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Volume 15 No. 08
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Accepted Papers

Scientific Investigations

Phenotypic Labelling Using Drug-Induced Sleep Endoscopy Improves Patient Selection for Mandibular Advancement Device Outcome: A Prospective Study

Sara Op de Beeck, MSc1,2,3; Marijke Dieltjens, PhD1,2,4; Annelies E. Verbruggen, MD, PhD1,2; Anneclaire V. Vroegop, MD, PhD1,2; Kristien Wouters, PhD5; Evert Hamans, MD, PhD1; Marc Willemen, MSc3; Johan Verbraecken, MD, PhD1,3,6; Wilfried A. De Backer, MD, PhD1; Paul H. Van de Heyning, MD, PhD1,2,3; Marc J. Braem, DDS, PhD1,4; Olivier M. Vanderveken, MD, PhD1,2,3
1Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium;; 2ENT, Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium;; 3Multidisciplinary Sleep Disorders Centre, Antwerp University Hospital, Edegem, Belgium;; 4Special Dentistry Care, Antwerp University Hospital, Edegem, Belgium;; 5Clinical Trial Centre (CTC), CRC Antwerp, Antwerp University Hospital, Edegem, Antwerp, Belgium;; 6Department of Pulmonology, Antwerp University Hospital, Edegem, Antwerp, Belgium

Study Objectives:

Mandibular advancement device (MAD) outcome varies between patients. We hypothesized that upper airway collapse sites, patterns, and degrees assessed during baseline drug-induced sleep endoscopy (DISE) affect MAD outcome.


One hundred patients with obstructive sleep apnea (OSA) were included and underwent baseline type 1 polysomnography. MAD was fitted intraorally at fixed 75% maximal protrusion. A total of 72 patients completed 3-month follow-up polysomnography and baseline DISE. Response was defined as apnea-hypopnea index (AHI) reduction ≥ 50%, deterioration as AHI increases during MAD treatment compared to baseline.


Adjusting for baseline AHI and body mass index, patients with tongue base collapse showed 3.69 higher odds (1.27–10.73; P = .0128) for response. Complete concentric collapse at the level of the palate (5.32 [1.21–23.28]; P = .0234) and complete laterolateral oropharyngeal collapse (6.62 [1.14–38.34]; P = .0330) related to deterioration. Results for tongue base collapse and complete concentric collapse at the level of the palate were confirmed in the moderate to severe OSA subgroup. Applying these results to this selected subgroup increased response rate with 54% and decreased deterioration rate with 53%. These results were confirmed using other response and deterioration definitions.


Three baseline DISE phenotypes identified during drug-induced sleep were significantly related to MAD treatment outcome: one beneficial, tongue base collapse, and two adverse, complete concentric collapse at the level of the palate and complete laterolateral oropharyngeal collapse. If confirmed in future prospective studies, these results could guide patient selection for MAD outcome.

Clinical Trial Registration:

This prospective clinical trial (PROMAD) was registered on with identifier: NCT01532050.


Op de Beeck S, Dieltjens M, Verbruggen AE, Vroegop AV, Wouters K, Hamans E, Willemen M, Verbraecken J, De Backer WA, Van de Heyning PH, Braem MJ, Vanderveken OM. Phenotypic labelling using drug-induced sleep endoscopy improves patient selection for mandibular advancement device outcome: a prospective study. J Clin Sleep Med. 2019;15(8):1089–1099.

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