A systematic approach to the evaluation and management of obstructive sleep apnea: The Jefferson Protocol

Jain, Nikhita; Rodin, Julianna; Boon, Maurits; Huntley, Colin

doi:10.1016/j.amjoto.2020.102866

Cited by 3 publications

(5 citation statements)

References 31 publications

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“…For those who pursued consultation (37), they reported doing so because of their inability to tolerate CPAP (73%, 27), not being a candidate for inspire (14%, 5), and to learn about alternative OSA treatment options (14%, 5). For those patients who sought consultation but did not pursue MMA (20), 85% (17) reported that this was due to concern about pain/invasiveness, recovery concerns, and/or both. Of the 17 patients who underwent MMA, all patients reported undergoing surgery because they preferred surgery to CPAP and/or wanting a definitive treatment for OSA.…”

Section: Resultsmentioning

confidence: 99%

“…All patients selected and recommended for OMFS referral and MMA were based on our institution's PAP Alternatives protocol at a single institution. 20 These patients may already have preconceived perceptions about MMA and its potential invasiveness, not giving it a proper chance upon referral to OMFS. Many patients referred for PAP alternatives are also often seeking UAS with hypoglossal nerve stimulation and may not be inclined to pursue other options if not a candidate.…”

Section: Discussionmentioning

confidence: 99%

“…The first limitation is that of potential selection bias. All patients selected and recommended for OMFS referral and MMA were based on our institution's PAP Alternatives protocol at a single institution 20 . These patients may already have pre‐conceived perceptions about MMA and its potential invasiveness, not giving it a proper chance upon referral to OMFS.…”

Section: Discussionmentioning

confidence: 99%

“…If patients have clear dentofacial abnormalities (i.e., retrognathia) and/or have significant obstruction at all upper airway subsites, especially concentric palatal and lateral oropharyngeal wall collapse, we will recommend OMFS referral for MMA discussion or return to CPAP with sleep medicine referral. 20 We typically do not discuss other surgical interventions with these patients as they would require at least two other interventions with likely less success. This practice inherently lends to possible selection bias of the cohort as it is not a completely standardized referral process.…”

Section: Methodsmentioning

confidence: 99%

“…At our institution, our primary CPAP alternative treatment modalities include oral appliance therapy, tonsillectomy, expansion sphincter pharyngoplasty (ESP) or modified UPPP, upper airway stimulation (UAS), transoral robotic surgery (TORS) lingual tonsillectomy with midline glossectomy and epiglottoplasty, and MMA. If patients have clear dentofacial abnormalities (i.e., retrognathia) and/or have significant obstruction at all upper airway subsites, especially concentric palatal and lateral oropharyngeal wall collapse, we will recommend OMFS referral for MMA discussion or return to CPAP with sleep medicine referral 20 . We typically do not discuss other surgical interventions with these patients as they would require at least two other interventions with likely less success.…”

Section: Methodsmentioning

confidence: 99%

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Patient Referral and Acceptance of Maxillomandibular Advancement for Obstructive Sleep Apnea

Rodin,

Fiorella,

Crippen

et al. 2023

The Laryngoscope

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ObjectiveMaxillomandibular advancement (MMA) is an effective surgical treatment for obstructive sleep apnea (OSA); however, it is unclear how many patients who are referred for MMA actually undergo surgery. This study aims to determine follow‐up rates for patients referred for MMA and the reasons behind their choices.MethodsVia retrospective review, we assessed consecutive patients with OSA intolerant to continuous positive airway pressure (CPAP) who underwent drug induced sleep endoscopy (DISE) between 2018 and 2020 at our institution. Patients recommended for MMA based on DISE and other findings were included. Patients were then contacted and administered an IRB‐approved survey in present time.ResultsOne hundred and fifty nine patients were referred to oral maxillofacial surgery (OMFS) for MMA consult. Seventy seven patients (48%) followed up with OMFS and 29 (18%) underwent MMA. Sixty two (40%) patients resumed CPAP. Fifty eight patients (36.5%) were lost to follow up.Seventy three patients (46%) completed our survey. Of those patients, 37 (51%) followed up with OMFS and 17 (23%) underwent MMA. Patients who did not follow up with OMFS cited the invasiveness of the surgery (39%), recovery time (17%), or both (31%) as reasons. Those who pursued consultation cited inability to tolerate CPAP (73%), not being a candidate for inspire (14%), and desire to learn about alternative treatments (14%) as reasons. Of those who did not undergo MMA, 28.6% are not using OSA treatment.ConclusionLess than half of patients referred for MMA followed up, and less than half of those patients underwent MMA. Most patients cited concerns about the invasiveness of the surgery and recovery process.Level of Evidence4 Laryngoscope, 2023

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 3 more Smart Citations

Patient Referral and Acceptance of Maxillomandibular Advancement for Obstructive Sleep Apnea

Rodin,

Fiorella,

Crippen

et al. 2023

The Laryngoscope

Self Cite

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Neurostimulation in the Management of Obstructive Sleep Apnea

Hsieh

Schell

Yeh

et al. 2022

Curr Sleep Medicine Rep

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Three-Stage Breathing Effort Quantification for Obstructive Sleep Apnea Detection Based on Thoracic and Abdominal Movement Signals

Adha

Igasaki

2021

IEEE Access

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A level-IV home-based sleep apnea monitoring system that utilizes alternative sensors, such as dual respiratory inductance plethysmography (RIP) belts, is proposed to promote routine apnea monitoring. Notably, continued excursion may occur in RIP belt signals, owing to the imperfect relationship between thoracic and abdominal movements during obstructive events. Therefore, we propose a novel algorithm to detect obstructive apnea based on an obstructive reciprocal divergence (ORD) continued excursion model and to explore the possibility of a multistage breathing-effort evaluation model using only RIP signals. Using the developed approach, we detected obstructive sleep apnea with a high accuracy of 99.83 ± 0.71% and a slight reduction of 73.34 ± 28.35% in hypopnea performance with overall combined objective metrics of 89.38 ± 10.53%. We found that introducing many stages improves specificity (p < 0.001). Furthermore, apart from apneic detection, we detected subtle changes in RIP signals qualitatively, which can help represent the inspiratory flow limitation (IFL) of the RIP. This study was validated by predicting an apnea hypopnea index (AHI) based on paradoxical breathing during sleep. A strong exponential relationship was observed between the proposed parameter based on the number of transitions with AHI (R 2 = 0.98; p < 0.001). The proposed approach can assist sleep technologists in characterizing obstructive and nonobstructive apneic events. Moreover, ORD is competent for further quantitative and qualitative IFL analysis and will significantly benefit the automated IFL detection system studies.

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A systematic approach to the evaluation and management of obstructive sleep apnea: The Jefferson Protocol

Cited by 3 publications

References 31 publications

Patient Referral and Acceptance of Maxillomandibular Advancement for Obstructive Sleep Apnea

Patient Referral and Acceptance of Maxillomandibular Advancement for Obstructive Sleep Apnea

Neurostimulation in the Management of Obstructive Sleep Apnea

Three-Stage Breathing Effort Quantification for Obstructive Sleep Apnea Detection Based on Thoracic and Abdominal Movement Signals

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