Correction to: Remotely controlled mandibular positioning of oral appliance therapy during polysomnography and drug-induced sleep endoscopy compared with conventional subjective titration in patients with obstructive sleep apnea: protocol for a randomized crossover trial

Abstract Background The amount of mandibular protrusion is a key factor in optimizing the efficacy of mandibular advancement device (MAD) therapy in an individual patient diagnosed with obstructive sleep apnea. This process is called titration and is generally based on resolution of subjective symptoms like snoring and/or daytime sleepiness as a function of protrusion. An objective approach uses a remotely controlled mandibular positioner (RCMP) during a full-night polysomnography (PSG), in analogy with continuous positive airway pressure (CPAP) titration. More recently, the feasibility of RCMP use during drug-induced sleep endoscopy (DISE) titration was reported. Methods This randomized crossover trial will compare DISE-assisted titration to PSG-guided titration, as well as with the conventional subjective titration method. The primary outcome is the actual mandibular protrusive position found to be the most optimal for each tested titration procedure. Furthermore, the therapeutic efficacy will be compared among the different titration modalities using level 1 sleep studies. Discussion Currently, the optimal titration of MAD therapy is most often based on ‘trial and error’. The conventional method relies on subjective improvement in symptoms, although this may not provide the most accurate indicator for efficient titration. Therefore, relying on objective criteria in the titration process should be advantageous. In analogy with CPAP, titration of the most optimal mandibular protrusion could be performed using RCMP during an overnight titration PSG. Recently, it was shown that titration under direct visualization of upper airway patency and collapsibility is feasible using the RCMP during DISE. However, no clinical results for such a procedure are as yet available. This study is the first to compare the most optimal mandibular protrusive position according to three titration procedures, as well as to compare the therapeutic efficacy of these titration methods. Trial registration ClinicalTrials.gov, NCT03716648. Registered on 23 October 2018.

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Towards a prediction model for drug-induced sleep endoscopy as selection tool for oral appliance treatment and positional therapy in obstructive sleep apnea

Sleep And Breathing ◽

10.1007/s11325-018-1649-z ◽

2018 ◽

Vol 22 (4) ◽

pp. 901-907 ◽

Cited By ~ 9

Author(s):

P. E. Vonk ◽

A. M. E. H. Beelen ◽

N. de Vries

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Prediction Model ◽

Oral Appliance ◽

Positional Therapy ◽

Sleep Endoscopy ◽

Drug Induced ◽

Selection Tool ◽

Drug Induced Sleep Endoscopy ◽

Obstructive Sleep

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Remotely controlled mandibular positioning of oral appliance therapy during polysomnography and drug-induced sleep endoscopy compared with conventional subjective titration in patients with obstructive sleep apnea: protocol for a randomized crossover trial

10.21203/rs.2.145/v2 ◽

2019 ◽

Author(s):

Marijke Dieltjens ◽

Marc J. BRAEM ◽

Sara Op de Beeck ◽

Anneclaire V.M.T. VROEGOP ◽

Elahe KAZEMEINI ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Therapeutic Efficacy ◽

Crossover Trial ◽

Sleep Endoscopy ◽

Drug Induced ◽

Randomized Crossover Trial ◽

Cpap Titration ◽

Obstructive Sleep ◽

Mandibular Protrusion

Abstract Background The amount of mandibular protrusion is a key factor in optimizing the efficacy of mandibular advancement device (MAD) therapy in the individual patient diagnosed with obstructive sleep apnea (OSA). This process is called titration and is generally based on resolution of subjective symptoms like snoring and/or daytime sleepiness as a function of protrusion. An objective approach uses a remotely controlled mandibular positioner (RCMP) during a full-night polysomnography, in analogy with CPAP titration. More recently, the feasibility of RCMP use during drug-induced sleep endoscopy (DISE) titration was reported. Methods This randomized crossover trial will compare DISE-assisted titration with PSG-guided-titration, as well as with the conventional subjective titration method. The primary outcome is the actual mandibular protrusive position found to be the most optimal for each tested titration procedure. Furthermore, the therapeutic efficacy will be compared among the different titration modalities using level 1 sleep studies. Discussion Currently, the optimal titration of MAD therapy is most often based on ‘trial and error’. The conventional method relies on subjective improvement in symptoms, although this may not provide the most accurate indicator for efficient titration. Therefore, relying on objective criteria in the titration process should be advantageous. In analogy with CPAP, titration of the most optimal mandibular protrusion could be performed using RCMP during an overnight titration PSG. Recently, it was shown that titration under direct visualization of upper airway patency and collapsibility is feasible using the RCMP during DISE. However, no clinical results of such a procedure are available yet. This study is the first to compare the most optimal mandibular protrusive position according to three titration procedures, as well as to compare the therapeutic efficacy of these titration methods.

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Remotely Controlled Mandibular Positioning of Oral Appliance Therapy during Polysomnography and Drug-induced Sleep Endoscopy Compared with Conventional Subjective Titration in Patients with Obstructive Sleep Apnea: A Randomized Crossover Trial

10.21203/rs.2.145/v1 ◽

2018 ◽

Author(s):

Marijke Dieltjens ◽

Marc J. Braem ◽

Anneclaire V.M.T. Vroegop ◽

Elahe Kazemeini ◽

Jolien Beyers ◽

...

Keyword(s):

Obstructive Sleep Apnea ◽

Sleep Apnea ◽

Therapeutic Efficacy ◽

Crossover Trial ◽

Sleep Endoscopy ◽

Drug Induced ◽

Randomized Crossover Trial ◽

Cpap Titration ◽

Obstructive Sleep ◽

Mandibular Protrusion

Abstract Background: The amount of mandibular protrusion is a key factor in optimizing the efficacy of mandibular advancement device (MAD) therapy in the individual patient diagnosed with obstructive sleep apnea (OSA). This process is called titration and is generally based on resolution of subjective symptoms like snoring and/or daytime sleepiness as a function of protrusion. An objective approach uses a remotely controlled mandibular positioner (RCMP) during a full-night polysomnography, in analogy with CPAP titration. More recently, the feasibility of RCMP use during drug-induced sleep endoscopy (DISE) titration was reported. Methods: This randomized crossover trial will compare DISE-assisted titration with PSG-guided-titration, as well as with the conventional subjective titration method. The primary outcome is the actual mandibular protrusive position found to be the most optimal for each tested titration procedure. Furthermore, the therapeutic efficacy will be compared among the different titration modalities using type 3 sleep studies. Discussion: Currently, the optimal titration of MAD therapy is most often based on ‘trial and error’. The conventional method relies on subjective improvement in symptoms, although this may not provide the most accurate indicator for efficient titration. Therefore, relying on objective criteria in the titration process should be advantageous. In analogy with CPAP, titration of the most optimal mandibular protrusion could be performed using RCMP during an overnight titration PSG. Recently, it was shown that titration under direct visualization of upper airway patency and collapsibility is feasible using the RCMP during DISE. However, no clinical results of such a procedure are available yet. This study is the first to compare the most optimal mandibular protrusive position according to three titration procedures, as well as to compare the therapeutic efficacy of these titration methods.

Download Full-text