Tailored Mandibular Advancement Therapy Guided Through a Mandibular Positioner: Predictive Value in Obstructive Sleep...

Area of Science:

• Sleep Medicine
• Otolaryngology
• Respiratory Medicine

Background:

• Mandibular advancement devices (MADs) are an alternative to CPAP for obstructive sleep apnea (OSA).
• Patient selection for MAD therapy remains a challenge.
• Drug-induced sleep endoscopy (DISE) with a mandibular titratable positioner (SAM) simulates MAD effects during endoscopy.

Purpose of the Study:

• To assess the positive predictive value (PPV) of a tailored MAD approach guided by DISE-SAM.
• To analyze changes in Apnea-Hypopnea Index (AHI), minimum oxygen saturation, and CT90.
• To evaluate treatment response based on OSA severity and SAM recommendations.

Main Methods:

• Prospective, multicenter cohort study of 77 OSA patients.
• DISE with the SAM device followed by MAD therapy in 66 patients based on SAM recommendations (S, A, M).
• Pre- and post-treatment sleep studies measured AHI, Min O2 Sat, and CT90; response analyzed with standard and tailored criteria.

Main Results:

• MAD therapy significantly improved AHI (32.26 to 7.19), min O2 Sat (80.83% to 85.87%), and CT90 (11.33% to 3.99%).
• Significant treatment effects observed across moderate and severe OSA groups and SAM recommendation categories.
• The DISE-SAM protocol showed high PPV, even with tailored success criteria.

Conclusions:

• The DISE-SAM protocol demonstrates high positive predictive value for MAD therapy in OSA.
• This protocol leads to significant improvements in respiratory parameters (AHI, oxygen saturation, CT90).
• DISE-SAM aids in selecting appropriate patients for MAD therapy, enhancing treatment efficacy.