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

Abstract

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

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

“…Differing from investigations using imaging tests such as CBCT and CT scans that focused on examining patients’ UA during wakefulness [ 23 , 24 , 25 , 26 , 53 ], in the current study, modifications were monitored during a DISE which is a validated technique representative of physiological sleep [ 29 , 34 , 54 , 55 , 56 , 57 ]. Our results are in line with other studies that consider DISE to be a good technique for evaluating the location and pattern of UA collapses, as well as the capability of mandibular advancement to identify candidates for MAD treatment [ 36 , 43 , 44 , 50 , 56 , 58 ].…”

“…According to some publications [ 36 , 41 , 50 ], performing manual maneuvers is not considered an appropriate technique for selecting patients eligible for MAD therapy, as it may lead to awakenings during the DISE and may not accurately replicate the real effect of a MAD.…”

“…[36] 2013 200 Simulation bite De Corso et al [37] 2015 65 Less than 5 mm manual advancement maneuver Huntley et al [38] 2018 20 Manual advancement maneuver Beelen et al [39] 2018 200 Manual advancement maneuver (jaw thrust) Kastoer et al [40] 2018 10 Remotely controlled mandibular positioner Park et al [41] 2019 40 Modified mandibular advancemen maneuver. 50-75% manual advancement Carrasco et al [42] 2019 -Modified Esmarch maneuver Vonk et al [43] 2020 63 Manual advancement maneuver and boil and bite mad Cavaliere et al [44] 2020 66 Simulation bite Koutsourelakis et al [45] 2021 49 Manual advancement maneuver Veugen et al [46] 2021 70 Manual advancement maneuver Kazemeini et al [47] 2022 10 Remotely controlled mandibular positioner Bosschieter et al [48] 2022 94 Manual advancement maneuver and boil and bite mad Fernández-Sanjuán et al [49] 2022 161 Mandibular titratable positioner (SAM) Van den Bossche et al [50] 2023 56 Manual advancement maneuver and mad in situ…”