Dose-dependent effects of mandibular advancement on upper airway collapsibility and muscle function in obstructive sleep apnea
| Autor: | Peter A. Cistulli, Joachim Ngiam, Danny J. Eckert, Peter G R Burke, Kate Sutherland, Lynne E. Bilston, Jane E. Butler, Ahmad A. Bamagoos |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Polysomnography medicine.medical_treatment Population Pharyngeal muscles 03 medical and health sciences 0302 clinical medicine Tongue stomatognathic system Physiology (medical) medicine Humans Obesity Continuous positive airway pressure Sleep study education Sleep Apnea Obstructive education.field_of_study Genioglossus Continuous Positive Airway Pressure medicine.diagnostic_test Electromyography business.industry Pharynx Middle Aged medicine.disease respiratory tract diseases Obstructive sleep apnea Treatment Outcome medicine.anatomical_structure 030228 respiratory system Anesthesia Pharyngeal Muscles Female Neurology (clinical) business Mandibular Advancement 030217 neurology & neurosurgery |
| Zdroj: | Sleep. 42 |
| ISSN: | 1550-9109 0161-8105 |
| DOI: | 10.1093/sleep/zsz049 |
| Popis: | STUDY OBJECTIVES Mandibular advancement splints (MAS) are the leading treatment alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). However, not all patients experience clinical benefit and treatment prediction remains challenging. Understanding the effects of mandibular advancement on pharyngeal collapsibility and muscle function may provide valuable information on the mechanisms of MAS, and thereby help to develop novel approaches for patient selection. Thus, we aimed to determine dose-dependent effects of mandibular advancement on pharyngeal collapsibility and muscle function concurrently in OSA patients undergoing MAS therapy. METHODS Twelve (11 male) MAS-naive patients underwent a detailed physiology sleep study (polysomnography) to quantify pharyngeal collapsibility (PCRIT), pharyngeal muscle responsiveness to negative pharyngeal pressure (via genioglossus intramuscular electromyography and an epiglottic pressure sensor) and effectiveness to restore airflow and minute ventilation (Vi) after 1-minute transient CPAP reductions (induced airflow-limitation) at three mandibular advancement positions: 0% (habitual bite), 50% and 100% of the maximum comfortable mandibular advancement. Standard clinical polysomnography after MAS therapy optimization was performed to determine treatment outcome. RESULTS Overall, participants were obese with severe OSA (mean ± SD: BMI = 31 ± 4 kg/m2, apnea-hypopnea index [AHI] = 33 ± 14 events/hour). PCRIT decreased with mandibular advancement in a dose-dependent manner (1.8 ± 3.9 vs. -0.9 ± 2.9 vs. -4.0 ± 3.6 cmH2O; p < 0.001). There was no systematic change in genioglossus muscle responsiveness (p = 0.09) or effectiveness to restore peak airflow (p = 0.4) or Vi (p = 0.7) with mandibular advancement. CONCLUSIONS Mandibular advancement reduces pharyngeal collapsibility in a dose-dependent manner without systematically changing genioglossus muscle function in a predominantly obese and severe OSA population. This indicates that the primary mode of action of MAS therapy is via improvement in passive pharyngeal anatomy. |
| Databáze: | OpenAIRE |
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