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Tailored Mandibular Advancement Therapy Guided Through a Mandibular Positioner: Predictive Value in Obstructive Sleep
Patricia Fernández-Sanjuán1, Gabriela Bosco1,2, Nuria Pérez-Martín3
1Sleep Breathing Disorders Unit, Hospital Universitario Sanitas La Zarzuela, Madrid, Spain.
Summary
The DISE-SAM protocol effectively guides mandibular advancement device (MAD) therapy for obstructive sleep apnea (OSA), showing high positive predictive value and improving key respiratory metrics like AHI and oxygen saturation.
Area of Science:
- Sleep Medicine
- Respiratory Physiology
- Medical Device Technology
Background:
- Obstructive sleep apnea (OSA) management often involves continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs).
- Patient selection for MAD therapy remains a challenge, impacting treatment efficacy.
- Drug-induced sleep endoscopy (DISE) with a mandibular titratable positioner (SAM) simulates MAD effects during endoscopy, offering a potential tool for personalized treatment.
Purpose of the Study:
- To assess the positive predictive value (PPV) of a tailored MAD approach guided by DISE-SAM protocol in OSA patients.
- To analyze improvements in apnea-hypopnea index (AHI), minimum oxygen saturation, and CT90 following DISE-SAM-guided MAD therapy.
- To evaluate treatment response based on OSA severity and SAM-based recommendations.
Main Methods:
- Prospective, multicenter cohort study involving 77 OSA patients.
- DISE with the SAM device was performed, followed by MAD therapy in 66 patients based on SAM recommendations (Single, Alternative, Multiple).
- Pre- and post-treatment sleep studies measured AHI, minimum O2 Sat, and CT90, with response analyzed using 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 were observed across moderate and severe OSA groups and different SAM recommendation categories.
- The DISE-SAM protocol demonstrated high PPV, even with tailored success criteria.
Conclusions:
- The DISE-SAM protocol is a valuable tool for guiding MAD therapy in OSA patients.
- This approach shows high positive predictive value and leads to significant improvements in respiratory parameters.
- Personalized MAD selection based on DISE-SAM can enhance treatment outcomes for obstructive sleep apnea.
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