Vonk Patty E, Uniken Venema Julia A M, Hoekema Aarnoud, Ravesloot Madeline J L, van de Velde-Muusers Johanna A, de Vries Nico
Department of Otorhinolaryngology-Head and Neck Surgery, OLVG, Amsterdam, Netherlands.
Department of Otorhinolaryngology-Head and Neck Surgery, Amsterdam UMC, Amsterdam, Netherlands.
J Clin Sleep Med. 2020 Jul 15;16(7):1021-1027. doi: 10.5664/jcsm.8378.
The objectives of this study were to analyze agreement in degree of obstruction and configuration of the upper airway between jaw thrust and an oral device in situ during drug-induced sleep endoscopy and to evaluate clinical decision making using jaw thrust or a boil-and-bite mandibular advancement device (MAD; the MyTAP).
This was a single-center prospective cohort study in patients with obstructive sleep apnea who underwent drug-induced sleep endoscopy between January and July 2019.
Sixty-three patients were included. Agreement among observations in the supine position for degree of obstruction was 60% (n = 36, κ = 0.41) at the level of the velum, 68.3% (n = 41, κ = 0.35) for oropharynx, 58.3% (n = 35, κ = 0.28) for tongue base, and 56.7% (n = 34, κ = 0.14) for epiglottis; agreement among observations in the lateral position were 81.7% (n = 49, κ = 0.32), 71.7% (n = 43, κ = 0.36), 90.0% (n = 54, κ = 0.23), and 96.7% (n = 58, κ = could not be determined), respectively. In the supine position, agreement for configuration of obstruction at the level of the velum was found in 20 of 29 patients (69.0%, κ = 0.41) and in the lateral position was 100%. Thirty patients would have been prescribed a MAD using jaw thrust and 34 using the boil-and-bite MAD as a screening instrument. The main reason for being labeled as nonsuitable was complete residual retropalatal collapse during jaw thrust. Using the boil-and-bite MAD, this was caused by complete retropalatal or hypopharyngeal collapse.
There is only slight to moderate agreement in degree of obstruction for jaw thrust and a new-generation boil-and-bite MAD during drug-induced sleep endoscopy. Greater improvement of upper airway patency at the hypopharyngeal level was observed during jaw thrust, but this maneuver was less effective in improving upper airway obstruction at the retropalatal level.
本研究的目的是分析药物诱导睡眠内镜检查期间下颌前推与口腔矫治器在位时上气道阻塞程度和形态的一致性，并评估使用下颌前推或热塑压膜式下颌前移装置（MAD；MyTAP）的临床决策。
这是一项针对阻塞性睡眠呼吸暂停患者的单中心前瞻性队列研究，这些患者于2019年1月至7月接受了药物诱导睡眠内镜检查。
共纳入63例患者。仰卧位时，软腭水平阻塞程度的观察一致性为60%（n = 36，κ = 0.41），口咽为68.3%（n = 41，κ = 0.35），舌根为58.3%（n = 35，κ = 0.28），会厌为56.7%（n = 34，κ = 0.14）；侧卧位时的观察一致性分别为81.7%（n = 49，κ = 0.32）、71.7%（n = 43，κ = 0.36）、90.0%（n = 54，κ = 0.23）和96.7%（n = 58，κ无法确定）。仰卧位时，29例患者中有20例（69.0%，κ = 0.41）软腭水平阻塞形态的观察一致，侧卧位时为100%。30例患者根据下颌前推结果会被处方MAD，34例根据热塑压膜式MAD筛查结果会被处方MAD。被标记为不合适的主要原因是下颌前推时软腭后完全残留塌陷。使用热塑压膜式MAD时，这是由软腭后或下咽完全塌陷引起的。
在药物诱导睡眠内镜检查期间，下颌前推与新一代热塑压膜式MAD在阻塞程度上只有轻微到中度的一致性。下颌前推时观察到下咽水平的上气道通畅性有更大改善，但该操作在改善软腭后水平的上气道阻塞方面效果较差。
