Drug-induced Sleep Endoscopy: Are there Predictors for Failure of Oral Appliance Treatment?

Abstract

Introduction In the literature, evidence is lacking on the predictive value of drug-induced sleep endoscopy (DISE) for oral appliance treatment (OAT). Objectives The aim of the present study is to evaluate whether DISE with concomitant mandibular advancement maneuver can predict failure of OAT. Methods An observational retrospective study including patients diagnosed with obstructive sleep apnea (OSA) who previously received OAT. Results of DISE were analyzed in a group with documented OAT failure (apnea-hypopnea index [AHI] > 10 events/hour or < 50% reduction) and a group with OAT benefit (AHI <10 events/hour or > 50% reduction). The upper airway was assessed using the velum, oropharynx, tongue base, epiglottis (VOTE) classification. Additionally, a mandibular advancement maneuver, manually protruding the mandible by performing a jaw thrust, was performed to mimic the effect of OAT. Results The present study included 50 patients with OAT failure and 20 patients with OAT benefit. A subgroup analysis of patients with OAT failure and an AHI < 30 events/hour included 26 patients. In the OAT failure group, 74% had a negative jaw thrust maneuver. In the subgroup with an AHI < 30 events/hour, 76.9% had a negative jaw thrust maneuver. In the OAT benefit group, 25% had a negative jaw thrust maneuver (p < 0.001). Conclusions A negative jaw thrust maneuver during DISE can be a valuable predictor for OAT failure, independent of AHI. Drug-induced sleep endoscopy should be considered as a diagnostic evaluation tool before starting OAT.

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

“…[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…”