Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance
Abstract Mandibular advancement devices (MADs) are frequently prescribed for obstructive sleep apnea (OSA) patients, but approximately one third of patients experience no therapeutic benefit. Understanding the mechanisms by which MADs prevent pharyngeal collapse may help optimize MAD therapy. This s...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-02-01
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| Series: | Physiological Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.14814/phy2.15558 |
| _version_ | 1811164950325886976 |
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| author | Guilherme J. M. Garcia Josiah J. Wolf David A. Campbell Ryan S. Bailey Rodney A. Sparapani Charles M. Welzig B. Tucker Woodson |
| author_facet | Guilherme J. M. Garcia Josiah J. Wolf David A. Campbell Ryan S. Bailey Rodney A. Sparapani Charles M. Welzig B. Tucker Woodson |
| author_sort | Guilherme J. M. Garcia |
| collection | DOAJ |
| description | Abstract Mandibular advancement devices (MADs) are frequently prescribed for obstructive sleep apnea (OSA) patients, but approximately one third of patients experience no therapeutic benefit. Understanding the mechanisms by which MADs prevent pharyngeal collapse may help optimize MAD therapy. This study quantified the relative contributions of changes in airspace cross‐sectional area (CSA) versus changes in velopharyngeal compliance in determining MAD efficacy. Sixteen patients with moderate to severe OSA (mean apnea–hypopnea index of 32 ± 15 events/h) underwent measurements of the velopharyngeal closing pressure (PCLOSE) during drug induced sedated endoscopy (DISE) via stepwise reductions in nasal mask pressure and recording of the intraluminal pressure with a catheter. Airspace CSA was estimated from video endoscopy. Pharyngeal compliance was defined as the slope of the area–pressure relationship of the velopharyngeal airspace. MAD therapy reduced PCLOSE from a median of 0.5 cmH2O pre‐advancement to a median of −2.6 cmH2O post‐advancement (p = 0.0009), increased the minimal CSA at the velopharynx by approximately 20 mm2 (p = 0.0067), but did not have a statistically significant effect on velopharyngeal compliance (p = 0.23). PCLOSE had a strong correlation with CSA but did not correlate with velopharyngeal compliance. Our results suggest that MADs reduce velopharyngeal collapsibility by increasing airway size as opposed to affecting velopharyngeal compliance. This contradicts the speculation of previous literature that the effectiveness of MADs is partially due to a reduction in velopharyngeal compliance resulting from stretching of the soft palate. These findings suggest that quantification of velopharyngeal CSA pre‐ and post‐MAD advancement has potential as a biomarker to predict the success of MAD therapy. |
| first_indexed | 2024-04-10T15:29:34Z |
| format | Article |
| id | doaj.art-db01bcc33e08458c9e80584cb6bca548 |
| institution | Directory Open Access Journal |
| issn | 2051-817X |
| language | English |
| last_indexed | 2024-04-10T15:29:34Z |
| publishDate | 2023-02-01 |
| publisher | Wiley |
| record_format | Article |
| series | Physiological Reports |
| spelling | doaj.art-db01bcc33e08458c9e80584cb6bca5482023-02-14T05:08:34ZengWileyPhysiological Reports2051-817X2023-02-01113n/an/a10.14814/phy2.15558Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal complianceGuilherme J. M. Garcia0Josiah J. Wolf1David A. Campbell2Ryan S. Bailey3Rodney A. Sparapani4Charles M. Welzig5B. Tucker Woodson6Department of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USADivision of Biostatistics Medical College of Wisconsin Milwaukee Wisconsin USADepartment of Medicine Tufts University School of Medicine Boston Massachusetts USADepartment of Otolaryngology and Communication Sciences Medical College of Wisconsin Milwaukee Wisconsin USAAbstract Mandibular advancement devices (MADs) are frequently prescribed for obstructive sleep apnea (OSA) patients, but approximately one third of patients experience no therapeutic benefit. Understanding the mechanisms by which MADs prevent pharyngeal collapse may help optimize MAD therapy. This study quantified the relative contributions of changes in airspace cross‐sectional area (CSA) versus changes in velopharyngeal compliance in determining MAD efficacy. Sixteen patients with moderate to severe OSA (mean apnea–hypopnea index of 32 ± 15 events/h) underwent measurements of the velopharyngeal closing pressure (PCLOSE) during drug induced sedated endoscopy (DISE) via stepwise reductions in nasal mask pressure and recording of the intraluminal pressure with a catheter. Airspace CSA was estimated from video endoscopy. Pharyngeal compliance was defined as the slope of the area–pressure relationship of the velopharyngeal airspace. MAD therapy reduced PCLOSE from a median of 0.5 cmH2O pre‐advancement to a median of −2.6 cmH2O post‐advancement (p = 0.0009), increased the minimal CSA at the velopharynx by approximately 20 mm2 (p = 0.0067), but did not have a statistically significant effect on velopharyngeal compliance (p = 0.23). PCLOSE had a strong correlation with CSA but did not correlate with velopharyngeal compliance. Our results suggest that MADs reduce velopharyngeal collapsibility by increasing airway size as opposed to affecting velopharyngeal compliance. This contradicts the speculation of previous literature that the effectiveness of MADs is partially due to a reduction in velopharyngeal compliance resulting from stretching of the soft palate. These findings suggest that quantification of velopharyngeal CSA pre‐ and post‐MAD advancement has potential as a biomarker to predict the success of MAD therapy.https://doi.org/10.14814/phy2.15558closing pressuredrug‐induced sedated endoscopymandibular advancement deviceobstructive sleep apneaoral appliancepharyngeal compliance |
| spellingShingle | Guilherme J. M. Garcia Josiah J. Wolf David A. Campbell Ryan S. Bailey Rodney A. Sparapani Charles M. Welzig B. Tucker Woodson Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance Physiological Reports closing pressure drug‐induced sedated endoscopy mandibular advancement device obstructive sleep apnea oral appliance pharyngeal compliance |
| title | Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance |
| title_full | Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance |
| title_fullStr | Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance |
| title_full_unstemmed | Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance |
| title_short | Mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance |
| title_sort | mandibular advancement reduces pharyngeal collapsibility by enlarging the airway rather than affecting velopharyngeal compliance |
| topic | closing pressure drug‐induced sedated endoscopy mandibular advancement device obstructive sleep apnea oral appliance pharyngeal compliance |
| url | https://doi.org/10.14814/phy2.15558 |
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