An interim oral appliance as a screening tool during drug-induced sleep endoscopy to predict treatment success with a mandibular advancement device for obstructive sleep apnea,Sleep and Breathing

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An interim oral appliance as a screening tool during drug-induced sleep endoscopy to predict treatment success with a mandibular advancement device for obstructive sleep apnea
Sleep and Breathing ( IF 2.1 ) Pub Date : 2022-08-09 , DOI: 10.1007/s11325-022-02689-w
Pien Fenneke Nicole Bosschieter ₁ , Julia A M Uniken Venema _{2,

3} , Patty E Vonk ₄ , Madeline J L Ravesloot ₁ , Joost W Vanhommerig ₅ , A Hoekema _{2,

3} , Joanneke M Plooij ₆ , F Lobbezoo ₂ , Nico de Vries _{1,

2,

7}

Affiliation

Purpose

Previous studies have shown a wide range of efficacy (29 to 71%) of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA). Currently, the ability to preselect suitable patients for MAD therapy based on individual characteristics related to upper airway collapsibility is limited. We investigated if the use of non-custom interim MAD during drug-induced sleep endoscopy (DISE) could be a valuable screening tool to predict MAD treatment outcome.

Methods

In a single-center prospective study including a consecutive series of patients with OSA, we compared DISE outcomes with a MAD in situ with polysomnography results after 3 months of using the same MAD that was used during DISE.

Results

Of 41 patients who completed the study, the median apnea–hypopnea index (AHI) was 16.0 events/h [IQR 7.4–23.4]. Respiratory outcomes on polysomnography, including apnea index (AI), total AHI, AHI in supine position, and oxygen desaturation index, all significantly improved after 3 months of MAD treatment. With complete improvement of the upper airway obstruction with the MAD in situ during DISE in supine position, patients were 6.3 times more likely to be a responder to MAD treatment compared to patients with a persisting complete obstruction, although not statistically significant (OR 6.3; 95%CI 0.9–42.7; p = 0.060).

Conclusion

The potential predictive value with regard to MAD therapy outcomes of the use of an interim MAD during DISE would be an important finding, since the prediction of MAD therapy outcome is of great clinical and scientific interest. A study with a larger cohort should be performed to further investigate our findings.

中文翻译：

一种临时口腔矫治器作为药物诱导睡眠内窥镜检查期间的筛查工具，以预测下颌前移装置治疗阻塞性睡眠呼吸暂停的成功

目的

先前的研究表明，下颌前移装置 (MAD) 在治疗阻塞性睡眠呼吸暂停 (OSA) 方面具有广泛的疗效（29% 至 71%）。目前，根据与上气道塌陷相关的个体特征预选合适患者进行 MAD 治疗的能力有限。我们调查了在药物诱导睡眠内窥镜检查 (DISE) 期间使用非定制临时 MAD 是否可以成为预测 MAD 治疗结果的有价值的筛查工具。

方法

在一项包括连续系列 OSA 患者的单中心前瞻性研究中，我们比较了 DISE 结果与原位 MAD 与使用 DISE 期间使用的相同 MAD 3 个月后的多导睡眠图结果。

结果

在完成研究的 41 名患者中，中位呼吸暂停低通气指数 (AHI) 为 16.0 次/小时 [IQR 7.4–23.4]。多导睡眠图的呼吸结果，包括呼吸暂停指数 (AI)、总 AHI、仰卧位 AHI 和氧饱和度指数，在 MAD 治疗 3 个月后均显着改善。在仰卧位 DISE 期间，原位 MAD 完全改善了上呼吸道阻塞，与持续完全阻塞的患者相比，患者对 MAD 治疗有反应的可能性高 6.3 倍，尽管没有统计学意义（OR 6.3；95 %CI 0.9–42.7；p = 0.060）。