Effects of mandibular advancement on upper airway dynamics in awake normal subjects: A pilot study with phrenic nerve stimulation

Verin, Eric; Petelle, Boris; Raux, Mathieu; Vincent, Gérard; Fleury, Bernard; Similowski, Thomas

doi:10.1016/j.sleep.2005.11.002

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Volume 7, Issue 4 , Pages 368-373, June 2006

Effects of mandibular advancement on upper airway dynamics in awake normal subjects: A pilot study with phrenic nerve stimulation

Eric Verin
- Service de Physiologie, CHU de Rouen, Rouen, France
- GRHV EA 3830, Université de Rouen, Rouen, France
Boris Petelle
- Service d'ORL et Chirurgie Cervico-Faciale, CHU Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
Mathieu Raux
- UPRES EA 2397, Université Paris VI Pierre et Marie Curie, Paris, France
Gérard Vincent
- Centre dentaire SM Colomb, Paris, France
Bernard Fleury
- Centre d'Evaluation et de Traitement des Troubles du Sommeil, Service de Pneumologie, CHU Saint Antoine, Assistance Publique Hôpitaux de Paris, Paris, France
Thomas Similowski
- UPRES EA 2397, Université Paris VI Pierre et Marie Curie, Paris, France
- Service de Pneumologie, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique—Hôpitaux de Paris, Paris, France
- Corresponding author. Address: Service de Pneumologie et Réanimation, Groupe Hospitalier Pitié-Salpêtrière, 47-83 Bd de l'Hôpital, 75651 Paris Cedex 13, France. Tel.: +33 1 42176797; fax: 33 1 42176708.

Received 12 July 2005; received in revised form 30 September 2005; accepted 5 November 2005.

Abstract

Background

Mandibular advancement (MA) can be an alternative to continuous positive airway pressure (CPAP) in the treatment of obstructive sleep apnea syndrome. This study was designed to describe its effects on upper airway mechanics.

Methods

Six awake healthy subjects (four men, 31+/−8 years, body mass index (BMI) 25+/−2kg/m2) were studied supine. Phrenic stimulation was used to measure pressure-flow relationships in response to diaphragm contractions without pre-activation of upper airway dilators during progressive MA.

Results

Phrenic stimulation consistently induced flow limitation (initial peak V′-t1, corresponding to the limiting pressure; reduction to a nadir V′-t2; reincrease to a second peak V′-t3). The upper airway resistances were negatively correlated with MA. Their values at 4mm were significantly lower than at baseline. Further MA reduced resistances.