Jaw thrust versus the use of a boil-and-bite mandibular advancement device as a screening tool during drug-induced sleep endoscopy

Patty E. Vonk, Julia A.M. Uniken Venema, Aarnoud Hoekema, Madeline J.L. Ravesloot, Johanna A.Van De Velde-Muusers, Nico de Vries

Research output: Contribution to JournalArticleAcademicpeer-review


Study Objectives: The objectives of this study were to analyze agreement in degree of obstruction and configuration of the upper airway between jaw thrust and an oral device in situ during drug-induced sleep endoscopy and to evaluate clinical decision making using jaw thrust or a boil-and-bite mandibular advancement device (MAD; the MyTAP). Methods: This was a single-center prospective cohort study in patients with obstructive sleep apnea who underwent drug-induced sleep endoscopy between January and July 2019. Results: Sixty-three patients were included. Agreement among observations in the supine position for degree of obstruction was 60% (n = 36, κ = 0.41) at the level of the velum, 68.3% (n = 41, κ = 0.35) for oropharynx, 58.3% (n = 35, κ = 0.28) for tongue base, and 56.7% (n = 34, κ = 0.14) for epiglottis; agreement among observations in the lateral position were 81.7%(n = 49, κ = 0.32), 71.7% (n = 43, κ = 0.36), 90.0%(n = 54, κ = 0.23), and 96.7%(n = 58, κ = could not be determined), respectively. In the supine position, agreement for configuration of obstruction at the level of the velum was found in 20 of 29 patients (69.0%, κ =0.41) and in the lateral position was 100%. Thirty patients would have been prescribed a MAD using jaw thrust and 34 using the boil-and-bite MAD as a screening instrument. The main reason for being labeled as nonsuitable was complete residual retropalatal collapse during jaw thrust. Using the boil-and-bite MAD, this was caused by complete retropalatal or hypopharyngeal collapse. Conclusions: There is only slight to moderate agreement in degree of obstruction for jaw thrust and a new-generation boil-and-bite MAD during drug-induced sleep endoscopy. Greater improvement of upper airway patency at the hypopharyngeal level was observed during jaw thrust, but this maneuver was less effective in improving upper airway obstruction at the retropalatal level.

Original languageEnglish
Pages (from-to)1021-1027
Number of pages7
JournalJournal of Clinical Sleep Medicine
Issue number7
Publication statusPublished - 15 Jul 2020

Bibliographical note

Funding Information:
All authors have seen and approved the final manuscript. Work for this study was performed at Department of Otorhinolaryngology–Head and Neck Surgery, OLVG, Amsterdam, Netherlands. This study was funded by Airway Management Inc (Dallas, TX), who provided the 63 MyTAPs. N. de Vries is a member of the Medical Advisory Board of NightBalance, an investigator of Inspire and Jazz Pharmaceutics, and a consultant of Philips, Olympus, and the AE Mann Foundation. A. Hoekema is a medical advisor for Airway Management Inc, Somnomed, and Zephyr Sleep Technologies. All other authors report no conflicts of interest.

Publisher Copyright:
© 2020 American Academy of Sleep Medicine. All rights reserved.


  • Drug-induced sleep endoscopy
  • Jaw thrust
  • Mandibular advancement device
  • Obstructive sleep apnea
  • Sleep-disordered breathing
  • Treatment outcome


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