Optimizing Mandibular Advancement Maneuvers during Sleep Endoscopy with a Titratable Positioner: DISE-SAM Protocol

Patricia Fernández-Sanjuán, Juan José Arrieta, Jaime Sanabria, Marta Alcaraz, Gabriela Bosco, Nuria Pérez-Martín, Adriana Pérez, Marina Carrasco-Llatas, Isabel Moreno-Hay, Marcos Ríos-Lago, Rodolfo Lugo, Carlos O’connor-Reina, Peter Baptista, Guillermo Plaza

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Mandibular advancement devices (MAD) are an effective alternative treatment to CPAP. Different maneuvers were performed during drug sleep-induced endoscopy (DISE) to mimic the effect of MAD. Using the Selector Avance Mandibular (SAM) device, we aimed to identify MAD candidates during DISE using a titratable, reproducible, and measurable maneuver. This DISE-SAM protocol may help to find the relationship between the severity of the respiratory disorder and the degree of response and determine the advancement required to improve the collapsibility of the upper airway. Explorations were performed in 161 patients (132 males; 29 females) with a mean age of 46.81 (SD = 11.42) years, BMI of 27.90 (SD = 4.19) kg/m2, and a mean AHI of 26.51 (SD = 21.23). The results showed no relationship between severity and MAD recommendation. Furthermore, there was a weak positive relationship between the advancement required to obtain a response and the disease severity. Using the DISE-SAM protocol, the response and the range of mandibular protrusion were assessed, avoiding the interexaminer bias of the jaw thrust maneuver. We suggest prescribing MAD as a single, alternative, or multiple treatment approaches following the SAM recommendations in a personalized design.

Original languageEnglish
Article number658
JournalJournal of Clinical Medicine
Issue number3
StatePublished - Feb 1 2022

Bibliographical note

Funding Information:
The authors are grateful for the technical support of the Sleep Unit and the library service of Hospital Universitario de Fuenlabrada.

Publisher Copyright:
© 2022 by the authors. Licensee MDPI, Basel, Switzerland.


  • Drug-induced sleep endoscopy
  • MAD
  • Mandibular advancement
  • Patient selection
  • Sleep breathing disorders
  • Titratable positioner

ASJC Scopus subject areas

  • Medicine (all)


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