Mandibular advancement devices in obstructive sleep apnea syndrome: The role of drug-induced sleep endoscopy

BACKGROUND: Oral appliances achieved an important role in the treatment of obstructive sleep apnea syndrome (OSAS). In particular, mandibular advancement devices (MAD) have been more and more used for mild and moderate OSAS. The correct indication for treatment with MADs is mandatory to achieve a good success rate. The aim of this retrospective observational study was to evaluate the efficacy of MAD in OSAS and analyze the role of drug-induced sleep endoscopy (DISE). METHODS: Clinical and poligraphic characteristics of 15 patients treated with MADs were evaluated. DISE outcomes with and without mandibular pull-up maneuver were analyzed. Nose Oropharynx Hypopharynx and Larynx classification was used. Our attention focused on oropharyngeal/retropalatal and hypopharyngeal/retrolingual collapse. Six months after daily use of oral appliances, the patients were clinically re-evaluated with home respiratory polygraphy and Epworth Sleepiness Scale (ESS). RESULTS: Success rate was 93.3%. There was a statistically significant amelioration of Apnea-Hypopnea Index (AHI), supine AHI, Oxygen Desaturation Index (ODI), and ESS score. The Müller test demonstrated a quite homogeneous distribution of oropharyngeal and hypopharyngeal obstruction. At DISE without mandibular pull-up maneuver, a predominant complete oropharyngeal and hypopharyngeal collapse was observed. The execution of mandibular pull-up maneuver showed a notable reduction in pharyngeal collapsibility. In particular, hypopharyngeal/retrolingual collapse zeroed in 93% of cases. CONCLUSIONS: Drug-induced sleep endoscopy with mandibular pull-up maneuver should became a routine step in the evaluation of patients candidate to oral appliances, in the context of a multidisciplinary management.