Clinical practice guideline recommendations on examination of the upper airway for adults with suspected obstructive sleep apnoea-hypopnoea syndrome

Esteller, Eduard Carbonell i; Carrasco, Marina; Díaz-Herrera, Miguel Ángel; Vila, Javier; Sampol, Gabriel; Juvanteny, Joan; Sieira, R.; Farré, Alex; Vilaseca, Isabel

doi:10.1016/j.otoeng.2018.06.006

Cited by 10 publications

(14 citation statements)

References 6 publications

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“…Hence, predicting the treatment response regarding the visualisation of the enlargement of the upper airway is not a useful tool. 27 In the study of Van Holsbeke, they observed an inverse correlation between the change in the upper airway volume and the percent change in upper airway resistance, in 58.7% of the patients.…”

Section: Discussionmentioning

confidence: 96%

“…The study of the upper airway with CBCT in patients treated with MAD is an optimal approach to understand the precise mechanism of this treatment option. 27 In fact, various studies have already shown how certain anatomical properties determined from three-dimensional computed tomographic images do correlate well with the severity of OSAS. 28,29 The main aim of this study was to evaluate the morphological changes based on a bi and tri-dimensional analysis of the upper airway of patients with OSAS treated with a MAD.…”

Section: Introduction 1| Backgroundmentioning

confidence: 99%

“…Although cone‐beam computed tomography (CBCT) is not the optimal method to evaluate soft tissues, it offers the clinician a three‐dimensional exploration tool, with a more accurate imaging and a lower radiation dose. The study of the upper airway with CBCT in patients treated with MAD is an optimal approach to understand the precise mechanism of this treatment option 27 . In fact, various studies have already shown how certain anatomical properties determined from three‐dimensional computed tomographic images do correlate well with the severity of OSAS 28,29 …”

Section: Introductionmentioning

confidence: 99%

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Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi‐ and three‐dimensional evaluation

Marco-Pitarch

Selva-García

Plaza-Espín

et al. 2021

J of Oral Rehabilitation

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Background The efficiency of the mandibular advancement device (MAD) in patients with obstructive sleep apnoea syndrome (OSAS) has been demonstrated. Nevertheless, the behaviour of the upper airway once MAD is placed and titrated, and its correlation with the apnoea‐hypopnoea index (AHI) is still under discussion. Objectives To analyse the morphological changes of the upper airway through a bi‐ and three‐dimensional study and correlate it with the polysomnographic variable, AHI. Methods Patients were recruited from two different hospitals for the treatment of OSAS with a custom‐made MAD. A cone‐beam computer tomography and a polysomnography were performed at baseline and once the MAD was titrated. Results A total of 41 patients completed the study. Treatment with MAD reduced the AHI from 22.5 ± 16.8 to 9.2 ± 11.6 (p ≤ .05). There was a significant increase of the total airway volume with MAD from 21.83 ± 7.05 cm3 to 24.19 ± 8.19 cm3, at the expense of the oropharynx. Moreover, the correlation between the improvement of the AHI and the augmentation of the volume of the upper airway was not statistically significant. Conclusions The oral device used in this prospective study increased the mean upper pharyngeal airway volume and significantly reduced the AHI. Future studies that measure the muscular tone are needed to completely understand the association between the AHI and the physiological and anatomical response of the upper airway.

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Section: Discussionmentioning

confidence: 96%

Section: Introduction 1| Backgroundmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi‐ and three‐dimensional evaluation

Marco-Pitarch

Selva-García

Plaza-Espín

et al. 2021

J of Oral Rehabilitation

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“…Patients with difficulties in tongue movements (Figure 5) may have poorer adherence to myofunctional therapy; however, this has not been reported. We note that examination of tongue-tie is not included in any otolaryngological clinical guidelines for evaluating the upper airway in the assessment of SDB [1,38]. However, we firmly believe it should be included.…”

Section: Discussionmentioning

confidence: 97%

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing

O’Connor-Reina

García

Alcalá

et al. 2021

JCM

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Myofunctional therapy (MT) is used to treat sleep-disordered breathing. However, MT has low adherence—only ~10% in most studies. We describe our experiences with MT delivered through a mobile health app named Airway Gym®, which is used by patients who have rejected continuous positive airway pressure and other therapies. We compared ear, nose, and throat examination findings, Friedman stage, tongue-tie presence, tongue strength measured using the Iowa oral performance instrument (IOPI), and full polysomnography before and after the 3 months of therapy. Participants were taught how to perform the exercises using the app at the start. Telemedicine allowed physicians to record adherence to and accuracy of the exercise performance. Fifty-four patients were enrolled; 35 (64.8%) were adherent and performed exercises for 15 min/day on five days/week. We found significant changes (p < 0.05) in the apnoea–hypopnoea index (AHI; 32.97 ± 1.8 to 21.9 ± 14.5 events/h); IOPI score (44.4 ± 11.08 to 49.66 ± 10.2); and minimum O2 saturation (80.91% ± 6.1% to 85.09% ± 5.3%). IOPI scores correlated significantly with AHI after the therapy (Pearson r = 0.4; p = 0.01). The 19 patients who did not adhere to the protocol showed no changes. MT based on telemedicine had good adherence, and its effect on AHI correlated with IOPI and improvement in tongue-tie.

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“…All patients underwent a comprehensive examination by a specialized otolaryngologist in respiratory sleep disorders. The examination included a sinonasal evaluation, a nasal endoscopic examination, and an evaluation of the oral and oropharyngeal cavity (uvula size, oropharyngeal morphology, soft palate, relationship between palatoglossal and palatopharyngeal muscles and uvula insertion, and tongue using the modified Mallampati scale and the Friedman tonsil examination), in addition to a nasofibrolaryngoscopic evaluation and cervical-facial morphology [25]. In addition, those patients who were candidates for surgery but ultimately candidates for oral devices underwent sleep endoscopy.…”

Section: Study Sample Identification and Selectionmentioning

confidence: 99%

Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices

Camañes-Gonzalvo

Marco-Pitarch

Plaza-Espín

et al. 2021

JCM

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Background. The effectiveness of mandibular advancement devices has been solidly demonstrated in the past. They are considered a valid alternative treatment to continuous positive airway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship between polysomnographic parameters and the increase in the volume of the upper airway in patients with obstructive sleep apnea syndrome has not been clearly established so far. This study aimed to determine the impact of these oral appliances upon the volume of the airway after the device titration phase and correlate it with the degree of mandibular advancement and the improvement of polysomnographic parameters. Methods. All patients were diagnosed by polysomnography and were treated with a customized, titratable mandibular advancement device. Three-dimensional volumetric measurements were performed using cone beam computed tomography. Results. The present study included 45 patients diagnosed with obstructive sleep apnea hypopnea syndrome (mild in 23 patients, moderate in 11 and severe in 11). Forty-four percent of the patients presented with an apnea hypopnea index <5/h at the end of treatment. The volume of the upper airway increased an average of 4.3 ± 5.9 cm3, this represents a percentage increase of 20.9%, which was significantly correlated with an apnea hypopnea index and a minimum oxygen saturation improvement. Conclusions. The mandibular advancement device used was found to be effective in improving polysomnographic parameters. Moreover, the oral appliance was able to significantly increase the tridimensional dimensions of the upper airway. Moreover, this finding was correlated with a reduction in the apnea hypopnea index (p = 0.007) and an increase on minimum oxygen saturation (p = 0.033).

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Clinical practice guideline recommendations on examination of the upper airway for adults with suspected obstructive sleep apnoea-hypopnoea syndrome

Cited by 10 publications

References 6 publications

Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi‐ and three‐dimensional evaluation

Dimensional analysis of the upper airway in obstructive sleep apnoea syndrome patients treated with mandibular advancement device: A bi‐ and three‐dimensional evaluation

Improving Adherence to Myofunctional Therapy in the Treatment of Sleep-Disordered Breathing

Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices

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