Drug-induced Sleep Endoscopy (DISE) with Simulation Bite to Predict the Success of Oral Appliance Therapy in Treating Obstructive Sleep Apnea/Hypopnea Syndrome (OSAHS)

Pietro De Luca

doi:10.37825/2239-9747.1011

Abstract

Study objectivesOral appliances have gained their place in the treatment of obstructive sleep apnea (OSA) where custom-made titratable mandibular advancement devices (MAD) have become the oral appliance of choice. This study aimed to asses the value of the drug-induced sleep endoscopy (DISE) using a MAD in the prediction of treatment outcome for OSAHSMethodsThis is a prospective, single-center cohort study that enrolled sixty-six consecutive patients with diagnosed OSA (5 events/h < apnea-hypopnea index (AHI) < 50 events/h) to be treated with a custom-made titratable MAD. The patients were evaluated polysomnographically with the MAD in situ after the adaptation and titration period of 3 months. The associations between findings during DISE and treatment outcome were assessedResultsThe subjects showed a wide range of severity of OSAHS pre-treatment: median AHI was 43.10 with a range from 20.13 to 66.07. The simulation bite was associated with a significant increase in cross-sectional area at level of the velopharynx, tongue base and epiglottis. MAD treatment response in the studied population was 91%, with a mean AHI improving from 43.10 to 12.93.ConclusionsDrug-induced sleep endoscopy with simulation bite is an acceptably reproducible technique for determining the sites of obstruction in OSAHS subjects; it thus offers possibilities as a prognostic indicator for treatment with MAD

Highlights

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by recurrent episodes of apnea and hypopnea during sleep, due to repetitive upper airway (UA) collapse, often resulting in decreased oxygen blood levels and arousal from sleep [1,2]
Mandibular advancement devices (MADs) are the most common class of oral appliances to treat OSAHS [3,4,5]; in selecting patients who might benefit from mandibular advancement device (MAD) treatment, several predictor factors of treatment outcome have been described in the literature, such as lower apnea– hypopnea index (AHI), lower body mass index (BMI), lower age, female gender and supine-dependent OSAHS [6,7]
The subjects showed a wide range of severity of OSAHS pre-treatment: median AHI was 43.10 with a range from 20.13 to 66.07 (Table II)

Summary

Introduction

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is characterized by recurrent episodes of apnea and hypopnea during sleep, due to repetitive upper airway (UA) collapse, often resulting in decreased oxygen blood levels and arousal from sleep [1,2]. Continuous positive airway pressure (cPAP) therapy is considered the gold standard for treatment, but oral appliance therapy could represent the main alternative treatment modality. Mandibular advancement devices (MADs) are the most common class of oral appliances to treat OSAHS [3,4,5]; in selecting patients who might benefit from MAD treatment, several predictor factors of treatment outcome have been described in the literature, such as lower apnea– hypopnea index (AHI), lower body mass index (BMI), lower age, female gender and supine-dependent OSAHS [6,7].

Objectives

Results

Conclusion