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Fernández-Sanjuán P, Arrieta JJ, Sanabria J, Alcaraz M, Bosco G, Pérez-Martín N, Pérez A, Carrasco-Llatas M, Moreno-Hay I, Ríos-Lago M, Lugo R, O’Connor-Reina C, Baptista P, Plaza G. Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol. J Clin Med 2022; 11:jcm11030658. [PMID: 35160107 PMCID: PMC8836970 DOI: 10.3390/jcm11030658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 01/20/2022] [Accepted: 01/24/2022] [Indexed: 12/21/2022] Open
Abstract
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/m2, 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.
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Affiliation(s)
- Patricia Fernández-Sanjuán
- 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
| | - Juan José Arrieta
- Department of Stomatology, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Jaime Sanabria
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain;
| | - Marta Alcaraz
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
| | - Gabriela Bosco
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
| | - Nuria Pérez-Martín
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
| | - Adriana Pérez
- Department of Otolaryngology Head and Neck Surgery, Hospital La Milagrosa, 28010 Madrid, Spain;
| | - Marina Carrasco-Llatas
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Dr. Peset., 46017 Valencia, Spain;
| | - Isabel Moreno-Hay
- Division of Orofacial Pain, Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, KY 40536, USA;
| | - Marcos Ríos-Lago
- Department of Basic Psychology II, Faculty of Psychology, UNED, 28040 Madrid, Spain;
| | - Rodolfo Lugo
- Department of Otolaryngology Head and Neck Surgery, Hospital San José, Monterrey 64718, Mexico;
| | - Carlos O’Connor-Reina
- Department of Otolaryngology Head and Neck Surgery, Hospital Quironsalud Marbella, 29603 Marbella, Spain;
- Department of Otolaryngology Head and Neck Surgery, Hospital Quironsalud Campo de Gibraltar, 11379 Palmones, Spain
| | - Peter Baptista
- Department of Otolaryngology Head and Neck Surgery, Clínica Universitaria de Navarra, 31008 Pamplona, Spain;
| | - Guillermo Plaza
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario Sanitas La Zarzuela, 28942 Madrid, Spain; (M.A.); (G.B.); (N.P.-M.)
- Department of Otolaryngology Head and Neck Surgery, Hospital Universitario de Fuenlabrada, Universidad Rey Juan Carlos, 28942 Madrid, Spain
- Correspondence:
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Esteller Moré E, Navazo Egía AI, Carrasco Llatas M. Drug-induced sleep endoscopy in children. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2019; 71:309-315. [PMID: 31056108 DOI: 10.1016/j.otorri.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/03/2019] [Indexed: 11/29/2022]
Abstract
This document is intended as a guide for Spanish ENT specialists who want to perform drug-induced sleep endoscopy. Indications, sedation method and important findings are discussed to unify criteria and methodology.
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Affiliation(s)
- Eduard Esteller Moré
- Servicio de Otorrinolaringología, Hospital General Universitario de Catalunya y Universitat Internacional de Catalunya, Sant Cugat del Vallès, Barcelona, España
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Lee LA, Lo YL, Yu JF, Lee GS, Ni YL, Chen NH, Fang TJ, Huang CG, Cheng WN, Li HY. Snoring Sounds Predict Obstruction Sites and Surgical Response in Patients with Obstructive Sleep Apnea Hypopnea Syndrome. Sci Rep 2016; 6:30629. [PMID: 27471038 PMCID: PMC4965759 DOI: 10.1038/srep30629] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022] Open
Abstract
Snoring sounds generated by different vibrators of the upper airway may be useful indicators of obstruction sites in patients with obstructive sleep apnea hypopnea syndrome (OSAHS). This study aimed to investigate associations between snoring sounds, obstruction sites, and surgical responses (≥50% reduction in the apnea-hypopnea index [AHI] and <10 events/hour) in patients with OSAHS. This prospective cohort study recruited 36 OSAHS patients for 6-hour snoring sound recordings during in-lab full-night polysomnography, drug-induced sleep endoscopy (DISE), and relocation pharyngoplasty. All patients received follow-up polysomnography after 6 months. Fifteen (42%) patients with at least two complete obstruction sites defined by DISE were significantly, positively associated with maximal snoring sound intensity (40-300 Hz; odds ratio [OR], 1.25, 95% confidence interval [CI] 1.05-1.49) and body mass index (OR, 1.48, 95% CI 1.02-2.15) after logistic regression analysis. Tonsil obstruction was significantly, inversely correlated with mean snoring sound intensity (301-850 Hz; OR, 0.84, 95% CI 0.74-0.96). Moreover, baseline tonsil obstruction detected by either DISE or mean snoring sound intensity (301-850 Hz), and AHI could significantly predict the surgical response. Our findings suggest that snoring sound detection may be helpful in determining obstruction sites and predict surgical responses.
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Affiliation(s)
- Li-Ang Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC
| | - Yu-Lun Lo
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC.,Department of Thoracic Medicine, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC
| | - Jen-Fang Yu
- Graduate Institute of Medical Mechatronics, Taiouan Interdisciplinary Otolaryngology Laboratory, Chang Gung University, Taoyuan 33303, Taiwan
| | - Gui-She Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 11221, Taiwan, ROC.,Department of Otolaryngology, Taipei City Hospital, Ren-Ai Branch, Taipei 10629, Taiwan, ROC
| | - Yung-Lun Ni
- Department of Thoracic Medicine, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Department of Chest Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung 42743, Taiwan, ROC
| | - Ning-Hung Chen
- Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC.,Department of Thoracic Medicine, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC
| | - Tuan-Jen Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Tao-Yuan 33303, Taiwan, ROC.,Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Tao-Yuan 33303, Taiwan, ROC
| | - Wen-Nuan Cheng
- Department of Sports Sciences, University of Taipei, Tai-Pei 11153, Taiwan, ROC
| | - Hsueh-Yu Li
- Department of Otorhinolaryngology - Head and Neck Surgery, Sleep Center, Linkou-Chang Gung Memorial Hospital, Tao-Yuan 33305, Taiwan, ROC.,Faculty of Medicine, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan, ROC.,Department of Sleep Medicine, Royal Infirmary of Edinburgh, Edinburgh EH16 4SA, UK
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Drug-induced sedation endoscopy versus clinical exploration for the diagnosis of severe upper airway obstruction in OSAHS patients. Sleep Breath 2015; 19:1367-72. [PMID: 26449550 DOI: 10.1007/s11325-015-1266-z] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 09/05/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Identifying the sites of obstruction of the upper airway in patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) is paramount for surgical planning. The aim of this study is to compare wake physical exam findings to the ones obtained during drug-induced sedation endoscopy (DISE) in the diagnosis of severe collapse of the upper airway in OSAHS patients. METHODS A retrospective chart review of OSAHS patients who underwent DISE at our institution during the 2006-2010 period was conducted. All the patients had previously undergone a physical examination that included modified Mallampati index (MMI), the Müller maneuver (MM), and the Friedman staging system. Level and severity of airway collapse were evaluated. A severe collapse was attributed to obstructions equal or greater than 75 % of the airway. RESULTS A total of 138 patients were included in the study. The incidence of severe airway collapse was compared between DISE and MM; at retropalatal level, no significant difference was found. At retrolingual level, 69 % of patients had severe collapse with DISE in comparison to a 28 % with the MM (p < 0.05). No relationship was found either with the MMI or with the Friedman staging system when compared to the incidence of severe retrolingual collapse diagnosed by DISE. Concordance was low between awake and DISE exploration in both retropalatal and retroglossal level. CONCLUSION The Müller maneuver underestimates tongue base severe obstruction diagnosis when compared to that obtained after DISE in OSAHS patients. The wake patient exploration does not accurately correlate to DISE exploration.
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