Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol

Fernández-Sanjuán, Patricia; Arrieta, Juan José; Sanabria, J.; Alcaraz, Marta; Bosco, Gabriela; Pérez-Martín, Nuria; Pérez, Adriana; Carrasco-Llatas, Marina; Moreno-Hay, Isabel; Ríos-Lago, Marcos; Lugo, Rodolfo; O’Connor-Reina, Carlos; Baptista, Peter; Plaza, Guillermo

doi:10.3390/jcm11030658

Cited by 11 publications

(9 citation statements)

References 64 publications

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“…The wide variability in the response to treatment needs a strict control in each phase of the therapy [ 29 , 30 , 31 ]. The literature proposes different methods to distinguish responders and not responders, among which DISE-SAM protocol [ 32 ] and trial MAD [ 13 ]. Adequate follow-up [ 20 , 33 , 34 ] is essential for evaluating the efficacy of the therapy as well as for monitoring side effects related to long-term MAD use.…”

Section: Discussionmentioning

confidence: 99%

Pilot Study of a New Mandibular Advancement Device

et al. 2022

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This study was conducted to determine the efficacy of a customized mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). Eight patients (M = 3; F = 5; mean age = 56.3 ± 9.4) with a diagnosis of OSA confirmed by polysomnography (PSG) were recruited on the basis of the following inclusion criteria: apnea-hypopnea index (AHI) > 5, age between 18 and 75 years, body mass index (BMI) < 25, and PSG data available at baseline (T0). All were treated with the new NOA® MAD by OrthoApnea (NOA®) for at least 3 months; PSG with NOA in situ was performed after 3 months of treatment (T1). The following parameters were calculated at T0 and T1: AHI, supine AHI, oxygen desaturation index (ODI), percentage of recording time spent with oxygen saturation <90% (SpO2 < 90%), and mean oxygen desaturation (MeanSpO2%). Data were submitted for statistical analysis. The baseline values were AHI = 21.33 ± 14.79, supine AHI = 35.64 ± 12.80, ODI = 17.51 ± 13.5, SpO2 < 90% = 7.82 ± 17.08, and MeanSpO2% = 93.45 ± 1.86. Four patients had mild OSA (5 > AHI < 15), one moderate OSA (15 > AHI < 30), and three severe OSA (AHI > 30). After treatment with NOA®, statistically significant improvements in AHI (8.6 ± 4.21) and supine AHI (11.21 ± 7.26) were recorded. OrthoApnea NOA® could be an effective alternative in the treatment of OSA: the device improved the PSG parameters assessed.

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Section: Discussionmentioning

confidence: 99%

Pilot Study of a New Mandibular Advancement Device

et al. 2022

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“…Measurements were taken twice during the DISE: first, during the baseline condition without any device for simulation of MAD treatment, then when the device for advancing the mandible and simulating a MAD treatment was introduced in the mouth. The progressive jaw advancement was produced following the DISE-SAM protocol [ 49 ]. A second measure using the VOTE scale was taken (with-SAM condition) (see Figure 1 ).…”

Section: Methodsmentioning

confidence: 99%

“…For simulating MAD treatment, a SAM device was used that was specifically designed for this purpose [ 49 ]. It is a titratable tool that allows the operator perform controlled maneuvers with high precision (in the mm range) during a DISE, starting from a neutral/retrusive position to reach the optimal position where, if the patient responds, apnea/snoring are eliminated ( Video S1 ).…”

Section: Methodsmentioning

confidence: 99%

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

Fernández-Sanjuán,

Alcaraz,

Bosco

et al. 2024

JCM

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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.

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“…The advancement distance could be gradually increased during DISE until the UA collapse were relieved, and then the actual range of OAT could be predicted. If residual or worse collapse remained under DISE + SAM, OA would not be recommended [ 58 ]. Apart from the SAM device for OAT titration, another device (MATRx) could also be used to perform OAT titrations during DISE [ 59 ].…”

Section: Clinical Significances Of Disementioning

confidence: 99%

The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea

2022

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Background and Objective: Obstructive sleep apnoea (OSA) is characterized by nocturnal repetitive upper airway (UA) collapse. For sleep physicians, the recognition of UA collapse characteristics is critical for understanding OSA mechanisms and developing individualized treatment plans. Drug-induced sleep endoscopy (DISE) is an exam during simulated sleep that allows the dynamic assessment of the UA of individuals with OSA. The initial recognition of DISE was to locate the sites of UA obstruction and direct the surgical selection of OSA since it was introduced in the 1990s. After approximately 30 years of studies, based on advances in endoscopic operative techniques and innovative treatments of OSA, DISE had been performed to explore mechanisms and comprehensive treatments related to UA collapse. Methods: This article reviewed contemporary DISE advances, including indications and contraindications, technique of induced sleep, endoscopic operation, UA characteristics classification. Results and Conclusions: Precise selection based on the association between collapse patterns and treatment modalities, such as continuous positive airway pressure, oral appliance, positional therapy, robotic surgery and neurostimulator implanting, is the future research prospect based on DISE. Key messages DISE provides sleep physicians with valuable information about the upper airway collapse characteristics and dynamic changes during sleep. The studies based on DISE findings improve the selectivity and efficiency of treatment modalities, including classical therapies such as continuous positive airway pressure, oral appliance, positional therapy, and innovative therapies such as neurostimulator implanting and robotic surgery, promote the advancement of OSA precision medicine

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Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol

Cited by 11 publications

References 64 publications

Pilot Study of a New Mandibular Advancement Device

Pilot Study of a New Mandibular Advancement Device

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

The clinical application progress and potential of drug-induced sleep endoscopy in obstructive sleep apnea

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