Qualitative assessment of awake nasopharyngoscopy for prediction of oral appliance treatment response in obstructive sleep apnoea

• Published in: Sleep & breathing Vol. 22; no. 4; pp. 1029 - 1036
• Main Authors: Sutherland, Kate, Chan, Andrew S. L., Ngiam, Joachim, Darendeliler, M. Ali, Cistulli, Peter A.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.12.2018; Springer Nature B.V
• Subjects: Adult; Apnea; Dentistry; Female; Humans; Hypopharynx; Internal Medicine; Male; Mandible; Mandibular Advancement - instrumentation; Mandibular Advancement - methods; Medicine; Medicine & Public Health; Middle Aged; Neurology; Oropharynx; Orthodontic Appliance Design - methods; Otorhinolaryngology; Palate, Soft - physiopathology; Pediatrics; Pharynx; Pharynx - physiopathology; Pneumology/Respiratory System; Polysomnography - methods; Qualitative Research; Respiratory tract; Sleep; Sleep apnea; Sleep Apnea, Obstructive - therapy; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Titration; Treatment Outcome; Mandibular advancement; Oral appliance therapy; Obstructive sleep apnoea; Treatment outcome prediction; Velopharynx; Nasopharyngoscopy
• ISSN: 1520-9512; 1522-1709; 1522-1709
• DOI: 10.1007/s11325-018-1624-8

Purpose Clinical methods to identify responders to oral appliance (OA) therapy for obstructive sleep apnoea (OSA) are needed. Awake nasopharyngoscopy during mandibular advancement, with image capture and subsequent processing and analysis, may predict treatment response. A qualitative assessment of awake nasopharyngoscopy would be simpler for clinical practice. We aimed to determine if a qualitative classification system of nasopharyngoscopic observations reflects treatment response. Methods OSA patients were recruited for treatment with a customised two-piece OA. A custom scoring sheet was used to record observations of the pharyngeal airway (velopharynx, oropharynx, hypopharynx) during supine nasopharyngoscopy in response to mandibular advancement and performance of the Müller manoeuvre. Qualitative scores for degree (< 25%, 25–50%, 50–75%, > 75%), collapse pattern (concentric, anteroposterior, lateral) and diameter change (uniform, anteroposterior, lateral) were recorded. Treatment outcome was confirmed by polysomnography after a titration period of 14.6 ± 9.8 weeks. Treatment response was defined as (1) Treatment AHI < 5, (2) Treatment AHI < 10 plus > 50% AHI reduction and (3) > 50% AHI reduction. Results Eighty OSA patients (53.8% male) underwent nasopharyngoscopy. The most common naspharyngoscopic observation with mandibular advancement was a small (< 50%) increase in velopharyngeal lateral diameter (37.5%). The majority of subjects (72.5%) were recorded as having > 75% velopharyngeal collapse on performance of the Müller manoeuvre. Mandibular advancement reduced the observed level of pharyngeal collapse at all three pharyngeal regions ( p  < 0.001). None of the nasopharyngoscopic qualitative scores differed between responder and non-responder groups. Conclusion Qualitative assessment of awake nasopharyngoscopy appears useful for assessing the effect of mandibular advancement on upper airway collapsibility. However, it is not sensitive enough to predict oral appliance treatment outcome.