The Relationship Between Specific Nasopharyngoscopic Features and Treatment Deterioration With Mandibular Advancement Devices: A Prospective Study.

The Relationship Between Specific Nasopharyngoscopic Features and Treatment Deterioration With Mandibular Advancement Devices: A Prospective Study.:

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The Relationship Between Specific Nasopharyngoscopic Features and Treatment Deterioration With Mandibular Advancement Devices: A Prospective Study.

J Clin Sleep Med. 2020 Apr 08;:

Authors: Van de Perck E, Op de Beeck S, Dieltjens M, Vroegop AV, Verbruggen AE, Willemen M, Verbraecken J, Van de Heyning PH, Braem MJ, Vanderveken OM

Abstract

STUDY OBJECTIVES: The variable efficacy of mandibular advancement device (MAD) treatment necessitates both accessible and accurate methods for patient selection. The role of awake nasopharyngoscopy for this purpose, however, remains dubious. We introduced an assessment method based on anatomical upper airway features during tidal breathing for nasopharyngoscopy. The current study aimed to relate these features to MAD treatment outcome.

METHODS: One hundred patients diagnosed with obstructive sleep apnea were prospectively recruited for MAD treatment in a fixed 75% degree of maximal protrusion. Nasopharyngoscopic observations during Müller's maneuver and tidal breathing were recorded both with and without MAD. Treatment outcome, confirmed by three-month follow-up polysomnography with MAD, was classified as (1) apnea-hypopnea index (AHI) reduction ≥50%, (2) treatment AHI <5 events/h, and (3) ≥10% increase in AHI compared to baseline (treatment deterioration).

RESULTS: A complete dataset was obtained in 65 patients. After adjusting for baseline AHI, body mass index and supine dependency, the position of the soft palate [odds ratio (OR) 4.0 (1.3-11.8); P=0.013] and crowding of the oropharynx [OR 7.7 (1.4-41.4); P=0.017] were related to treatment deterioration. Addition of both features significantly (P=0.031) improved the accuracy of baseline models based on clinical measurements alone. Moreover, with the MAD in situ, a posteriorly located soft palate [OR 9.8 (1.7-56.3); P=0.010] and a posteriorly located tongue base [OR 7.4 (1.5-35.9); P=0.013] were associated with treatment deterioration.

CONCLUSIONS: Awake nasopharyngoscopy might be a valuable office-based examination to exclude the risk of treatment deterioration and improve patient selection for MAD treatment.

PMID: 32267227 [PubMed - as supplied by publisher]