Using individualized mandibular advancement device to avoid confusing jaw maneuvers during DISE in 114 consecutive sleep-apnea patients

During Drug Induced Sleep Endoscopy (DISE) and under pharmacological relaxation the passive external maneuvers like the jaw thrust and chin-lift can be confusing for the interpretation of the internal collapse patterns. These maneuvers try to help selecting the patient candidate to mandibular advancement device (M.A.D.) but it´s difficult to perform them without overdisplacement, giving an unreal impression (Vroegop et al., Journal Sleep Res 2013; 22: 348-55). We have studied 114 consecutive sleep apnea patients (99 men, 15 women, apnea / hypopnea index [AHI] 38 ± 19, body mass index [BMI] 26 ± 3 Kg / m2) with DISE using an individualized MAD (70% advance of each maximal protrusion) to record the real changes in internal collapse patterns without any artificial external mandibular movement. We have compared in each patient the V.O.T.E. (velopharyngeal, oropharyngeal, tongue, epiglottis) classification score with and without an individualized mandibular simulated protrusion/advancement device, very similar to a final MAD. Our results demonstrate a 76% of positive effect of individualized MAD in internal collapse patterns observed with VOTE classification scores. The overall response using this individualized MAD in the VOTE scores are almost 2 points ( 1.8 + 1.7 points in the 8 point VOTE scale ) and reach statistical significance, p<0.001, in all of the four anatomical areas compared without using the MAD, moreover without needing any external mandibular movement. Our results help selecting the patient candidate to MAD without any artificial mandibular movement that could affect the VOTE scores due to overdisplacement.