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Drug-induced sleep endoscopy improves intervention efficacy among patients treated for obstructive sleep apnea with a mandibular advancement device

  • Sleep Breathing Physiology and Disorders • Original Article
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Abstract

Purpose

To compare the short-term treatment effect of a mandibular advancement device (MAD) with and without previous drug-induced sleep endoscopy (DISE) on polysomnography (PSG) and other sleep apnea–related treatment outcomes (Short Form Health Survey [SF-36] and Epworth Sleepiness Scale [ESS]) among adults with mild, moderate, and severe obstructive sleep apnea (OSA). We hypothesized that using DISE would improve the efficacy of MADs on the sleep apnea parameters.

Methods

The study sample consisted of patients with OSA who were unable or unwilling to tolerate a CPAP device, divided into an experimental (with DISE) and a control (without DISE) group.

Results

Of 50 patients with OSA, 40 men (80%), mean age was 48.8 ± 12,3 years. The mean apnea–hypopnea index (AHI) score of both groups decreased significantly between baseline and the 8-week follow-up titration PSG with MAD in situ, from 31.7 ± 17.3 (mean ± SD) apnea–hypopnea episodes/h to 7.0 ± 6.4/h (p < 0.0001) in the experimental group, and from 22.5 ± 16.6 episodes/h to 11.4 ± 8.0/h (p < 0.024) in the control group. Capillary oxygen saturation (SpO2) levels did not change significantly between the two timepoints for either group. The SF-36 (p < 0.023) and ESS (p < 0.036) results of both groups improved significantly between baseline and the 8-week follow-up after starting MAD treatment; however, the improvement in quality of life was significantly more pronounced in the experimental group than in the control group (p < 0.0001).

Conclusion

DISE provides a significant benefit to patients with OSA undergoing MAD treatment. It can be used as a valuable prediction tool in clinical practice for the management of patients with OSA, even those with moderate and severe disease.

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Author information

Authors and Affiliations

  1. Orofacial Pain Clinic, Dental School, National and Kapodistrian University of Athens, GR-11527, Athens, Greece

    Evgenia Sp. Gogou, Vasilios Psarras & Michail Ger. Tzakis

  2. Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, GR-11527 , Athens, Greece

    Nikolaos Nikitas Giannakopoulos

  3. Department of Prosthodontics, University Clinic of Würzburg, Würzburg, Germany

    Nikolaos Nikitas Giannakopoulos

  4. Department of Otolaryngology-Head and Neck Surgery, Weill Cornell Medicine, New York, NY, 10021, USA

    Ioannis Koutsourelakis

  5. Department of Orthodontics, School of Dentistry, National and Kapodistrian University of Athens, GR-11527, Athens, Greece

    Demetrios J. Halazonetis

Authors
  1. Evgenia Sp. Gogou
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  2. Vasilios Psarras
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  3. Nikolaos Nikitas Giannakopoulos
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  4. Ioannis Koutsourelakis
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  5. Demetrios J. Halazonetis
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  6. Michail Ger. Tzakis
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Contributions

Evgenia Gogou was involved in the study design and was responsible for the clinical work and data collection and interpretation; Vasilios Psarras was involved in the study design and manuscript preparation; Ioannis Koutsourelakis was involved in the drug-induced sleep endoscopy procedure and interpretation; Demetrios Halazonetis contributed to data acquisition and interpretation; Nikolaos Nikitas Giannakopoulos was involved in data analysis, interpretation of the results, and manuscript preparation; Michail Tzakis was involved in the supervision of the project, the study design, the fabrication details of the mandibular advancement device, data analysis, and manuscript preparation. All authors critically revised the manuscript and gave final approval.

Corresponding author

Correspondence to Evgenia Sp. Gogou.

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Ethical approval

This study was conducted in accordance with the tenets of the 1964 Declaration of Helsinki and its later amendments, and all procedures involving human participants were approved by the Ethics Committee of the Dental School of Athens University (approval number: 291). Written informed consent was obtained from all study participants.

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The authors declare no competing interests.

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Gogou, E.S., Psarras, V., Giannakopoulos, N.N. et al. Drug-induced sleep endoscopy improves intervention efficacy among patients treated for obstructive sleep apnea with a mandibular advancement device. Sleep Breath 26, 1747–1758 (2022). https://doi.org/10.1007/s11325-021-02561-3

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  • DOI: https://doi.org/10.1007/s11325-021-02561-3

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