Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol.

Area of Science:

• Sleep Medicine
• Otolaryngology
• Biomedical Engineering

Background:

• Mandibular advancement devices (MAD) offer an alternative to CPAP for sleep-disordered breathing.
• Drug-induced sleep endoscopy (DISE) is used to evaluate upper airway collapse.
• Standard maneuvers during DISE may not accurately predict MAD efficacy.

Purpose of the Study:

• To introduce and validate the Selector Avance Mandibular (SAM) device and DISE-SAM protocol.
• To identify patients who would benefit from MAD treatment.
• To correlate the degree of mandibular advancement with treatment response and disease severity.

Main Methods:

• A novel DISE-SAM protocol was developed using a titratable, reproducible, and measurable maneuver.
• 161 patients (mean age 46.81 years, BMI 27.90 kg/m², AHI 26.51) underwent the DISE-SAM procedure.
• The protocol assessed MAD response and required mandibular protrusion, minimizing interexaminer bias.

Main Results:

• No significant relationship was found between sleep apnea severity (AHI) and the recommendation for MAD.
• A weak positive correlation existed between the required mandibular advancement and disease severity.
• The DISE-SAM protocol successfully assessed response and protrusion range, offering objective data.

Conclusions:

• The DISE-SAM protocol provides a standardized method for evaluating MAD candidacy.
• It allows for personalized MAD treatment recommendations based on objective measurements.
• MAD prescription can be tailored as a primary, alternative, or adjunctive therapy.