Pathophysiological endotyping in patients treated with a mandibular advancement device and upper airway stimulation for obstructive sleep apnea
2 October 2020
UAntwerpen, Campus Drie Eiken, Aula O8 and ONLINE - Gebouw O - Universiteitsplein 1 - 2610 Wilrijk (route: UAntwerpen, Campus Drie Eiken
Sara Op de Beeck
Prof. O. Vanderveken, Prof. A. Wellman, Prof. J. Verbraecken and Em.Prof. P. Van de Heyning
PhD defence Sara Op de Beeck - Faculty of Medicine and Health Sciences
Pathophysiology of obstructive sleep apnea can be subdivided into 5 endotypic traits: site of upper airway collapse, loop gain, muscle responsiveness and arousal threshold. Each of these traits can be measured using gold standard techniques, however, these are not available in routine measurements.
Currently, only the site of upper airway collapse is assessed in routine clinical practice using drug-induced sleep endoscopy. The 4 other traits are not routinely measured. Recently, however, an algorithm was developed that calculates these traits based on routine clinical polysomnography traits. Our aim was to define these traits using DISE and the algorithm, and to associate them to mandibular advancement device (MAD) and upper airway stimulation (HGNS) treatment outcome.
Our research showed that OSA pathophysiology holds great promise as a patient selection tool for both MAD and HGNS treatment outcome.
MAD efficacy was associated with the site of upper airway collapse, in analogy with HGNS, and with loop gain, in analogy with upper airway surgery and previous research. Regarding HGNS, the effect of site of collapse is established, yet our research adds that the other 4 endotypic traits, and especially arousal threshold, are also associated with treatment outcome.