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

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.