Phenotypic Labelling Using Drug-Induced Sleep Endoscopy Improves Patient Selection for Mandibular Advancement Device Outcome : A Prospective Study
© 2019 American Academy of Sleep Medicine..
STUDY OBJECTIVES: Mandibular advancement device (MAD) outcome varies between patients. We hypothesized that upper airway collapse sites, patterns, and degrees assessed during baseline drug-induced sleep endoscopy (DISE) affect MAD outcome.
METHODS: One hundred patients with obstructive sleep apnea (OSA) were included and underwent baseline type 1 polysomnography. MAD was fitted intraorally at fixed 75% maximal protrusion. A total of 72 patients completed 3-month follow-up polysomnography and baseline DISE. Response was defined as apnea-hypopnea index (AHI) reduction ≥ 50%, deterioration as AHI increases during MAD treatment compared to baseline.
RESULTS: Adjusting for baseline AHI and body mass index, patients with tongue base collapse showed 3.69 higher odds (1.27-10.73; P = .0128) for response. Complete concentric collapse at the level of the palate (5.32 [1.21-23.28]; P = .0234) and complete laterolateral oropharyngeal collapse (6.62 [1.14-38.34]; P = .0330) related to deterioration. Results for tongue base collapse and complete concentric collapse at the level of the palate were confirmed in the moderate to severe OSA subgroup. Applying these results to this selected subgroup increased response rate with 54% and decreased deterioration rate with 53%. These results were confirmed using other response and deterioration definitions.
CONCLUSIONS: Three baseline DISE phenotypes identified during drug-induced sleep were significantly related to MAD treatment outcome: one beneficial, tongue base collapse, and two adverse, complete concentric collapse at the level of the palate and complete laterolateral oropharyngeal collapse. If confirmed in future prospective studies, these results could guide patient selection for MAD outcome.
CLINICAL TRIAL REGISTRATION: This prospective clinical trial (PROMAD) was registered on Clinicaltrials.gov with identifier: NCT01532050.
CITATION: Op de Beeck S, Dieltjens M, Verbruggen AE, Vroegop AV, Wouters K, Hamans E, Willemen M, Verbraecken J, De Backer WA, Van de Heyning PH, Braem MJ, Vanderveken OM. Phenotypic labelling using drug-induced sleep endoscopy improves patient selection for mandibular advancement device outcome: a prospective study. J Clin Sleep Med. 2019;15(8):1089-1099.
| Errataetall: |
CommentIn: J Clin Sleep Med. 2019 Aug 15;15(8):1073-1074. - PMID 31482825 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:15 |
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| Enthalten in: |
Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine - 15(2019), 8 vom: 15. Aug., Seite 1089-1099 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Op de Beeck, Sara [VerfasserIn] |
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| Links: |
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| Themen: |
DISE |
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| Anmerkungen: |
Date Completed 13.10.2020 Date Revised 13.10.2020 published: Print ClinicalTrials.gov: NCT01532050 CommentIn: J Clin Sleep Med. 2019 Aug 15;15(8):1073-1074. - PMID 31482825 Citation Status MEDLINE |
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| doi: |
10.5664/jcsm.7796 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM300919220 |
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| 100 | 1 | |a Op de Beeck, Sara |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Phenotypic Labelling Using Drug-Induced Sleep Endoscopy Improves Patient Selection for Mandibular Advancement Device Outcome |b A Prospective Study |
| 264 | 1 | |c 2019 | |
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| 500 | |a Date Completed 13.10.2020 | ||
| 500 | |a Date Revised 13.10.2020 | ||
| 500 | |a published: Print | ||
| 500 | |a ClinicalTrials.gov: NCT01532050 | ||
| 500 | |a CommentIn: J Clin Sleep Med. 2019 Aug 15;15(8):1073-1074. - PMID 31482825 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2019 American Academy of Sleep Medicine. | ||
| 520 | |a STUDY OBJECTIVES: Mandibular advancement device (MAD) outcome varies between patients. We hypothesized that upper airway collapse sites, patterns, and degrees assessed during baseline drug-induced sleep endoscopy (DISE) affect MAD outcome | ||
| 520 | |a METHODS: One hundred patients with obstructive sleep apnea (OSA) were included and underwent baseline type 1 polysomnography. MAD was fitted intraorally at fixed 75% maximal protrusion. A total of 72 patients completed 3-month follow-up polysomnography and baseline DISE. Response was defined as apnea-hypopnea index (AHI) reduction ≥ 50%, deterioration as AHI increases during MAD treatment compared to baseline | ||
| 520 | |a RESULTS: Adjusting for baseline AHI and body mass index, patients with tongue base collapse showed 3.69 higher odds (1.27-10.73; P = .0128) for response. Complete concentric collapse at the level of the palate (5.32 [1.21-23.28]; P = .0234) and complete laterolateral oropharyngeal collapse (6.62 [1.14-38.34]; P = .0330) related to deterioration. Results for tongue base collapse and complete concentric collapse at the level of the palate were confirmed in the moderate to severe OSA subgroup. Applying these results to this selected subgroup increased response rate with 54% and decreased deterioration rate with 53%. These results were confirmed using other response and deterioration definitions | ||
| 520 | |a CONCLUSIONS: Three baseline DISE phenotypes identified during drug-induced sleep were significantly related to MAD treatment outcome: one beneficial, tongue base collapse, and two adverse, complete concentric collapse at the level of the palate and complete laterolateral oropharyngeal collapse. If confirmed in future prospective studies, these results could guide patient selection for MAD outcome | ||
| 520 | |a CLINICAL TRIAL REGISTRATION: This prospective clinical trial (PROMAD) was registered on Clinicaltrials.gov with identifier: NCT01532050 | ||
| 520 | |a CITATION: Op de Beeck S, Dieltjens M, Verbruggen AE, Vroegop AV, Wouters K, Hamans E, Willemen M, Verbraecken J, De Backer WA, Van de Heyning PH, Braem MJ, Vanderveken OM. Phenotypic labelling using drug-induced sleep endoscopy improves patient selection for mandibular advancement device outcome: a prospective study. J Clin Sleep Med. 2019;15(8):1089-1099 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a DISE | |
| 650 | 4 | |a MAD | |
| 650 | 4 | |a OSA | |
| 650 | 4 | |a obstructive sleep apnea | |
| 650 | 4 | |a personalized medicine | |
| 650 | 7 | |a Hypnotics and Sedatives |2 NLM | |
| 700 | 1 | |a Dieltjens, Marijke |e verfasserin |4 aut | |
| 700 | 1 | |a Verbruggen, Annelies E |e verfasserin |4 aut | |
| 700 | 1 | |a Vroegop, Anneclaire V |e verfasserin |4 aut | |
| 700 | 1 | |a Wouters, Kristien |e verfasserin |4 aut | |
| 700 | 1 | |a Hamans, Evert |e verfasserin |4 aut | |
| 700 | 1 | |a Willemen, Marc |e verfasserin |4 aut | |
| 700 | 1 | |a Verbraecken, Johan |e verfasserin |4 aut | |
| 700 | 1 | |a De Backer, Wilfried A |e verfasserin |4 aut | |
| 700 | 1 | |a Van de Heyning, Paul H |e verfasserin |4 aut | |
| 700 | 1 | |a Braem, Marc J |e verfasserin |4 aut | |
| 700 | 1 | |a Vanderveken, Olivier M |e verfasserin |4 aut | |
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