Panthera Impact Grid

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Intervention impact calculator

UARS phenotype Β· epiglottic/laryngeal-dominant Β· MAD partial responder Β· predicted Oura / SnoreLab / v3 deltas per stack

Current baseline (MAD 2 mm)

Restless / night
323
Deep sleep
15.7 %
HRV
45 ms
Lowest HR
50.5 bpm
SnoreLab
37.6
v3 UARS proxy
+0.25 Οƒ

Pick your stack

Each toggle adds its expected effect on top of baseline. Effects are mid-range estimates; 95% CI bands shown in the grid below. All predictions are hypotheses translated from RCT/MA effect sizes into consumer-metric space β€” Oura restless is a proprietary proxy, not PSG-validated. Use these as testable predictions against your own pipeline, not promises.

PΓ©pin 2025 dose-response: βˆ’2.6% TST REMOV per mm (linear to 6.5 mm then plateau) tier 1

Predicted response

Overall confidence of prediction: β€”

Full grid: every stack row

Raw deltas from INTERVENTION-STACK.md Β§7. Ranges = 95% CI or qualitative confidence. Tier color shows evidence strength.

Stack Ξ”Restless Ξ”Deep % Ξ”HRV (ms) Ξ”Lowest HR Ξ”SnoreLab Ξ”v3 (Οƒ) Tier

Per-metric rationale

Oura restless periods Β· baseline 323/night, proxy metric

Not PSG-validated against arousal index. Oura publishes 79% stage-classification agreement with PSG but no published mapping of restless periods β†’ AI. Changes <30/night within noise; >50/night meaningful.

Mechanism-based mapping: MFT's 20–30% arousal index reduction in combined MAs should translate proportionally if Oura restless tracks arousal index. PΓ©pin 2025 dose-response for respiratory effort is the most reliable anchor for MAD titration.

Deep sleep fraction Β· baseline 15.7%, target β‰₯ 18%

Oura deep-sleep detection has 79.5% sensitivity vs PSG. Trend reliable, absolutes less so. Target 18%+ achievable if fragmentation resolves.

Expected gains are modest because deep-sleep is ceiling-bounded (~20%). Stacking typically yields 1–4 percentage points at most without CPAP.

HRV Β· baseline 45 ms, +9% post-MAD

Conceptual link to arousal burden is strong (lower sympathetic activity β†’ higher HRV) but no direct Oura-HRV vs PSG-arousal-index validation published. Robust RERA treatment should lift HRV by 20-40%.

SnoreLab aggregate score Β· baseline 37.6, already βˆ’47% from pre-MAD

Acoustic OSA diagnosis AUC 0.94 (meta). Reasonable proxy for OSA severity trend. But silent RERAs don't show here β€” Pierre's phenotype is partly below SnoreLab's detection threshold.

v3 UARS proxy Β· baseline +0.25Οƒ

No PSG validation. Research metric derived from envelope-modulation 3-10 Hz palatal-flutter band, IBI CV, crescendo-silence arousal pattern. Within-patient trend only.

Phenotype caveat

Your dominant acoustic signal is epiglottic/laryngeal flutter. Neither MFT nor nasal adjuncts have validated mechanisms for the epiglottis.

Van de Perck 2022 (n=20 primary-epiglottic collapse): MAD still works at same 50% responder rate via tongue-base pull. DOI
Tukanov 2025 (n=69, MAD at 75% MVP): DISE shows MAD reduces collapse at every level except epiglottis (OR 0.65, p=0.058). DOI

Reconciliation: titration gives you gains through the tongue-base and palatal channel even if the epiglottis stays mechanically closed. If the next round plateaus and RDI doesn't drop β‰₯30% at 12-week PSG, the escalation is CPAP / BiPAP / Inspire β€” not more titration.

Key citations

Generated 2026-04-16 Β· companion to pipelines/panthera-titration/INTERVENTION-STACK.md Β· not medical advice Β· use as decision-support not prescription.