Drug-induced Sleep Endoscopy (DISE) with Simulation Bite to Predict the Success of Oral Appliance Therapy in Treating Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)

Abstract

Study objectives Oral appliances have gained their place in the treatment of obstructive sleep apnea (OSA) where custom-made titratable mandibular advancement devices (MAD) have become the oral appliance of choice. This study aimed to asses the value of the drug-induced sleep endoscopy (DISE) using a MAD in the prediction of treatment outcome for OSAHS Methods This is a prospective, single-center cohort study that enrolled sixty-six consecutive patients with diagnosed OSA (5 events/h < apnea-hypopnea index (AHI) < 50 events/h) to be treated with a custom-made titratable MAD. The patients were evaluated polysomnographically with the MAD in situ after the adaptation and titration period of 3 months. The associations between findings during DISE and treatment outcome were assessed Results The subjects showed a wide range of severity of OSAHS pre-treatment: median AHI was 43.10 with a range from 20.13 to 66.07. The simulation bite was associated with a significant increase in cross-sectional area at level of the velopharynx, tongue base and epiglottis. MAD treatment response in the studied population was 91%, with a mean AHI improving from 43.10 to 12.93. Conclusions Drug-induced sleep endoscopy with simulation bite is an acceptably reproducible technique for determining the sites of obstruction in OSAHS subjects; it thus offers possibilities as a prognostic indicator for treatment with MAD

Upper Airway Surgery or Weight Control? Modified Drug‐Induced Sleep Endoscopy for Obstructive Sleep Apnea

“…That is, the integration of various conservative treatments, such as OA, positional therapy, intermittent negative airway pressure, weight control, and several kinds of surgical treatments, may effectively treat OSA, especially CCC. [19][20][21] In our study, 32 patients (39%) had positional OSA. Our study found that upper airway patency improved in a proportion of patients during head rotation or with OA use, and some patients did not improve.…”

“…Therefore, we can use these DISE modification findings to adjust our future surgery and treatment protocol. That is, the integration of various conservative treatments, such as OA, positional therapy, intermittent negative airway pressure, weight control, and several kinds of surgical treatments, may effectively treat OSA, especially CCC 19‐21 …”

“…This exam could also help us to investigate the pathophysiology of specific collapse patterns and determine the best treatment option for our patients. In addition, DISE could also be used as a test model for other conservative treatments, such as positional therapy 17,18 or oral appliance (OA) use 19 . Positional therapy and OA use are effective conservative treatments for OSA.…”

“…In addition, DISE could also be used as a test model for other conservative treatments, such as positional therapy 17,18 or oral appliance (OA) use. 19 Positional therapy and OA use are effective conservative treatments for OSA. However, previous studies of these treatment indications only focused on which sleep test phenotype and severity.…”

Indications for Dental Specialists for Treating Obstructive Sleep Apnea with Mandibular Advancement Devices: A Narrative Review

“…Since MADs maintain airway patency by displacing the mandible and attached soft tissues forward, the assumption is that the site of collapse during sleep is an important parameter to predict the responsiveness of the treatment [ 62 ]. In this regard, primary oropharyngeal collapse, both at the level of the soft palate and tongue base, was associated with positive treatment response and should be considered a predictor of MAD response [ 29 , 39 , 63 ].…”