Functional contribution of mandibular advancement to awake upper airway patency in obstructive sleep apnea

2007 ◽  
Vol 11 (4) ◽  
pp. 245-251 ◽  
Author(s):  
Satoru Tsuiki ◽  
C. Frank Ryan ◽  
Alan A Lowe ◽  
Yuichi Inoue
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
Airway Patency ◽  
Obstructive Sleep

scholarly journals A singular oral appliance to treat obstructive sleep apnea in CPAP non-adherent patients

2020 ◽  
Vol 25 (5) ◽  
pp. 44-50
Author(s):  
Denise Fernandes Barbosa ◽  
Lilian Chrystiane Giannasi ◽  
Liege Maria Di Bisceglie Ferreira ◽  
Miguel Meira e Cruz ◽  
Marcelo Corrêa Alves ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Oral Appliance ◽  
Mandibular Advancement ◽  
Occlusal Plane ◽  
Apnea Hypopnea Index ◽  
Study Objective ◽  
Airway Patency ◽  
Obstructive Sleep

ABSTRACT Introduction: The most prescribed treatment option for Obstructive Sleep Apnea (OSA) is CPAP; however, its adherence is limited. Oral Appliance therapy (OAT) is frequently an option or even an adjuvant, being the mandibular advancement Oral Appliance (OAm) the most used prescription. It modifies the upper airway, improving the airway patency. OAm construction is based on the occlusal plane to disocclusion. In this study, the DIORS® appliance was used, a singular OAm, based on Neuro-Occlusal Rehabilitation concepts, that uses Camper’s plane as a disocclusion reference, in order to achieve neuromuscular balance and functional stability. Objective: This study primarily aimed to assess the DIORS® effectiveness in relation to clinical and polysomnographic outcomes. It was also evaluated if the use of DIORS® is as effective as titrated CPAP to treat CPAP non-adherent patients. Methods: Twenty patients were included in this study. Objective and subjective clinical data were assessed at a sleep laboratory using all-night polysomnography, and Epworth Sleepiness Scale (ESS), taken at three moments: Baseline, CPAP titration, and using DIORS®. Analysis of respiratory parameters as apnea/hypopnea index (AHI), oxyhemoglobin saturation levels, the arousal index and daytime sleepiness were taken as criteria for a successful OAT. Results: Respiratory and arousal parameters improved in both therapies, while DIORS® promoted a better ESS. Conclusion: Results from the present work support that DIORS® is a viable and effective adjuvant therapy for patients with moderate to severe OSA non-adherent to CPAP.

Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

2009 ◽  
Vol 106 (5) ◽  
pp. 1668-1673 ◽  
Author(s):  
Ron Oliven ◽  
Naveh Tov ◽  
Majed Odeh ◽  
Luis Gaitini ◽  
Uri Steinfeld ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Upper Airway ◽  
Combined Effect ◽  
Mandibular Advancement ◽  
Cross Sectional ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Critical Closing Pressure ◽  
Stimulation Of

Both mandibular advancement (MA) and stimulation of the genioglossus (GG) have been shown to improve upper airway patency, but neither one achieves the effect of continuous positive airway pressure (CPAP) treatment. In the present study we assessed the combined effect of MA and GG stimulation on the relaxed pharynx in patients with obstructive sleep apnea (OSA). We evaluated responses of upper airway pressure-flow relationships and endoscopically determined pharyngeal cross-sectional area to MA and electrical stimulation of the GG in 14 propofol-anesthetized OSA patients. Measurements were undertaken at multiple levels of CPAP, enabling calculation of the critical closing pressure (Pcrit), upstream resistance (Rus), and pharyngeal compliance. GG stimulation, MA, and the combination of both shifted the pressure:flow relationships toward higher flow levels, resulting in progressively lower Pcrit (from baseline of 2.9 ± 2.2 to 0.9 ± 2.5, −1.4 ± 2.9, and −4.2 ± 3.3 cmH2O, respectively), without significant change in Rus. ΔPcrit during GG stimulation was significantly larger during MA than under baseline conditions (−2.8 ± 1.4 vs. −2.0 ± 1.4 cmH2O, P = 0.011). Combining the effect of GG stimulation with MA lowered Pcrit below 0 in all patients and restored pharyngeal patency to a level that enabled flow above the hypopnea level in 10/14 of the patients. Velopharyngeal compliance was not affected by either manipulation. We conclude that the combined effect of MA and GG stimulation is additive and may act in synergy, preventing substantial flow limitation of the relaxed pharynx in most OSA patients.

scholarly journals Respiratory-related displacement of the trachea in obstructive sleep apnea

2019 ◽  
Vol 127 (5) ◽  
pp. 1307-1316
Author(s):  
Joshua Tong ◽  
Lauriane Jugé ◽  
Peter GR Burke ◽  
Fiona Knapman ◽  
Danny J Eckert ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Dynamic Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Quiet Breathing ◽  
Airway Patency ◽  
Peak Displacement ◽  
Obstructive Sleep

Tracheal displacement is thought to be the primary mechanism by which changes in lung volume influence upper airway patency. Caudal tracheal displacement during inspiration may help preserve the integrity of the upper airway in response to increasing negative airway pressure by stretching and stiffening pharyngeal tissues. However, tracheal displacement has not been previously quantified in obstructive sleep apnea (OSA). Accordingly, we aimed to measure tracheal displacements in awake individuals with and without OSA. The upper head and neck of 34 participants [apnea-hypopnea index (AHI) = 2–74 events/h] were imaged in the midsagittal plane using dynamic magnetic resonance imaging (MRI) during supine awake quiet breathing. MRI data were analyzed to identify peak tracheal displacement and its timing relative to inspiration. Epiglottic pressure was measured separately for a subset of participants ( n = 30) during similar experimental conditions. Nadir epiglottic pressure and its timing relative to inspiration were quantified. Peak tracheal displacement ranged from 1.0–9.6 mm, with a median (25th–75th percentile) of 2.3 (1.7–3.5) mm, and occurred at 89 (78–99)% of inspiratory time. Peak tracheal displacement increased with increasing OSA severity (AHI) ( R2 = 0.28, P = 0.013) and increasing negative nadir epiglottic pressure ( R2 = 0.47, P = 0.023). Relative inspiratory timing of peak tracheal displacement also correlated with OSA severity, with peak displacement occurring earlier in inspiration with increasing AHI ( R2 = 0.36, P = 0.002). Tracheal displacements during quiet breathing are larger in individuals with more severe OSA and tend to reach peak displacement earlier in the inspiratory cycle. Increased tracheal displacement may contribute to maintenance of upper airway patency during wakefulness in OSA, particularly in those with severe disease. NEW & NOTEWORTHY Tracheal displacement is thought to play an important role in stabilizing the upper airway by stretching/stiffening the pharyngeal musculature. Using dynamic magnetic resonance imaging, this study shows that caudal tracheal displacement is more pronounced during inspiration in obstructive sleep apnea (OSA) compared with healthy individuals. Softer pharyngeal muscles and greater inspiratory forces in OSA may underpin greater tracheal excursion. These findings suggest that tracheal displacement may contribute to maintenance of pharyngeal patency during wakefulness in OSA.

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