Van de Perck Eli, Op de Beeck Sara, Dieltjens Marijke, Vroegop Anneclaire V, Verbruggen Annelies E, Willemen Marc, Verbraecken Johan, Van de Heyning Paul H, Braem Marc J, Vanderveken Olivier M
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
J Clin Sleep Med. 2020 Jul 15;16(7):1189-1198. doi: 10.5664/jcsm.8474.
The variable efficacy of mandibular advancement device (MAD) treatment necessitates both accessible and accurate methods for patient selection. However, the role of awake nasopharyngoscopy for this purpose 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.
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 3-month follow-up polysomnography with MAD, was classified as (1) apnea-hypopnea index reduction ≥ 50%, (2) treatment apnea-hypopnea index < 5 events/h, and (3) ≥ 10% increase in apnea-hypopnea index compared with baseline (treatment deterioration).
A complete dataset was obtained in 65 patients. After adjusting for baseline apnea-hypopnea index, body mass index, and supine dependency, the position of the soft palate (odds ratio, 4.0; 95% confidence interval, 1.3-11.8; P = .013) and crowding of the oropharynx (odds ratio, 7.7; 95% confidence interval, 1.4-41.4; P = .017) were related to treatment deterioration. Addition of both features significantly (P = .031) improved the accuracy of baseline models based on clinical measurements alone. Moreover, with the MAD in situ, a posteriorly located soft palate (odds ratio, 9.8; 95% confidence interval, 1.7-56.3; P = .010) and a posteriorly located tongue base (odds ratio, 7.4; 95% confidence interval, 1.5-35.9; P = .013) were associated with treatment deterioration.
Awake nasopharyngoscopy might be a valuable office-based examination to exclude the risk of treatment deterioration and improve patient selection for MAD treatment.
Registry: ClinicalTrials.gov; Name: Predicting Therapeutic Outcome of Mandibular Advancement Device Treatment in Obstructive Sleep Apnea (PROMAD); URL: https://clinicaltrials.gov/ct2/show/NCT01532050; Identifier: NCT01532050.
下颌前移装置（MAD）治疗效果存在差异，因此需要有便捷且准确的患者选择方法。然而，清醒状态下的鼻咽喉镜检查在此方面的作用仍不明确。我们引入了一种基于潮气呼吸时上气道解剖特征的鼻咽喉镜检查评估方法。本研究旨在将这些特征与MAD治疗效果相关联。
前瞻性招募100例诊断为阻塞性睡眠呼吸暂停的患者，使用MAD进行治疗，最大前突度固定为75%。在使用和不使用MAD的情况下，记录Müller动作和潮气呼吸时的鼻咽喉镜观察结果。通过使用MAD进行3个月的随访多导睡眠图确认治疗效果，分为以下三类：（1）呼吸暂停低通气指数降低≥50%；（2）治疗后呼吸暂停低通气指数<5次/小时；（3）与基线相比，呼吸暂停低通气指数增加≥10%（治疗效果恶化）。
65例患者获得了完整数据集。在对基线呼吸暂停低通气指数、体重指数和仰卧位依赖性进行校正后，软腭位置（优势比，4.0；95%置信区间，1.3 - 11.8；P = 0.013）和口咽拥挤程度（优势比，7.7；95%置信区间，1.4 - 41.4；P = 0.017）与治疗效果恶化相关。同时加入这两个特征可显著（P = 0.031）提高仅基于临床测量的基线模型的准确性。此外，佩戴MAD时，软腭后位（优势比，9.8；95%置信区间，1.7 - 56.3；P = 0.010）和舌根后位（优势比，7.4；95%置信区间，1.5 - 35.9；P = 0.013）与治疗效果恶化相关。
清醒状态下的鼻咽喉镜检查可能是一项有价值的门诊检查，可排除治疗效果恶化的风险，改善MAD治疗的患者选择。
注册机构：ClinicalTrials.gov；名称：阻塞性睡眠呼吸暂停下颌前移装置治疗的治疗结果预测（PROMAD）；网址：https://clinicaltrials.gov/ct2/show/NCT01532050；标识符：NCT01532050。
