Jaw Thrust Versus the Use of a Boil-And-Bite Mandibular Advancement Device as a Screening Tool During Drug-Induced Sleep Endoscopy.

STUDY OBJECTIVES 1) to analyse agreement in degree of obstruction and configuration of the upper airway (UA) between jaw thrust and an oral device in situ during drug-induced sleep endoscopy (DISE) 2) to evaluate clinical decision making using jaw thrust or a boil-and-bite MAD, the MyTAP. METHODS single-centre prospective cohort study in obstructive sleep apnea patients who underwent DISE between January - July 2019. RESULTS Sixty-three patients were included. Agreement amongst observations in the supine position for degree of obstruction was 60% (N=36, k=0.41) at the level of the velum, 68.3% (N=41, k=0.35) for oropharynx, 58.3% (N=35, k=0.28) for tongue base, 56.7% (N=34, k=0.14) for epiglottis; in the lateral position 81.7% (N=49, k=0.32), 71.7% (N=43, k=0.36), 90.0% (N=54, k=0.23) and 96.7% (N=58, k= could not be determined) respectively. In the supine position agreement for configuration of obstruction at level of the velum was found in 20 of 29 patients (69.0%, k=0.41), in the lateral position 100%. Thirty patients would have been prescribed a MAD using jaw thrust, 34 using the boil-and-bite MAD as a screening instrument. The main reason for being labelled as non-suitable was complete residual retropalatal collapse during jaw thrust. Using the boil-and-bite MAD, this was both due to complete retropalatal or hypopharyngeal collapse. CONCLUSION There is only slight to moderate agreement in degree of obstruction for jaw thrust and a new-generation boil-and-bite MAD during DISE. Greater improvement of UA patency at hypopharyngeal level was observed during jaw thrust, but this manoeuvre was less effective in improving UA obstruction at retropalatal level.