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Clinical InvestigationsSLEEP AND BREATHINGDose-Dependent Effects of Mandibular Advancement on Pharyngeal Mechanics and Nocturnal Oxygenation in Patients With Sleep-Disordered Breathing
Section snippets
Subjects
The study consisted of 43 adult patients with SDB treated with our OA. In addition to clinical symptoms suggesting SDB, such as daytime hypersomnolence, loud snoring, and witnessed repetitive apneas, nocturnal oximetry (Pulsox 5; Minolta; Tokyo, Japan) indicated that oxygen desaturation index (ODI), defined as the number of oxygen dips> 4% from the baseline, was > 10/h, and the percent of time spent at arterial oxygen saturation (Sao2)< 90% (CT90) was > 1% in all patients. After being informed
Dose-Dependent Effects of Mandibular Advancement on Static Pharyngeal Mechanics
Pressure–area relationships of the passive pharynx with or without the OAs were satisfactorily fitted by exponential functions with reasonably high regression coefficient values. Table 2 presents the effects of mandibular advancement on mechanical variables obtained by the fitted pressure–area curves of the VP and OP. No statistical significance was evident in VP and OP k values and Amax at the oropharynx. Increases in Amax at the VP and decreases in P′close at the VP and OP significantly
Discussion
Major findings of this study are that (1) step-advancement of mandibular position resulted in dose-dependent reduction of closing pressure of the passive pharynx, (2) successful improvement of nocturnal oxygenation appeared to be achieved when the OA reduced the closing pressure of the passive pharynx below atmospheric pressure, and (3) each 2-mm mandibular advancement coincided with approximate 20% improvement of the number and severity of nocturnal desaturations.
Conclusion
Improvement of both nocturnal oxygenation and pharyngeal collapsibility significantly depends on the position of the mandible advanced by oral devices. Successful treatment of SDB by oral devices is likely to be associated with body size and baseline severity of SDB. Reduction of pharyngeal closing pressure, especially at the VP, appears to be the key for mandibular advancement treatment.
ACKNOWLEDGMENT
The authors thank Sara Shimizu, MD, for her help in improving this article.
References (18)
Treatment of obstructive sleep apnea: a review
Chest
(1996)- et al.
The effect of a modified functional appliance on obstructive sleep apnea
Am J Orthod Dentofacial Orthop
(1988) - et al.
Treatment of snoring and obstructive sleep apnea with a dental orthosis
Chest
(1991) - et al.
Oral appliances for the treatment of snoring and obstructive sleep apnea: a review
Sleep
(1995) Dental appliances for the treatment of snoring and obstructive sleep apnea
- et al.
Advancement of the mandible improves velopharyngeal airway patency
J Appl Physiol
(1995) - et al.
Anatomy of the pharynx in patients with obstructive sleep apnea and normal subjects
J Appl Physiol
(1997) - et al.
Pharyngeal patency in response to advancement of the mandible in obese anesthetized persons
Anesthesiology
(1997) - et al.
Airway changes in relationship to mandibular posturing
Otolaryngol Head Neck Surg
(1992)
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