Building a model to precisely target the responders of a novel intermittent negative air pressure device-with mechanism definition

Novel Intraoral Negative Airway Pressure in Drug-Induced Sleep Endoscopy with Target-Controlled Infusion

“…12 Hung et al (2020) performed magnetic resonance imaging and reported that iNAP therapy could increase the volume of the upper airway and retropalatal region but did not exert a substantial effect on the retroglossal region. 13 In other words, the effect of iNAP therapy on the hypopharyngeal airway was not notable; this explains why epiglottic collapse could not be adequately corrected by iNAP therapy alone in the present study. In addition, the pulling effect of the tongue after the application of iNAP therapy may increase the cross-sectional area of the lingual epiglottis, thereby exacerbating the anterior-posterior collapse.…”

“…This finding is attributable to the fact that the intraoral and intermittent application of negative pressure reshapes soft tissues (ie, the tongue and soft palate) into a more forward-resting position. 13 In one study, the iNAP device effectively improved the patency of the upper airway when the heads of patients with OSA syndrome were in the lateral position. The mechanism exhibited an increase in the distance between the tongue or soft palate and the back wall of the upper airway.…”

“…8 Oral pressure therapy (OPT) is an alternative treatment modality for patients with poor compliance to CPAP. [9][10][11][12][13] Nigam et al 10 reported that the OPT success rate (defined as a reduction of ≥50% from the baseline apnea-hypopnea index [AHI] and a post-OPT treatment residual AHI of ≤10) varies between 25% and 37%. However, the success rate does not correlate with OSA severity or the body mass index (BMI); 10,12 therefore, identifying responders and nonresponders to OPT treatment necessitates the establishment and comprehensive examination of predictors.…”

“…Intermittent negative airway pressure (iNAP) therapy (Figure 1), the latest form of OPT, is characterized by a lower oral tissue discomfort rate and possibly more favorable compliance. [11][12][13] By providing intermittent negative pressure to the oral cavity, the iNAP device moves both the soft palate and tongue in an anterior direction, thereby increasing retropalatal and retroglossal areas and reducing airway obstruction during sleep. 13 The device is battery powered, and the air flow is designed to stop when the targeted negative oral pressure is achieved and restart again only when air flow is required to prevent a decrease in target pressure.…”

“…[11][12][13] By providing intermittent negative pressure to the oral cavity, the iNAP device moves both the soft palate and tongue in an anterior direction, thereby increasing retropalatal and retroglossal areas and reducing airway obstruction during sleep. 13 The device is battery powered, and the air flow is designed to stop when the targeted negative oral pressure is achieved and restart again only when air flow is required to prevent a decrease in target pressure. 12 Through this design, iNAP enhances the patency of the pharyngeal upper airway without a mask and forced air, thereby preventing local tissue discomfort and systematic dryness of the mouth.…”