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Baseline DISE Anatomy Predicts Jaw-Thrust Responsiveness in Obstructive Sleep Apnea.

Wei-Hung Chang1, Kuan-Pen Yu1, Li-Kuo Kuo1

  • 1Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei 10449, Taiwan.

Life (Basel, Switzerland)
|March 28, 2026
PubMed
Summary

Jaw thrust maneuver during drug-induced sleep endoscopy (DISE) improves airway obstruction in obstructive sleep apnea (OSA). Responsiveness is linked to baseline anatomy, not just polysomnography severity, guiding non-CPAP therapy selection.

Keywords:
DISE phenotypingVOTE scoringhypopharyngeal collapsejaw-thrust responsivenessmandibular advancement simulationmultilevel obstructionnon-CPAP therapy selectiontongue-base collapse

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Area of Science:

  • Sleep Medicine
  • Otolaryngology
  • Respiratory Medicine

Background:

  • Drug-induced sleep endoscopy (DISE) with jaw-thrust maneuver simulates mandibular advancement for obstructive sleep apnea (OSA).
  • Understanding factors influencing functional airway improvement during DISE is crucial.
  • Determinants of jaw-thrust responsiveness in OSA patients require further definition.

Purpose of the Study:

  • To identify clinical, polysomnographic, and baseline DISE anatomic factors associated with jaw-thrust responsiveness in OSA patients.
  • To elucidate predictors of airway improvement using the jaw-thrust maneuver during DISE.
  • To correlate baseline airway anatomy with functional response to jaw thrust in OSA.

Main Methods:

  • Retrospective observational study of 355 adults with polysomnography-confirmed OSA undergoing DISE.
  • Paired baseline and jaw-thrust VOTE assessments were performed.
  • Multivariable logistic regression identified independent correlates of jaw-thrust responsiveness, defined as reduced obstruction.

Main Results:

  • Jaw thrust significantly reduced obstruction burden from 2 to 1 site (p < 0.001).
  • Greatest improvement occurred at hypopharyngeal levels, particularly tongue base and epiglottis.
  • Baseline tongue-base collapse (aOR 2.46) and multilevel obstruction (aOR 1.85) predicted responsiveness, unlike PSG severity.

Conclusions:

  • Jaw-thrust responsiveness in OSA is primarily associated with baseline anatomic phenotype, not polysomnography severity.
  • Standardized DISE offers complementary information for selecting non-CPAP therapies.
  • Findings support phenotype-informed treatment strategies for OSA, pending validation.