Effectiveness of drug-induced sleep endoscopy in improving patients selection and outcomes of mandibular advancement device therapy for obstructive sleep apnea: A multicenter case-control study
Year: 2025
Type: article
Study design: Observational Study
Abstract: PURPOSE: To evaluate, in Obstructive sleep apnea (OSA) patients, the use of pre-treatment drug-induced sleep endoscopy (DISE) as a patient selection tool, that could improve the outcomes of mandibular advancement device (MAD) therapy. A multicenter retrospective case-control study has been performed. METHODS: A multicenter case-control study with two parallel arms was conducted to compare functional outcomes in patients undergoing MAD therapy. Group A (n = 118) received MAD therapy based solely on static clinical assessments, including dentoskeletal features, oropharyngeal anatomy, and upper airway endoscopy. Group B (n = 87) underwent pre-treatment DISE to dynamically evaluate the site, type, and pattern of upper airway collapse, thereby guiding patient selection for MAD therapy. RESULTS: In Group A, the mean pre-treatment apnea-hypopnea index (AHI) was 28.1, decreasing significantly to 12.4 post-treatment (p = 0.0001). In Group B, the mean AHI decreased from 31.3 to 9.5 (p = 0.0001). The Delta apnea-hypopnea index (ΔAHI) was significantly greater in Group B (-21.7) than in Group A (-16.6; p = 0.04). Similarly, the Delta Oxigen desaturation index (ΔODI) was -18.6 in Group B versus -14.1 in Group A (p = 0.04). The therapeutic success rate was significantly higher in Group B (82.7 %) compared to Group A (60.1 %) (p = 0.001). CONCLUSION: In OSA patients, a pre-treatment DISE evaluation, improves the selection of appropriate candidates for MAD therapy by enabling dynamic assessment of upper airway collapsibility during a pharmacologically induced sleep. This targeted selection results in significantly better therapeutic outcomes for MAD therapy for the OSA treatment.
Authors: Giannicola Iannella, Sergio Terranova, Marco Brunori, Claudio Vicini, Alberto Caranti, Ruggero Campisi, Vincenzo De Ceglie, Manuele Casale, Antonio Moffa, Fabrizio Salamanca, Federico Leone, Andrea De Vito, Giovanni Cammaroto, Salvatore Cocuzza, Antonino Maniaci, Armando De Virgilio, Jerome R. Lechien, Carlos-Miguel Chiesa-Estomba, Luigi A. Vaira, Paolo Boscolo-Rizzo, Stéphane Gargula, Andrea Costantino, Aurelio D'Ecclesia, Luca Lombardo, Francesca Cremonini, Mario Giuseppe Bellizzi, Enrica Croce, Antonella Polimeni, Giuseppe Magliulo, Annalisa Pace
Institutions: Sapienza University of Rome, University of Ferrara, University of Bari Aldo Moro, Università Campus Bio-Medico, Campus Bio Medico University Hospital, Ospedale G.B. Morgagni - L.Pierantoni, University of Catania, Università degli Studi di Enna Kore, University of Mons, Biogipuzkoa Health Research Institute, Osakidetza, Donostiako Unibertsitate Ospitalea, University of Sassari, University of Trieste, Hôpital Rothschild, Fondation de Rothschild, AdventHealth Orlando, AdventHealth Celebration, Ospedale San Carlo
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,630
OpenAlex ID: W4416439237