Tailored Mandibular Advancement Therapy Guided Through a Mandibular Positioner: Predictive Value in Obstructive Sleep Apnea.

Abstract

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. Prospective cohort study. Academic secondary medical centers. 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 O₂ Sat, and CT90. Response was analyzed with standard AHI-oxygen saturation-based criteria and newly tailored criteria per SAM recommendation category. MAD therapy led to significant improvement in AHI (from 32.26 to 7.19), min O₂ 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. The DISE-SAM protocol demonstrated a high positive predictive value and significant improvements in key respiratory parameters among the selected patients using MAD.