percentage of time at or below each of the one or more protrusion levels is greater than or equal to a predefined percentage of the test period. 
     
     
         38 . The system of  claim 37 , wherein the memory has further computer-executable instructions stored thereon that, when executed by the processing unit, cause the system to determine that an effective protrusion level for oral appliance therapy with the mandibular repositioning appliance is a smallest protrusion level where the frequency of respiratory events at the one or more of the plurality of protrusion levels during the test period is less than the predefined value and the percentage of time at or below the one or more of the plurality of protrusion levels is greater than or equal to the predefined percentage of the test period. 
     
     
         39 . The system of  claim 27 , wherein the monitoring unit comprises at least one of an oxygen saturation monitor, an airflow monitor, a sound monitor, or a vibration monitor, and the one or more physiological inputs from the subject comprise at least one of oxygen saturation, respiratory airflow, acoustic energy, or vibration generated by the subject. 
     
     
         40 . The system of  claim 39 , wherein the one or more physiological inputs further comprise at least one of sleep stage, sleep position, or force applied on the subject's teeth by the adjustable mandibular displacement device. 
     
     
         41 . The system of  claim 27 , wherein the monitoring unit is an oxygen saturation monitor, and the one or more physiological inputs from the subject comprise oxygen saturation. 
     
     
         42 . The system of  claim 24 , wherein the history of movement includes at least one change in the protrusion level of the adjustable mandibular displacement device during a non-event period of the test period. 
     
     
         43 . The system of  claim 42 , wherein the non-event period comprises a portion of the test period wherein a frequency of one or more respiratory events is less than a predetermined threshold. 
     
     
         44 . The system of  claim 24 , further comprising a mandibular displacement device controller or a computing device, wherein the mandibular displacement device controller or the computing device comprises the processing unit and the memory. 
     
     
         45 . The system of  claim 44 , further comprising the mandibular displacement device controller and the computing device. 
     
     
         46 . The system of  claim 45 , wherein the mandibular displacement device controller is located at the subject's bedside, and wherein the computing device is located at the subject's bedside or remotely from the subject. 
     
     
         47 . A non-transitory computer-readable medium having computer-executable instructions stored thereon for performing a titration for oral appliance therapy that, when executed by a processing unit, cause the processing unit to:
 control a protrusion level of an adjustable mandibular displacement device during a test period, wherein the adjustable mandibular displacement device is positioned in an oral cavity of a subject during the titration;   monitor changes in the protrusion level of the adjustable mandibular displacement device during the test period; and   evaluate an outcome of oral appliance therapy with a mandibular repositioning appliance based on a history of movement of the adjustable mandibular displacement device and the physiological information during the test period, wherein the changes in the protrusion level of the adjustable mandibular displacement device define the history of movement of the adjustable mandibular displacement device.