Tailored Mandibular Advancement Therapy Guided Through a Mandibular Positioner: Predictive Value in Obstructive Sleep Apnea
Patricia Fernández‐Sanjuán, Gabriela Bosco, Nuria Pérez‐Martín, Marta Alcaraz, Juan J. Arrieta, Jaime Sanabria, Silvia González‐Pondal, Rodolfo Lugo, Marcos Ríos‐Lago, Carlos O'Connor‐Reina, Peter Baptista, Guillermo PlazaAbstract
Objective
Mandibular advancement devices (MADs) are a recognized alternative to continuous positive airway pressure (CPAP) for treating obstructive sleep apnea (OSA), though patient selection is still challenging. Tailored MAD guided through drug induced sleep endoscopy (DISE) with a mandibular titratable positioner (SAM) offers a stable and reproducible simulation of MAD effects during DISE, potentially enhancing outcomes after this DISE‐SAM protocol. We aim to assess its positive predictive value (PPV) in patients treated with MAD by analyzing changes in AHI, minimum oxygen saturation, and CT90, considering OSA severity and recommendations based on the expected response.
Study Design
Prospective cohort study.
Setting
Academic secondary medical centers.
Methods
A prospective, multicenter study was conducted including 77 OSA patients across 3 hospitals. After DISE with the SAM device, 66 patients concluded MAD therapy based on SAM recommendations: Single use (S), Alternative (A), or Multiple treatment approach (M). Pretreatment and posttreatment sleep studies measured AHI, Min O 2 Sat, and CT90. Response was analyzed with standard AHI‐oxygen saturation‐based criteria and newly tailored criteria per SAM recommendation category.
Results
MAD therapy led to significant improvement in AHI (from 32.26 to 7.19), min O 2 Sat (from 80.83% to 85.87%), and CT90 (from 11.33% to 3.99%). Stratified analyses showed significant treatment effects in moderate and severe OSA groups and across SAM recommendations. The MAD therapy guided through DISE‐SAM protocol demonstrated high PPV, also when using tailored success criteria.
Conclusions
The DISE‐SAM protocol demonstrated a high positive predictive value and significant improvements in key respiratory parameters among the selected patients using MAD.