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. 2019 Oct 15;15(10):1503-1508.
doi: 10.5664/jcsm.7986.

The Effect of the Modified Jaw-Thrust Maneuver on the Depth of Sedation During Drug-Induced Sleep Endoscopy

Donghwi Park  1 , Jung-Soo Kim  2 , Sung Jae Heo  3
Affiliations

The Effect of the Modified Jaw-Thrust Maneuver on the Depth of Sedation During Drug-Induced Sleep Endoscopy

Donghwi Park et al. J Clin Sleep Med. .

Abstract

Study objectives: The modified jaw-thrust maneuver (MJTM) during drug-induced sleep endoscopy (DISE) is known to predict the treatment effect of mandibular advancement devices. However, its effect on the depth of sedation and potential to provoke arousal by awakening patients during the maneuver has not been studied so far. This study investigated the effect of the MJTM on the depth of sedation during DISE.

Methods: Forty patients on whom the MJTM was performed during DISE were included. The effect of the maneuver was evaluated at the levels of the velum, lateral wall of the oropharynx, base of the tongue, and epiglottis. Obstruction was defined as the collapse of the upper airway exceeding 75%, and improvement with the MJTM was defined as the widening of the upper airway by more than 50% during the maneuver. A bolus injection of midazolam was used to induce sedation and control the depth of sedation (bispectral index value of 60 to 80).

Results: Obstructions were present in the velum of all patients, lateral wall of the oropharynx of 13 patients, base of the tongue of 28 patients, and epiglottis of 6 patients. After the MJTM, improvement of the obstruction was observed in 57.5%, 61.5%, 82%, and 66.7% of patients with velum, lateral wall of the oropharynx, base of the tongue, and epiglottis obstructions, respectively. An increase in the bispectral index value of more than 20 was observed in 8 patients. Four patients awakened during the procedure.

Conclusions: The MJTM significantly relieved obstruction during DISE, especially at the base of the tongue. However, this might have been caused by an increase in the degree of awakening during the maneuver. Therefore, MJTM's effect on the depth of sedation may help in improving the degree of airway obstruction.

Keywords: continuous positive airway pressure; endoscopy; mandibular advancement; obstructive sleep apnea; sleep stages.

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Figures

Figure 1
Figure 1. Depiction of modified jaw-thrust maneuver.
The modified jaw-thrust maneuver displaces the mandible forward by pushing the posterior aspects of the lower jaw with the index and middle fingers.
Figure 2
Figure 2. Comparison of the improvement of the upper airway obstruction before and after the modified jaw-thrust maneuver.
MJTM = modified jaw-thrust maneuver.
Figure 3
Figure 3. Changes of the obstruction pattern in the velum before and after the modified jaw-thrust maneuver.
MJTM = modified jaw-thrust maneuver.
Figure 4
Figure 4. Changes in the mean bispectral index after the modified jaw-thrust maneuver.
BIS = bispectral index, MJTM = modified jaw-thrust maneuver.
Figure 5
Figure 5. Reactions caused by the modified jaw-thrust maneuver and the difference in the bispectral index during the maneuver.
BIS = bispectral index, MJTM = modified jaw-thrust maneuver.
Figure 6
Figure 6. Correlation between the bispectral index during drug-induced sleep endoscopy and the visual analog scale of pain during the modified jaw-thrust maneuver performed before drug-induced sleep endoscopy.
BIS = bispectral index, VAS = visual analog scale.
See this image and copyright information in PMC

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