Van de Perck Eli, Dieltjens Marijke, Vroegop Anneclaire V, Verbraecken Johan, Braem Marc, Vanderveken Olivier M
Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.
Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium.
Sleep Breath. 2022 Dec;26(4):1915-1920. doi: 10.1007/s11325-021-02532-8. Epub 2022 Jan 7.
Epiglottic collapse is a specific sleep-endoscopic finding that can prove challenging to treat in patients with obstructive sleep apnea (OSA). Its effect on mandibular advancement devices (MAD) remains largely unknown. Therefore, this study assessed whether or not epiglottic collapse affects treatment outcome with MAD.
Patients with diagnosed OSAD underwent drug-induced sleep endoscopy (DISE) and were treated with a titratable MAD. Two age- and gender-matched controls were selected for every subject with primary epiglottic collapse (i.e., complete closure without involvement of other upper airway structures). Treatment response was defined as a reduction in oxygen desaturation index (ODI) of ≥ 50% following MAD therapy.
Of 101 patients who underwent DISE, twenty (20%) showed primary epiglottic collapse (mean [SD]: 17 men; age 49.8 [10.1]; body mass index 28.3 [2.9] kg/m; apnea-hypopnea index 27.0 [16.9] events/h). There were no significant differences in baseline clinical characteristics between cases and controls. MAD therapy was equally effective in patients with and without epiglottic collapse (mean [SD]; ODI with MAD, 8.7 [7.7] events/h vs. 7.8 [7.5] events/h, P = .62; ΔODI, 53.3 [29.6]% vs. 50.6 [37.7]%, P = .82; responder status, 10/20 vs. 22/40, P = .79). Logistic regression analysis revealed no associations between epiglottic collapse and treatment outcome.
The presence of epiglottic collapse during DISE does not impair the effectiveness of MAD. Therefore, MAD therapy should be considered in patients with predominant epiglottic collapse.
会厌塌陷是一种特定的睡眠内镜检查结果，对于阻塞性睡眠呼吸暂停（OSA）患者的治疗可能具有挑战性。其对下颌前移装置（MAD）的影响在很大程度上尚不清楚。因此，本研究评估了会厌塌陷是否会影响MAD的治疗效果。
确诊为阻塞性睡眠呼吸暂停低通气综合征（OSAD）的患者接受药物诱导睡眠内镜检查（DISE），并使用可滴定的MAD进行治疗。为每例原发性会厌塌陷（即完全闭合，不累及其他上气道结构）的患者选择两名年龄和性别匹配的对照。治疗反应定义为MAD治疗后氧饱和度下降指数（ODI）降低≥50%。
在101例行DISE的患者中，20例（20%）表现为原发性会厌塌陷（平均[标准差]：17名男性；年龄49.8[10.1]岁；体重指数28.3[2.9]kg/m²；呼吸暂停低通气指数27.0[16.9]次/小时）。病例组和对照组的基线临床特征无显著差异。MAD治疗在有和没有会厌塌陷的患者中同样有效（平均[标准差]；使用MAD时的ODI，8.7[7.7]次/小时对7.8[7.5]次/小时，P = 0.62；ΔODI，53.3[29.6]%对50.6[37.7]%，P = 0.82；反应者状态，10/20对22/40，P = 0.79）。逻辑回归分析显示会厌塌陷与治疗结果之间无关联。
DISE期间会厌塌陷的存在并不损害MAD的有效性。因此，对于以会厌塌陷为主的患者应考虑MAD治疗。
