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The predictive value of drug-induced sleep endoscopy for treatment success with a mandibular advancement device or positional therapy for patients with obstructive sleep apnea

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

As drug-induced sleep endoscopy (DISE) can provide additional diagnostic information on collapse patterns of the upper-airway, it is widely used in patients with obstructive sleep apnea (OSA). Although more controversial, DISE may also predict the success of treatment with a mandibular advancement device (MAD) and/or positional therapy (PT). In 2018, we proposed a prediction model to investigate the predictive value of passive maneuvers during DISE — such as jaw thrust and changes in body position — on upper-airway patency. Based on the outcomes of various studies, we then adjusted our DISE protocol to better mimic the effect of a MAD, PT, or a combination of both. The aim of this study was to verify whether or not our adjustments would increase the value of DISE as a selection tool.

Methods

This single-center retrospective cohort study involved a consecutive series of patients with OSA. Patients were included if a DISE had been performed in supine and non-supine sleeping position and with and without a boil-and-bite MAD in situ between December 2018 and February 2020. The VOTE scoring system was used to evaluate the obstruction at four levels of the upper-airway.

Results

Among 94 patients included. the median apnea–hypopnea index (AHI) was 16.2 (events/h). As a temporary MAD during DISE reduced obstruction by 54% and jaw thrust by 57%, both mimicked the effect of the custom-made MADs referred to in the literature, which reduces the AHI by 60%. Head-and-trunk rotation reduced obstruction by 55% and thus mimicked the effect of PT, which is known to reduce the AHI by 50%.

Conclusion

A jaw thrust, a temporary MAD, and head-and-trunk rotation during DISE all seem to mimic the treatment effects of MAD and PT. These findings may be of added value when choosing OSA treatment. To prove the predictive value of these maneuvers during DISE, a prospective study should be performed.

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Availability of data and material

The data that support the finding of this study are available upon reasonable request.

Code availability

Not applicable

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Authors and Affiliations

  1. Department of Otorhinolaryngology, Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, Netherlands

    P. F. N. Bosschieter & N. de Vries

  2. Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands

    P. E. Vonk

  3. Department of Oral Kinesiology, ACTA, MOVE Research Institute Amsterdam, University of Amsterdam and VU University Amsterdam, Amsterdam, Netherlands

    N. de Vries

  4. Department of Otorhinolaryngology, Head and Neck Surgery, University of Antwerp, Antwerp, Belgium

    N. de Vries

Authors
  1. P. F. N. Bosschieter
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  2. P. E. Vonk
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  3. N. de Vries
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Correspondence to P. F. N. Bosschieter.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (name of institute/committee) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required. The study was submitted to the local advisory board of scientific research (ACWO) and approved by the board of directors (IRB) of OLVG hospital.

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The authors declare no competing interests.

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Bosschieter, P.F.N., Vonk, P.E. & de Vries, N. The predictive value of drug-induced sleep endoscopy for treatment success with a mandibular advancement device or positional therapy for patients with obstructive sleep apnea. Sleep Breath 26, 1153–1160 (2022). https://doi.org/10.1007/s11325-021-02501-1

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  • DOI: https://doi.org/10.1007/s11325-021-02501-1

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