药物诱导睡眠内镜对伴有阻塞性睡眠呼吸暂停的患者使用下颌前伸装置或体位治疗的治疗效果的预测价值。

The predictive value of drug-induced sleep endoscopy for treatment success with a mandibular advancement device or positional therapy for patients with obstructive sleep apnea.

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, OLVG, Jan Tooropstraat 164, 1061AE, Amsterdam, Netherlands.

Department of Otorhinolaryngology, Head and Neck Surgery, Amsterdam UMC, Amsterdam, The Netherlands.

出版信息

Sleep Breath. 2022 Sep;26(3):1153-1160. doi: 10.1007/s11325-021-02501-1. Epub 2021 Oct 1.

DOI:10.1007/s11325-021-02501-1

PMID:34596877

Abstract

PURPOSE

As drug-induced sleep endoscopy (DISE) can provide additional diagnostic information on collapse patterns of the upper-airway, it is widely used in patients with obstructive sleep apnea (OSA). Although more controversial, DISE may also predict the success of treatment with a mandibular advancement device (MAD) and/or positional therapy (PT). In 2018, we proposed a prediction model to investigate the predictive value of passive maneuvers during DISE - such as jaw thrust and changes in body position - on upper-airway patency. Based on the outcomes of various studies, we then adjusted our DISE protocol to better mimic the effect of a MAD, PT, or a combination of both. The aim of this study was to verify whether or not our adjustments would increase the value of DISE as a selection tool.

METHODS

This single-center retrospective cohort study involved a consecutive series of patients with OSA. Patients were included if a DISE had been performed in supine and non-supine sleeping position and with and without a boil-and-bite MAD in situ between December 2018 and February 2020. The VOTE scoring system was used to evaluate the obstruction at four levels of the upper-airway.

RESULTS

Among 94 patients included. the median apnea-hypopnea index (AHI) was 16.2 (events/h). As a temporary MAD during DISE reduced obstruction by 54% and jaw thrust by 57%, both mimicked the effect of the custom-made MADs referred to in the literature, which reduces the AHI by 60%. Head-and-trunk rotation reduced obstruction by 55% and thus mimicked the effect of PT, which is known to reduce the AHI by 50%.

CONCLUSION

A jaw thrust, a temporary MAD, and head-and-trunk rotation during DISE all seem to mimic the treatment effects of MAD and PT. These findings may be of added value when choosing OSA treatment. To prove the predictive value of these maneuvers during DISE, a prospective study should be performed.

摘要

目的

由于药物诱导睡眠内镜（DISE）可以提供有关上呼吸道塌陷模式的额外诊断信息，因此它被广泛用于阻塞性睡眠呼吸暂停（OSA）患者。尽管存在更多争议，但 DISE 也可能预测下颌前伸装置（MAD）和/或体位治疗（PT）的治疗效果。2018 年，我们提出了一种预测模型，旨在研究 DISE 期间的被动手法（如下颌推力和体位改变）对上呼吸道通畅性的预测价值。基于各种研究的结果，我们调整了 DISE 方案，以更好地模拟 MAD、PT 或两者结合的效果。本研究的目的是验证我们的调整是否会增加 DISE 作为选择工具的价值。

方法

这是一项单中心回顾性队列研究，涉及一系列 OSA 患者。如果在 2018 年 12 月至 2020 年 2 月期间进行了仰卧位和非仰卧位睡眠以及原位放置煮沸和咬合剂 MAD 的 DISE，则将患者纳入研究。使用 VOTE 评分系统评估上呼吸道四个水平的阻塞情况。

结果

在 94 例患者中，中位呼吸暂停低通气指数（AHI）为 16.2（事件/小时）。作为 DISE 期间的临时 MAD，它将阻塞减少了 54%，下颌推力减少了 57%，这两种方法都模拟了文献中提到的定制 MAD 的效果，可将 AHI 降低 60%。头和躯干旋转将阻塞减少了 55%，从而模拟了已知可将 AHI 降低 50%的 PT 的效果。