Drug-induced sleep endoscopy improves intervention efficacy among patients treated for obstructive sleep apnea with a mandibular advancement device

Gogou, Evgenia Sp.; Psarras, Vasilios; Giannakopoulos, Nikolaos Nikitas; Koutsourelakis, Ioannis; Halazonetis, Demetrios J.; Tzakis, Michail

doi:10.1007/s11325-021-02561-3

Cited by 7 publications

(5 citation statements)

References 51 publications

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“…This clinical investigation has become a valuable concept in patient selection for surgical non‐CPAP treatment modalities 15–19 . Moreover, DISE with and without a MAD may aid clinical decision‐making in patients with an incomplete response to MAD treatment 20–23 . During DISE, a chin lift maneuver, whereby maximal mandibular protrusion is actively achieved through pushing or pulling the lower jaw forwards, can be performed to predict MAD treatment response, although previous studies showed rather limited predictive value 24,25 .…”

Section: Introductionmentioning

confidence: 99%

“…[15][16][17][18][19] Moreover, DISE with and without a MAD may aid clinical decision-making in patients with an incomplete response to MAD treatment. [20][21][22][23] During DISE, a chin lift maneuver, whereby maximal mandibular protrusion is actively achieved through pushing or pulling the lower jaw forwards, can be performed to predict MAD treatment response, although previous studies showed rather limited predictive value. 24,25 Nevertheless, no detailed endoscopic quantitative measurements of the pharyngeal dimensions with and without mandibular advancement have been made during DISE.…”

Section: Introductionmentioning

confidence: 99%

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Quantitative Measurement of Pharyngeal Dimensions During Drug‐induced Sleep Endoscopy for Oral Appliance Outcome

et al. 2023

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ObjectiveTo quantitatively investigate the effect of mandibular advancement devices (MADs) on pharyngeal airway dimensions in a transverse plane as measured during drug‐induced sleep endoscopy (DISE).MethodsData from 56 patients, treated with MAD at 75% maximal protrusion and with baseline Apnea‐Hypopnea Index ≥10 events/h, were analyzed. For each patient, three snapshots were selected from DISE video footage at baseline, with MAD presence, and during chin lift, resulting in 498 images (168/168/162, baseline/MAD/chin lift). Cross‐sectional areas, anteroposterior (AP) and laterolateral (LL) dimensions on both retroglossal and retro‐epiglottic levels were measured. To define the effect of MAD and chin lift on pharyngeal dimensions, linear mixed‐effect models were built. Associations between MAD treatment response and pharyngeal expansion (MAD/chin lift) were determined.ResultsSignificant differences were found between retroglossal cross‐sectional areas, AP, and LL dimensions at baseline and with MAD presence. At a retro‐epiglottic level, only LL dimensions differed significantly with MAD presence compared to baseline, with significant relation of LL expansion ratio to treatment response (p = 0.0176). After adjusting the response definition for the sleeping position, greater retroglossal expansion ratios were seen in responders (1.32 ± 0.48) compared to non‐responders (1.11 ± 0.32) (p = 0.0441). No significant association was found between response and pharyngeal expansion by chin lift.ConclusionOur observations highlight the additional value of quantitative pharyngeal airway measurements during DISE with MAD presence in evaluating MAD treatment outcome. These findings demonstrate an increase in retroglossal airway dimensions during DISE, with MAD presence, and more pronounced increase in retroglossal expansion ratios in MAD treatment responders compared to non‐responders after sleeping position correction.Level of Evidence3 Laryngoscope, 2023

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quantitative Measurement of Pharyngeal Dimensions During Drug‐induced Sleep Endoscopy for Oral Appliance Outcome

et al. 2023

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“…Studies generally rely on subjective titration wherein the degree of mandibular advancement is progressively increased over several weeks (5–40 weeks) until an improvement or a resolution of symptoms occurs or until the patient cannot tolerate any further advancement. Studies have also used objective guided titration, which means selecting the mandibular position that has determined the abolishment of respiratory events or nonphysiologic parameters during the diagnostic instruments/procedures (DISE, PSG, oximetry) [ 99 , 100 ]. Objective-guided titration is more reproducible and could avoid the overextension of mandibular protrusion, which may occur with subjective titration, and that can generate discomfort and consequently less adherence to the treatment.…”

Section: Resultsmentioning

confidence: 99%

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

Lo Giudice,

La Rosa,

Ronsivalle

et al. 2024

International Journal of Dentistry

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Obstructive sleep apnea (OSA) syndrome is characterized by repeated airway collapse during sleep. It determines cardiovascular, pulmonary, and neurocognitive consequences and is associated with several daytime and nighttime symptoms that influence the patient’s quality of life. The contribution of the dental specialist in the clinical management of OSA patients entails participating in the screening process as diagnostic sentinels and providing adequate treatment using mandibular advancement devices (MADs). Since the treatment of OSA requires a multidisciplinary approach, including different medical specialists, dentists should have a comprehensive understanding of medical and dental factors that influence the strategy and effectiveness of OSA treatment with MAD. Such expertise is crucial in determining the appropriate treatment indications and helps clinicians establish a consolidated position within the multidisciplinary OSA team. In this regard, this review summarizes the evidence of the clinical indications for MAD treatment and provides the dental specialist with helpful information about medical, functional, and other relevant factors that should be considered during diagnosis, treatment plan, and follow-up stages. Information retrieved was organized and discussed, generating specific domains/queries oriented to the clinical management of OSA patients from the clinical perspective of dental specialists.

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“…We might expect associations to be stronger if natural sleep was used. However, we emphasise that DISE is the current clinical standard used to characterise site of collapse and is known to provide insight into non-CPAP treatment efficacy [ 2 – 6 , 31 ].…”

Section: Discussionmentioning

confidence: 99%

Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy

Op de Beeck,

Vena,

Mann

et al. 2024

Eur Respir J

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RationaleDifferences in the pharyngeal site-of-collapse influences efficacy of non-CPAP therapies for obstructive sleep apnoea (OSA). Notably, complete concentric collapse at the palate (CCCp) during drug-induced sleep endoscopy (DISE) is associated with reduced efficacy of hypoglossal nerve stimulation, but CCCp is currently not recognisable using polysomnography. Here we develop a means to estimate DISE-based site-of-collapse using overnight polysomnography.Methods182 OSA patients provided DISE and polysomnography data. Six polysomnographic flow-shape characteristics (mean during hypopnoeas) were identified as candidate predictors of CCCp (primary outcome variable, N=44/182), including inspiratory skewness and inspiratory scoopiness. Multivariable logistic regression combined the six characteristics to predict clear presence (N=22)versusabsence (N=128) of CCCp (partial collapse and concurrent tongue-base collapse excluded). Odds ratios for actual CCCp between predicted subgroups were quantified after cross-validation. Secondary analyses examined complete lateral wall, tongue-base, or epiglottis collapse. External validation was performed on a separate dataset (Ntotal=466).ResultsCCCp was characterised by greater scoopiness (β=1.5±0.6 per 2SD, multivariable estimate±se) and skewness (β=11.4±2.4) compared to non-CCCp. Odds ratio [95%CI] for CCCp in predicted positiveversusnegative subgroups was 5.0[1.9–13.1]. The same characteristics provided significant cross-validated prediction of lateral wall (OR=6.3[2.4–16.5]), tongue-base (3.2[1.4–7.3]), and epiglottis (4.4[1.5–12.4]) collapse. CCCp and lateral wall collapse shared similar characteristics (skewed, scoopy), diametrically opposed to tongue-base and epiglottis collapse characteristics. External validation confirmed model prediction.ConclusionsThe current study provides a means to recognise patients with likely CCCp or other DISE-based site-of-collapse categories using routine polysomnography. Since site-of-collapse influences therapeutic responses, polysomnographic airflow shape analysis could facilitate precision site-specific OSA interventions.

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Drug-induced sleep endoscopy improves intervention efficacy among patients treated for obstructive sleep apnea with a mandibular advancement device

Cited by 7 publications

References 51 publications

Quantitative Measurement of Pharyngeal Dimensions During Drug‐induced Sleep Endoscopy for Oral Appliance Outcome

Quantitative Measurement of Pharyngeal Dimensions During Drug‐induced Sleep Endoscopy for Oral Appliance Outcome

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

Polysomnographic airflow shapes and site of collapse during drug-induced sleep endoscopy

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