Change of Obstruction Site by Modified Jaw Thrust Maneuver in Obstructive Sleep Apnea Patients

Abstract

Background and Objective We evaluated possibility of modified jaw thrust maneuver with drug induced sleep endoscopy (DISE), as an indicator of mandibular advancement treatment such as mandibular advance device, geniohyoid advancement and other treatment modalities. Methods Sixty seven Korean male, obstructive sleep apnea patient, confirmed by full night polysomnography were enrolled. We performed DISE and analyzed obstruction sites before and after modified jaw thrust maneuver. Degree of improvement in obstruction more than one grade of obstruction, was defined as “responder by modified jaw thrust maneuver”. Non-responder was defined as the airway does not open by the modified jaw thrust maneuver. Association was analyzed among the patient’s characteristics [body mass index (BMI), Friedman stage, and respiratory disturbance index (RDI)] and the results. Results In retropalatal level obstruction, responder by modified jaw thrust maneuver was most commonly observed at antero-posterior (AP) obstruction (70.31%) while it was least observed at combined obstruction (66.67%). In retroglossal level obstruction, responder by modified jaw thrust maneuver was most commonly observed at AP obstruction (77.50%), while lateral obstruction was least observed (68.75%). Between group comparisons including, group of responder and group of non-responder of combined obstruction of retropalatal level and lateral obstruction of retroglossal level, revealed that there were no statistically significant differences in BMI, Friedman stage, and RDI (p < 0.05). Conclusions Airway obstruction did not extend to the same pattern by modified jaw thrust maneuver. Modified jaw thrust maneuver under DISE is a useful diagnostic tool and predictor of therapeutic effects of mandibular advancement treatment.

Keywords

• Sleep apnea
• Obstructive
• Diagnosis
• Mandibular advancement