Fernández-Sanjuán Patricia, Arrieta Juan José, Sanabria Jaime, Alcaraz Marta, Bosco Gabriela, Pérez-Martín Nuria, Pérez Adriana, Carrasco-Llatas Marina, Moreno-Hay Isabel, Ríos-Lago Marcos, Lugo Rodolfo, O'Connor-Reina Carlos, Baptista Peter, Plaza Guillermo
Department of Maxillofacial Surgery and Dentistry, Hospital Universitario San Francisco de Asís, Universidad Rey Juan Carlos, 28002 Madrid, Spain.
Dental Sleep Medicine, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain.
J Clin Med. 2022 Jan 27;11(3):658. doi: 10.3390/jcm11030658.
Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.
下颌前移装置（MAD）是持续气道正压通气（CPAP）的一种有效替代治疗方法。在药物诱导睡眠内镜检查（DISE）期间进行了不同的操作，以模拟MAD的效果。使用Selector Avance Mandibular（SAM）装置，我们旨在通过一种可滴定、可重复且可测量的操作，在DISE期间识别MAD的适用患者。这种DISE-SAM方案可能有助于找到呼吸障碍严重程度与反应程度之间的关系，并确定改善上气道可塌陷性所需的前移程度。对161例患者（132例男性；29例女性）进行了研究，这些患者的平均年龄为46.81岁（标准差=11.42），体重指数为27.90（标准差=4.19）kg/m²，平均呼吸暂停低通气指数为26.51（标准差=21.23）。结果显示严重程度与MAD推荐之间没有关系。此外，获得反应所需的前移程度与疾病严重程度之间存在微弱的正相关关系。使用DISE-SAM方案，评估了反应和下颌前突范围，避免了下颌前推操作中检查者之间的偏差。我们建议按照个性化设计中的SAM建议，将MAD作为单一、替代或多种治疗方法进行处方。
