Mandibular advancement device therapy in patients with epiglottic collapse

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Epiglottic collapse is a specific finding during sleep endoscopy for obstructive sleep apnea (OSA).
• Its impact on the efficacy of mandibular advancement devices (MAD) is not well understood.
• Treating OSA with epiglottic collapse can be challenging.

Purpose of the Study:

• To assess if epiglottic collapse affects treatment outcomes in patients with obstructive sleep apnea (OSA) using mandibular advancement devices (MAD).

Main Methods:

• Patients with diagnosed OSA underwent drug-induced sleep endoscopy (DISE).
• Subjects with primary epiglottic collapse were compared to age- and gender-matched controls.
• Treatment response was defined by a ≥50% reduction in oxygen desaturation index (ODI) with MAD therapy.

Main Results:

• Twenty percent (20%) of 101 patients exhibited primary epiglottic collapse.
• No significant differences in baseline characteristics were observed between cases and controls.
• MAD therapy demonstrated similar effectiveness in patients with and without epiglottic collapse (P=.62 for ODI, P=.82 for ΔODI, P=.79 for responder status).

Conclusions:

• Epiglottic collapse during DISE does not negatively impact the effectiveness of MAD therapy.
• Mandibular advancement devices (MAD) should be considered for patients with predominant epiglottic collapse.
• Further research may explore combined therapies for complex OSA cases.