Abstract
Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.
Highlights
Obstructive sleep apnea (OSA) is a highly prevalent disease with significant public health outcomes [1] whose primary symptom is excessive daytime sleepiness that, together with mood alteration and cognitive impairment, produces a progressive deterioration in the quality of life of patients
The results showed no relationship between severity and Mandibular advancement devices (MAD) YES/NO and Selector Avance Mandibular (SAM) recommendation
The SAM device allowed a reproducible, measurable, and titratable maneuver to maintain a stable position during DISE
Summary
Obstructive sleep apnea (OSA) is a highly prevalent disease with significant public health outcomes [1] whose primary symptom is excessive daytime sleepiness that, together with mood alteration and cognitive impairment, produces a progressive deterioration in the quality of life of patients. It has been associated with an increased risk of arterial hypertension, cardiovascular morbidity and mortality, and occupational and traffic accidents [2,3]. Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP for many of these patients Their mechanism of action is based on the advancement and stabilization of the mandible and the hyoid. This high variability in response suggests the need for the identification of potential responders
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