The role of sleep endoscopy in oral appliance therapy for obstructive sleep apnea

Objective: Although oral appliance therapy is considered a validated treatment for obstructive sleep apnea, its therapeutic success varies significantly among patients. Drug-induced sleep endoscopy is often employed in order to identify candidates for upper airway surgery; however, it remains unknown whether its findings can be associated with success of oral appliance therapy. This study tested the hypothesis that drug-induced sleep endoscopy variables can predict the outcome of oral appliance therapy in obstructive sleep apnea patients. Methods: Forty-nine obstructive sleep apnea patients [45 men; mean apnea-hypopnea index 25.3 +/- 7.5 events/h; mean body mass index 28.2 +/- 3.0 kg/m(2)] underwent drug-induced sleep endoscopy, followed by a one-month of oral appliance therapy, and subsequently a follow-up polysomnography to assess outcome. Results: Thirty-three patients (67.3%) were responders and sixteen were non-responders (32.6%). Non-responders had a higher occurrence of complete or partial circumferential collapse at velum in comparison with responders. Multivariate logistic regression analysis revealed that, among baseline clinical and polysomnographic characteristics and sleep endoscopy findings, the presence of complete circumferential collapse at velum and increased body mass index were the only independent predictors of oral appliance therapy failure. Conclusion: Drug-induced sleep endoscopy can be used to predict a higher likelihood of success to oral appliance therapy in obstructive sleep apnea patients. (C) 2020 Oto-Rhino-Laryngological Society of Japan Inc. Published by Elsevier B.V. All rights reserved.