Mechanical parameters determining pharyngeal collapsibility in patients with sleep apnea

2010 ◽  
Vol 109 (4) ◽  
pp. 1037-1044 ◽  
Author(s):  
Arie Oliven ◽  
Eran Kaufman ◽  
Rotem Kaynan ◽  
Ron Oliven ◽  
Uri Steinfeld ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Close Correlation ◽  
Mandibular Advancement ◽  
Cross Sectional ◽  
Pressure Flow ◽  
Pharyngeal Pressure ◽  
Obstructive Sleep ◽  
Mechanical Factors ◽  
Stimulation Of

The relative impact of mechanical factors on pharyngeal patency in patients with obstructive sleep apnea is poorly understood. The present study was designed to evaluate parameters of the “tube law” on pharyngeal pressure-flow relationships and collapsibility in patients with obstructive sleep apnea. We developed a mathematical model that considered the collapsible segment of the pharynx to represent an orifice of varying diameter. The model enabled us to assess the effects of pharyngeal compliance ( C), neutral cross-sectional area ( A o), external peripharyngeal pressure (Pex), and the resistance proximal to the site of collapse on flow mechanics and pharyngeal collapsibility [critical pressure (Pcrit)]. All parameters were measured in 15 patients with obstructive sleep apnea under propofol anesthesia, both at rest and during mandibular advancement and electrical stimulation of the genioglossus. The data was used both to confirm the validity of the model and to compare expected and actual relationships between the tube-law parameters and the pharyngeal pressure-flow relationship and collapsibility. We found a close correlation between predicted and measured Pcrit ( R = 0.98), including changes observed during pharyngeal manipulations. C and A o were closely and directly interrelated ( R = 0.93) and did not correlate with Pcrit. A significant correlation was found between Pex and Pcrit ( R = 0.77; P < 0.01). We conclude that the pharynx of patients with obstructive sleep apnea can be modeled as an orifice with varying diameter. Pharyngeal compliance and A o are closely interrelated. Pharyngeal collapsibility depends primarily on the surrounding pressure.

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.

Ansa Cervicalis Stimulation Increases Pharyngeal Patency in Patients with Obstructive Sleep Apnea

2021 ◽  
Author(s):  
David T. Kent ◽  
William C. Scott ◽  
David Zealear ◽  
Alan R. Schwartz
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Hypoglossal Nerve ◽  
Cross Sectional Area ◽  
Sectional Area ◽  
Cross Sectional ◽  
Ansa Cervicalis ◽  
Obstructive Sleep ◽  
The Right ◽  
Stimulation Of

Rationale: Hypoglossal nerve stimulation (HNS) is an alternative treatment option for obstructive sleep apnea (OSA) that reduces pharyngeal collapsibility, but HNS non-responders often demonstrate continued retropalatal and lateral pharyngeal wall collapse. Recent evidence suggests that caudal pharyngeal traction with sternothyroid muscle contraction via ansa cervicalis stimulation (ACS) can also stabilize the pharynx, but the underlying mechanisms have not been elucidated. Objectives: To evaluate the effect of ACS on pharyngeal patency during expiration when the airway is most hypotonic. Methods: Eight participants with OSA underwent sustained ultrasound-guided fine-wire stimulation of the medial branch of the right hypoglossal nerve with and without transient stimulation of the branch of the ansa cervicalis nerve plexus innervating the right sternothyroid muscle during drug-induced sleep endoscopy. Airway cross-sectional area and expiratory airflow (VE) were measured from endoscopy video with ImageJ and pneumotachometry, respectively. Measurements and Main Results: ACS significantly increased retropalatal cross-sectional area (CSArp) to 211% [159-263] of unstimulated CSArp (p<0.05). Adding ACS to HNS increased CSArp from baseline by 341% [244-439] (p<0.05), a 180% [133-227] increase over isolated HNS (p<0.05). ACS increased VE from baseline by 177% [138-217] (p < 0.05). Adding ACS to HNS increased VE by 254% [207-301], reflecting decreases in pharyngeal collapsibility. Conclusions: Combining ACS with HNS increased retropalatal cross-sectional area and increased expiratory airflow, suggesting decreases in pharyngeal collapsibility. Our findings suggest that ACS exerts caudal traction on the upper airway through sternothyroid muscle contraction, and that it may augment HNS efficacy in patients with OSA.

Airway obstruction during sleep increases blood pressure without arousal

1996 ◽  
Vol 80 (3) ◽  
pp. 773-781 ◽  
Author(s):  
C. P. O'Donnell ◽  
T. Ayuse ◽  
E. D. King ◽  
A. R. Schwartz ◽  
P. L. Smith ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Obstruction ◽  
Blood Pressure Response ◽  
Pressure Response ◽  
Intrapleural Pressure ◽  
Obstructive Sleep ◽  
Mechanical Factors ◽  
Stimulation Of

Recent studies suggest that arousal is the dominant factor acutely increasing blood pressure in obstructive sleep apnea and that neither stimulation of chemoreceptors nor mechanical factors associated with large negative swings in intrapleural pressure substantially contribute to the rise in blood pressure associated with each obstructive apneic event. A canine model of obstructive sleep apnea was used to examine the relative contributions of these mechanisms in the blood pressure response to induced airway obstruction during non-rapid-eye-movement sleep. In part A of the study, the arousal response was eliminated from an obstructive event by restoring airway patency just before the expected arousal, allowing blood pressure responses to be compared between obstructive events with and without arousal. In part B of the study, the protocol of Part A was repeated after pharmacological blockade of the autonomic nervous system with hexamethonium (20 mg/kg iv), eliminating neurally mediated responses due to arousal, stimulation of chemoreceptors, or other reflexes, while maintaining any mechanical effects on blood pressure related to swings in intrapleural pressure. The results of part A (n = 4 dogs) show that obstructive apneic events of 28.5 +/- 3.1 s duration, with arterial hemoglobin desaturation to 92.9 +/- 0.8% and airway pressure swings of -37.6 +/- 6 mmHg, significantly increased mean arterial pressure (MAP) by 13.8 +/- 1.5 mmHg in the absence of arousal (P < 0.005). In comparison, when arousal was allowed to occur, MAP increased by a further 11.8 +/- 1.2 mmHg (P < 0.01). In part B (n = 3 dogs), there was no change in MAP during the obstructive apneic event, and MAP fell by = 10 mmHg in the postobstruction period whether or not arousal occurred (P < 0.05). We conclude that neural reflexes, but not mechanical factors, substantially contribute to the acute blood pressure response to an obstructive apneic event and that arousal produces a separate, additional acute hypertensive response.

scholarly journals Patient satisfaction to evaluate the efficacy of mandibular advancement device in a treatment modality for mild to moderate sleep apnea patient in Indore Region

2021 ◽  
Vol 7 (3) ◽  
pp. 157-160
Author(s):  
Aanchal Verma ◽  
Sumeet Jain
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Upper Airway ◽  
Obstructive Sleep Apnea Patient ◽  
Mandibular Advancement ◽  
Berlin Questionnaire ◽  
Age Group ◽  
Cross Sectional ◽  
Male And Female ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) represents the most severe syndrome associated with obstruction of the upper airway. People with obstructive sleep apnea (OSA) repeatedly stop breathing during their sleep for a moment or longer and as several as many times throughout one night. The Aim of study was to evaluate the efficacy of mandibular advancement devices in different age group, between male and female and according to body mass index in mild to moderate obstructive sleep apnea patient.cross sectional study. 30 patients of different gender and age group were selected with mild to moderate OSA and asked to fill the Berlin questionnaire for diagnosis of obstructive sleep apnea after obtaining the necessary consent.The analysis was done by using SPSS, IBM version 20.0. The level of significance was fixed at 5% and p ≤ 0.05. On evaluation of berlin questionnaire revealed that 83% of patients (including male and female) shows the significant improvement after the MAD treatment 16.7 % patient are not satisfied with the MAD. Study shows that the patient with OSA showed Positive Berlin Questionnaire before the MAD treatment and after 2 month it was revealed that MAD treatment showed statically significant improvement in OSA.

scholarly journals 0663 The Longterm Effect of CPAP Compared to Mandibular Advancement Device on Metabolic Profile in Mild Obstructive Sleep Apnea

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A253-A253
Author(s):  
S Togeiro ◽  
L S Oliveira ◽  
T M Guimaraes ◽  
G P Luz ◽  
G Coelho ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Metabolic Profile ◽  
Current Treatment ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Control Group ◽  
Cross Sectional ◽  
Intention To Treat ◽  
Obstructive Sleep

Abstract Introduction Moderate and severe Obstructive Sleep Apnea (OSA) have been independently associated to dyslipidemia with controversial results of improvement with CPAP. Less evidence exists regarding this issue in mild OSA. A current treatment for mild OSA is Mandibular Advancement Device (MAD), however its effectiveness on metabolic profile needs to be compared to CPAP.Our aim was to compare MAD with CPAP and no treatment on metabolic profile during one year in mild OSA. Methods Cross sectional analyses included 79 mild OSA patients randomized in CPAP group (n: 31), MAD group (n. 25) and Control group (n: 23). Metabolic profile was investigated before and after 6 and months. Results Mean age: 47± 9 years, BMI: 28±3.7 kg/m AHI: 9.5±2.9/h. There were no differences in anthropometric data, total cholesterol (TCT) HDL-C, LDL-C, Triglycerides (TC) and glycated Hemoglobin (Hb1c) among groups. MAD and CPAP reduced AHI at 6 and 12 months (9.3 ± 5.2 to 4.2 ± 9.1 to 3.8 ± 12.6 / 10.0 ± 4.6 to 1.2 ± 9.9 to 1.7 ± 14.2, p: 0.01 respectively). BMI did not change in groups at 6 and 12 months. MAD adherence was higher than CPAP at 6 months (5.8 ± 2.8 hs/day vs 3.8 ± 3.0 hs/day; p: 0.01) and 12 months 5.7 ± 2.7 hs/day vs 3.8 ± 3.4 hs/day; p: 0.01). Despite of lower adherence than MAD, CPAP was effective in reduce TCT and LDL- CT at 6 and 12 months (Intention to treat analyses TCT: 189.3±51.4 mg/dl to 186.1±51.4 mg/dl to 174.6±51 mg/dl; p: 0.03 / 112.8±48.7 mg/dl to 110.5±48.7 mg/dl to 95.8±48.7mg/dl; p: 0.03 respectively), however HDL-C, TG and Hbc didn′t change. Conclusion Long term CPAP treatment was effective in reducing cholesterol in mild OSA. Support Associação Fundo Incentivo à Psicobiologia (AFIP) CAPES

scholarly journals Continuous Positive Airway Pressure-Mandibular Advancement Device Combination Therapy for Moderate-to-Severe Obstructive Sleep Apnea: A Preliminary Study

2021 ◽  
Author(s):  
Thyagaseely Sheela Premaraj ◽  
Jacob Stadiem ◽  
Shyamaly Arya Premaraj ◽  
Charles R. Davies ◽  
Matthew Dennis ◽  
...  
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Daytime Sleepiness ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Mandibular Advancement Device ◽  
Mandibular Advancement ◽  
Severe Obstructive Sleep Apnea ◽  
Obstructive Sleep ◽  
The Mean

Abstract Objectives The purpose of this pilot study was to determine whether compliance to auto-adjusting positive airway pressure (APAP) improves with the addition of a mandibular advancement device (MAD). Secondary outcome measures included were APAP pressure, subjective daytime sleepiness, apnea–hypopnea index (AHI), and mask leaks. Setting and Sample Population Participants included were diagnosed with moderate-to-severe obstructive sleep apnea (OSA) and became noncompliant to prescribed APAP. Thirteen participants with a mean age of 61.6 years were recruited for this study. Materials and Methods All participants were given a MAD to use with their APAP. Parameters measured included APAP pressure, AHI, mask leak reported via ResMed AirViewTM software, and self-reported daytime sleepiness (Epworth Sleepiness Scale [ESS]). A paired two-sample for mean t-test was performed to determine significance. Results The mean difference of pre- and postintervention APAP compliance was 23.1%, which was statistically significant (p = 0.015). The mean APAP air pressures were unchanged. The difference between pre- and postintervention mean ESS scores was 1.4 and was statistically significant (p = 0.027). The mean difference between pre- and postintervention AHI values and mask leak showed no significant difference. Conclusion This study showed that combination of APAP-MAD therapy, for patients with moderate-to-severe OSA who were noncompliant to APAP use, significantly increased compliance with APAP therapy, and significantly decreased the daytime sleepiness of participants.

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