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

• Published in: Sleep & breathing Vol. 27; no. 3; pp. 983 - 989
• Main Authors: Bosschieter, Pien Fenneke Nicole, Uniken Venema, Julia A. M., Vonk, Patty E., Ravesloot, Madeline J. L., Vanhommerig, Joost W., Hoekema, A., Plooij, Joanneke M., Lobbezoo, F., de Vries, Nico
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.06.2023; Springer Nature B.V
• Subjects: Airway management; Apnea; Dentistry; Endoscopy; Endoscopy - methods; Humans; Internal Medicine; Mandible; Mandibular Advancement - methods; Medicine; Medicine & Public Health; Neurology; Occlusal Splints; Otorhinolaryngology; Patients; Pediatrics; Pneumology/Respiratory System; Prospective Studies; Respiratory tract; Sleep; Sleep apnea; Sleep Apnea, Obstructive - diagnosis; Sleep Apnea, Obstructive - therapy; Sleep Breathing Physiology and Disorders • Original; Sleep Breathing Physiology and Disorders • Original Article; Sleep disorders; Statistical analysis; Treatment Outcome; Drug-induced sleep endoscopy; Mandibular advancement device; Obstructive sleep apnea; Sleep-disordered breathing; Treatment success
• ISSN: 1520-9512; 1522-1709
• DOI: 10.1007/s11325-022-02689-w

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.