Modifications in Upper Airway Collapsibility during Sleep Endoscopy with a Mandibular Positioner: Study in Snorers and Obstructive Sleep Apnea Patients

Abstract

Background: Mandibular advancement devices (MADs) are an effective treatment for patients with sleep-related breathing disorders, with variable response. Increasingly more research points to the predictive value of Drug-Induced Sleep Endoscopy (DISE) in patient selection. This study aims to analyze the changes in upper airway collapsibility using a titratable MAD simulator during DISE. Methods: This study included 104 patients with simple snoring and obstructive sleep apnea (OSA). The VOTE scale was used to assess the presence of collapses during the DISE both without and with the MAD simulator. Results: In snorers, there was a decrease in collapses at the level of the soft palate and oropharynx when the advancement was achieved. Patients with mild OSA also showed a decrease in collapses at the base of the tongue. Patients with moderate/severe OSA exhibited significant amelioration at all levels. The levels at which there were residual collapses despite the maneuver were, in order, the velopharynx, oropharynx, epiglottis, and tongue. Conclusions: The MAD simulator reduces collapsibility at all levels and in all severity groups. Residual collapses suitable for combined treatments were able to be identified. This highlights the need for individualized patient selection, as upper airway collapsibility exhibits variable improvement or worsening with the MAD simulator regardless of the severity of the condition.

Upper Airway Collapsibility during Sleep Endoscopy with a Titratable Mandibular Advancement Simulator in Obstructive Sleep Apnea Patients

“…Particularly, the sites (velopharynx, oropharynx, tongue, epiglottis), degrees (none, partial, complete), and patterns (latero-lateral, anteroposterior, circular) of upper airway collapse were described at baseline and with TMA simulator placed intraorally in order to detect characteristics that, if confirmed in further prospective studies, will help in identifying beneficial and/or adverse phenotypes related to MAD treatment outcome. A previous prospective study investigated the locations and degree of upper airway collapse to different mandibular advancements during DISE using a selector advance mandibular device but failed to evaluate the collapse pattern which is an important variable for phenotypes identification and included both snoring and OSA patients [22]. Our study is the first to be conducted on a large sample undergoing DISE with a TMA simulator and including only patients with OSA, thus enhancing the generalizability of the results.…”

“…A recent study investigated the locations and degrees of upper airway collapse at various mandibular advancements during DISE using a selector advance mandibular device in 161 snoring and OSA patients; however, it failed to evaluate collapse patterns, which are important for identifying phenotypes. The study included both snoring and OSA patients [22].…”

The Resolution of Obstructive Sleep Apnea in a Patient with Goiter after Total Thyroidectomy: A Case Report

“…The resolution of OSA after total thyroidectomy, in this case, led to the conclusion that the goiter was indeed the causal factor for OSA. Studying the behavior of the upper airway under sedation could lead to more precise and personalized approaches for diagnosing and treating respiratory disorders [19]. Drug-induced sleep endoscopy (DISE) allows for the three-dimensional and dynamic visualization of the upper airway during sleep.…”