ArticleNature and science of sleep2026
Mandibular Advancement for Obstructive Sleep Apnea: Efficacy and the Trade-off of Expiratory Velopharyngeal Obstruction During Sleep Endoscopy - An Exploratory Observational Study.
Article in Nature and science of sleep, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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6 authors.
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Abstract
Purpose: Mandibular advancement devices (MADs) are effective alternatives for obstructive sleep apnea (OSA), yet robust predictors of response are lacking, and the phenomenon of device-induced expiratory velopharyngeal obstruction (EVO) remains overlooked. This study conducted an exploratory clinical simulation to compare the efficacy and airway dynamics of a custom-fitted, maximally protrusive advanced MAD simulator versus a conventional edge-to-edge oral appliance (OA) during drug-induced sleep endoscopy (DISE). Patients and Methods: In this prospective observational study, 75 adults with OSA underwent target-controlled infusion DISE. Upper airway obstruction (VOTE classification) and EVO were assessed in supine and head-rotated positions under three conditions: baseline, conventional OA, and advanced MAD simulator. A monitored subset (n=18) underwent simultaneous home sleep apnea testing to quantify apnea-hypopnea index (AHI) and lowest oxygen saturation (SpO Results: Compared to the conventional OA, the advanced MAD simulator resolved complete velum obstruction in 34.8% of cases (supine, Conclusion: While the advanced MAD simulator effectively resolves inspiratory obstruction at the velum and epiglottis, it significantly increases EVO. This exploratory simulation highlights a critical mechanical trade-off between inspiratory patency and expiratory resistance. These hypothesis-generating results warrant further longitudinal research to determine the net clinical impact on long-term treatment adherence and sleep quality.
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