Multimodal phenotypic labelling using drug‐induced sleep endoscopy, awake nasendoscopy and computational fluid dynamics for the prediction of mandibular advancement device treatment outcome: a prospective study

Bossche, Karlien Van den; Beeck, Sara Op de; Dieltjens, Marijke; Verbruggen, Annelies E.; Vroegop, Anneclaire V.; Verbraecken, Johan; Heyning, P.H. Van de; Braem, M; Vanderveken, Olivier M.

doi:10.1111/jsr.13673

Cited by 16 publications

(10 citation statements)

References 42 publications

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“…This is in line with former literature using functional imaging, which reports that cross‐sectional areas increase with the use of a MAD at a retroglossal level 10,31 . In addition, previous research states that tongue base collapse is associated with a favorable MAD outcome, which could be reflected as the potential for the retroglossal area to reopen 23,32,33 …”

Section: Discussionsupporting

confidence: 91%

“…10,31 In addition, previous research states that tongue base collapse is associated with a favorable MAD outcome, which could be reflected as the potential for the retroglossal area to reopen. 23,32,33 At a retro-epiglottic level, only an increase in the LL diameter is significantly related to the presence of a MAD and MAD response. We could hypothesize that this association is present rather due to an increase in dimensions of the hypopharyngeal lateral walls than a reduction in epiglottic collapse.…”

Section: Discussionmentioning

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: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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

et al. 2023

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“…The clinical value of DISE has been proven in multiple trials and it is recommended as a diagnostic tool in patients with OSA seeking PAP alternatives, especially in screening for MAD and HNS or for planning of surgical interventions on the upper airway [ 13 , 14 ]. As expected, the examination is used in Germany, but in the absence of a specific procedure code, it was not possible to estimate the actual use until now.…”

Section: Discussionmentioning

confidence: 99%

Use of drug-induced sleep endoscopy in Germany—an analysis based on claims data

et al. 2023

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Background Drug-induced sleep endoscopy (DISE) has recently gained relevance as a diagnostic tool for obstructive sleep apnea (OSA). However, it is unclear to what extent and in which patient cohorts DISE is used in Germany. With introduction of specific coding for this method in 2021 (Operationen- und Prozedurenschluessel, OPS code), usage can now be analyzed based on diagnosis-related groups (DRG) claims data. Methods Aggregated data from all inpatient DISE procedures conducted in German hospitals in 2021 were obtained from the publicly available Institut fuer das Entgeltsystem im Krankenhaus (InEK) database. Patient-relevant information as well as data on hospitals providing the examinations were exported and analyzed. Results Between January and December 2021, a total of 2765 DISE procedures were conducted and documented using the newly introduced specific code (1-611.01). Most patients were male (75.6%), in the age categories 30–39 (15.2%) and 40–49 years (17.2%), and presented with the lowest patient clinical complexity level (PCCL; class 0 = 81.88%). Pediatric use was rare (1.8%). Leading main diagnoses of patients were G47.31 (OSA) and J34.2 (deviation of nasal septum). The most common procedures conducted together with DISE were nasal surgery, and the examination was mostly provided in large public hospitals with more than 800 beds. Conclusion Though the OSA prevalence in Germany is high, use of DISE as a diagnostic tool is low and represented only 4.4% of cases with a main diagnosis of OSA in 2021. Since specific coding was only introduced in January 2021, trends cannot yet be identified. Noticeable is the frequent combination of DISE with nasal surgery, which is not obviously related to a diagnosis of OSA. Limitations of the study are mainly related to the underlying data, which are available for the inpatient sector only, and due to potentially limited use of the OPS code, which was introduced recently and might not be known to all hospitals.

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“…In the future, it will be important to improve this selection procedure in order to achieve a more individualised treatment option in relation to other available methods, particularly compared with CPAP with its more stable mechanism of action. The identification of traits that have been associated with success, such as a low loop gain, a high arousal threshold, milder pharyngeal collapsibility, shallower events and tongue base collapse will be simplified by the use of new analysis methods of the respiratory sleep recordings and drug-induced sleep endoscopy [132][133][134][135]. It will also become necessary to define treatment success from a wider perspective and use new grading systems that consider a number of variables beyond AHI to identify OAT responders [136,137].…”

Section: Side-effects Of Oatmentioning

confidence: 99%

The role of oral appliance therapy in obstructive sleep apnoea

et al. 2023

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There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the “gold standard” in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-madeversusnoncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.

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Multimodal phenotypic labelling using drug‐induced sleep endoscopy, awake nasendoscopy and computational fluid dynamics for the prediction of mandibular advancement device treatment outcome: a prospective study

Cited by 16 publications

References 42 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

Use of drug-induced sleep endoscopy in Germany—an analysis based on claims data

The role of oral appliance therapy in obstructive sleep apnoea

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