Functional Upper Airway Space Endoscopy: A Prognostic Indicator in Obstructive Sleep Apnea Treatment with Mandibular Advancement Devices.

Giulio Gasparini,Horia Vasile Hreniuc,Alessandro Moro,Enrico Foresta,Lorenzo Cigni,Roberta Gaia Parcianello,Paolo De Angelis,Camillo Azzuni,Gianmarco Saponaro,Piero Doneddu,Giorgio Barbera,Gabriele Ciasca,Mattia Todaro

doi:10.3390/ijerph18052393

Abstract

Purpose: The use of a mandibular advancement device (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy. This study aimed to evaluate the predictive value of awake upper airways (UA) functional endoscopy in identifying the outcome of MAD therapy. Methods: This observational prospective study included 30 adult OSA patients, all patients underwent pre-treatment awake UA functional endoscopy, during the exam subjects were instructed to advance their mandible maximally, and they were divided into three different groups according to the response of the soft tissue, group A (expansion), group B (stretch), group C (unchanged). The results of this test were used in combination with other noninvasive indexes to predict the treatment outcome in terms of apnea-hypopnea index (AHI) reduction. Results: We found that a substantial AHI reduction occurred in group A and group B while e slight AHI reduction was measured in group C. Conclusion: Based on our experience the awake UA endoscopy is a valid prognostic exam for discriminating responder and non-responder patients; in addition our results indicate the possibility of predicting a range of post-treatment AHI index values.

Highlights

We evaluated any signs of gastroesophageal reflux disease (GERD) and evaluated the presence of any neoformations to report to an ENT colleague for further diagnostic investigations
We evaluated the possibility of identifying obstructive sleep apnea (OSA) patients who would benefit from mandibular advancement device (MAD) treatment by performing an awake upper airways (UA) functional endoscopy
We think that UAs awake functional endoscopy can be a discriminant exam to distinguish responder vs. non-responder patients in OSA therapy with MADs

Summary

Introduction

Several treatment options are available for the effective management of obstructive sleep apnea (OSA). Surgery plays an important role and various authors have described many techniques with good results [1,2,3,4,5]. In addition to surgical therapy, there are other therapeutic options aimed at improving the symptoms and quality of life of patients, among these the use of mandibular advancement devices (MAD) in the treatment of obstructive sleep apnea (OSA) is a consolidated therapy [6]. MADs are indicated in cases of mild and moderate OSA, while they remain one of the few therapeutic options in patients with severe OSA who are unable to undergo continuous positive airway pressure (cPAP)

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