[Endoscopically-assisted adjustment of an oral appliance in patients with obstructive sleep apnoea]

Abstract

Background: The treatment effect of patients suffering from obstructive sleep apnoea/hypopnea (OSAHS) with an oral appliance is considerably varied, and its clinical outcome is unpredictable. The aim of our investigation was to examine the changes in pharyngeal airway size at different degrees of mandibular protrusion in order to assess the therapeutic efficacy in relation to the amount of protrusion.

Methods: Fifteen patients with the polysomnographic diagnosis of mild to moderate OSAHS were included in this prospective study. Nasal video endoscopy of the pharynx was done with the patients in supine position at four different degrees of mandibular protrusion do assess the changes of airway size. After 3 - 4 weeks a control polysomnography was carried out, with the mandible in optimal protrusion.

Results: The pharyngeal diameter did not increase linearly to the amount of mandibular protrusion. In the polysomnographic examination the respiratory variables were significantly increased. None of the patients in this group was classified as a non-responder to the oral appliance therapy.

Conclusions: The endoscopically-assisted adjustment of the mandibular protrusion appliance is an additional tool to optimise treatment effectiveness. The increase in pharyngeal diameter is not proportional to the amount of mandibular protrusion.