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.

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.

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.

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.

Effect of Mandibular Position on Upper Airway Collapsibility and Resistance

2005 ◽  
Vol 84 (6) ◽  
pp. 554-558 ◽  
Author(s):  
T. Inazawa ◽  
T. Ayuse ◽  
S. Kurata ◽  
I. Okayasu ◽  
E. Sakamoto ◽  
...  
Keyword(s):  
Airway Pressure ◽  
Upper Airway ◽  
Mandibular Advancement ◽  
Neutral Position ◽  
Airway Patency ◽  
Airway Collapsibility ◽  
Critical Closing Pressure ◽  
Mandibular Position ◽  
Upper Airway Collapsibility ◽  
Closing Pressure

It has been proposed that advancement of the mandible is a useful method for decreasing upper airway collapsibility. We carried out this study to test the hypothesis that mandibular advancement induces changes in upper airway patency during midazolam sedation. To explore its effect, we examined upper airway pressure-flow relationships in each of 4 conditions of mouth position in normal, healthy subjects (n = 9). In the neutral position, Pcrit ( i.e., critical closing pressure, an index of upper airway collapsibility) was −4.2 cm H2O, and upstream resistance (Rua) was 21.2 cm H2O/L/sec. In the centric occlusal position, Pcrit was −7.1 cm H2O, and Rua was 16.6 cm H2O/L/sec. In the incisor position, Pcrit was significantly reduced to −10.7 cm H2O, and Rua was significantly reduced to 14.0 cm H2O/L/sec. Mandibular advancement significantly decreased Pcrit to −13.3 cm H2O, but did not significantly influence Rua (22.1 cm H2O/L/sec). We conclude that the mandibular incisors’ position improved airway patency and decreased resistance during midazolam sedation.

scholarly journals The Effect of Continuous Positive Airway Pressure Therapy on Obstructive Sleep Apnea-Related Hypertension

2021 ◽  
Vol 22 (5) ◽  
pp. 2300
Author(s):  
Ronni Baran ◽  
Daniela Grimm ◽  
Manfred Infanger ◽  
Markus Wehland
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Continuous Positive Airway Pressure ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Common Disease ◽  
Cpap Therapy ◽  
Pressure Therapy ◽  
Airway Patency ◽  
Obstructive Sleep

Obstructive sleep apnea (OSA) is a common disease, with approximately 3–7% of men and 2–5% of women worldwide suffering from symptomatic OSA. If OSA is left untreated, hypoxia, microarousals and increased chemoreceptor stimulation can lead to complications like hypertension (HT). Continuous positive airway pressure (CPAP) is the most common treatment for OSA, and it works by generating airway patency, which will counteract the apnea or hypopnea. More than one billion people in the world suffer from HT, and the usual treatment is pharmacological with antihypertensive medication (AHM). The focus of this review will be to investigate whether the CPAP therapy for OSA affects HT.

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.

scholarly journals A Detection and Therapeutic Device to Overcome Sleep Apnea in Infants

2020 ◽  
Vol 2 (1) ◽  
pp. 35
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Airway Pressure ◽  
Upper Airway ◽  
Periodic Breathing ◽  
Breathing Patterns ◽  
Efficient System ◽  
Pressure Therapy ◽  
Obstructive Sleep ◽  
Upper Airway Structure

Among the various sleep-disordered breathing patterns infant’s experience, like periodic breathing, premature apnea, obstructive sleep apnea, has been considered a major cause of concern. Upper airway structure, mechanics of the pulmonary system, etc., are a few reasons why the infants are vulnerable to obstructive sleep-disordered. An imbalance in the viscoelastic properties of the pharynx, dilators, and pressure can lead to airway collapse. A low level of oxygen in blood or hypoxemia is considered a characteristic in infants with severe OSA. Invasive treatments like nasopharyngeal tubes, continuous positive airway pressure (CPAP), or tracheostomy are found to be helpful in most cases where infants experience sleep apnea. This paper proposes an efficient system for monitoring obstructive sleep apnea in infants on a long-term basis, and if any anomaly is detected, the device provides Continuous Airway Pressure therapy until the abnormality is normalized.

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