Dose-dependent effects of mandibular protrusion on genioglossus activity in sleep apnoea

Almeida, Fernanda R.; Tsuiki, Satoru; Hattori, Yoshinori; Takei, Yoichiro; Inoue, Yuichi; Lowe, Alan A.

doi:10.1183/09031936.00194809

Cited by 28 publications

(16 citation statements)

References 12 publications

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“…However, a standardized value has yet to be established. Pulling the lower jaw forward expands the upper airway and increases treatment efficacy [30]. However, the burden on the temporomandibular joint, masticatory muscles, and teeth increase, which can lead to an increased risk of side effects such as temporomandibular disorders or tooth movement [31].…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Ishiyama

Hasebe

Sato

et al. 2019

IJERPH

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Oral appliance (OAm) therapy has demonstrated efficacy in treating obstructive sleep apnea (OSA). The aim of this systematic review was to clarify the efficacy of device designs (Mono-block or Bi-block) in OAm therapy for OSA patients. We performed a meta-analysis using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system. Two studies (Mono-block OAm versus Bi-block OAm) remained eligible after applying the exclusion criteria. When comparing Mono-block OAm and Bi-block OAm, Mono-block OAm significantly reduced the apnea–hypopnea index (2.92; 95% confidence interval (95%CI), 1.26 to 4.58; p = 0.0006), and patient preference for Mono-block OAm was significantly higher (2.06; 95%CI, 1.44 to 2.06; p < 0.0001). Lowest SpO2, arousal index, non-REM stage 3, sleep efficiency, Epworth Sleepiness Scale (ESS), Snoring Scale, and side effects were not significantly different between the two groups (lowest SpO2: −11.18; 95%CI, −26.90 to 4.54; p = 0.16, arousal index: 4.40; 95%CI, −6.00 to 14.80; p = 0.41, non-REM stage 3: −2.00; 95%CI, −6.00 to 14.80; p = 0.41, sleep efficiency: −1.42, 95%CI, −4.71 to 1.86; p = 0.40, ESS: 0.12; 95%CI, −1.55 to 1.79; p = 0.89, Snoring Scale: 0.55; 95%CI, −0.73 to 1.83, p = 0.55, side effects: 1.00, 95%CI, 0.62 to 1.61, p = 1.00). In this systematic review, the use of Mono-block OAm was more effective than Bi-block OAm for OSA patients.

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Section: Discussionmentioning

confidence: 99%

The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Ishiyama

Hasebe

Sato

et al. 2019

IJERPH

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“…By comparison, GG activity in severe OSA patients measured during wakefulness is about four times higher than in age- and body weight-matched control subjects (5), and sternohyoid muscle activity in English bulldogs measured during SWS is nearly three times higher than in control dogs (37). Interestingly, upper airway muscle tone was also acutely reduced in OSA patients by graded mandibular advancement when measured during wakefulness (38). Thus, there are both central and reflex mechanisms that mediate the compensatory changes in the level of upper airway muscle tone that can be elicited by experimental manipulations such as recurrent hypoxia or flow limitation, and their dynamic range seems to be larger that the effects observed in our present study.…”

Section: Discussionmentioning

confidence: 99%

Lingual Muscle Activity Across Sleepâ€“Wake States in Rats with Surgically Altered Upper Airway

et al. 2014

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Obstructive sleep apnea (OSA) patients have increased upper airway muscle activity, including such lingual muscles as the genioglossus (GG), geniohyoid (GH), and hyoglossus (HG). This adaptation partially protects their upper airway against obstructions. Rodents are used to study the central neural control of sleep and breathing but they do not naturally exhibit OSA. We investigated whether, in chronically instrumented, behaving rats, disconnecting the GH and HG muscles from the hyoid (H) apparatus would result in a compensatory increase of other upper airway muscle activity (electromyogram, EMG) and/or other signs of upper airway instability. We first determined that, in intact rats, lingual (GG and intrinsic) muscles maintained stable activity levels when quantified based on 2 h-long recordings conducted on days 6 through 22 after instrumentation. We then studied five rats in which the tendons connecting the GH and HG muscles to the H apparatus were experimentally severed. When quantified across all recording days, lingual EMG during slow-wave sleep (SWS) was modestly but significantly increased in rats with surgically altered upper airway [8.6 ± 0.7% (SE) vs. 6.1 ± 0.7% of the mean during wakefulness; p = 0.012]. Respiratory modulation of lingual EMG occurred mainly during SWS and was similarly infrequent in both groups, and the incidence of sighs and central apneas also was similar. Thus, a weakened action of selected lingual muscles did not produce sleep-disordered breathing but resulted in a relatively elevated activity in other lingual muscles during SWS. These results encourage more extensive surgical manipulations with the aim to obtain a rodent model with collapsible upper airway.

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“…This leads to a reduction in pharyngeal collapsibility [3]. There are indications that MADs cause a change in muscle activity during sleep, with the relaxation of the genioglossus muscle during incremental mandibular advancement [4] and the activation of the masseter and submental muscles [5].…”

mentioning

confidence: 99%

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

Marklund¹,

Verbraecken²,

Randerath³

2011

Eur Respir J

166

136

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Mandibular advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respiratory Society Task Force was to review the evidence in favour of MAD therapy. Effects of tongue-retaining devices are not included in this report.Custom-made MADs reduce apnoea/hypopnoea index (AHI) and daytime sleepiness compared with placebo devices. CPAP more effectively diminishes AHI, while increasing data suggest fairly similar outcomes in relation to symptoms and cardiovascular health from these treatments. Patients often prefer MADs to CPAP. Milder cases and patients with a proven increase in upper airway size as a result of mandibular advancement are most likely to experience treatment success with MADs. A custom-made device titrated from an initial 50% of maximum mandibular advancement has been recommended. More research is needed to define the patients who will benefit from MAD treatment compared with CPAP, in terms of the effects on sleep-disordered breathing and on other diseases related to OSA.In conclusion, MADs are recommended for patients with mild to moderate OSA (Recommendation Level A) and for those who do not tolerate CPAP. The treatment must be followed up and the device adjusted or exchanged in relation to the outcome.

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Dose-dependent effects of mandibular protrusion on genioglossus activity in sleep apnoea

Cited by 28 publications

References 12 publications

The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

The Efficacy of Device Designs (Mono-block or Bi-block) in Oral Appliance Therapy for Obstructive Sleep Apnea Patients: A Systematic Review and Meta-Analysis

Lingual Muscle Activity Across Sleepâ€“Wake States in Rats with Surgically Altered Upper Airway

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

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