Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome

Abstract

Isabelle Arnulf, et al.. Mandibular advancement reveals long-term suppression of breathing discomfort in patients with obstructive sleep apnea syndrome. Respiratory Physiology and Neurobiology, Elsevier, 2019, 263, pp. AbstractObstructive sleep apnoea syndrome (OSAS) patients do not report breathing discomfort in spite of abnormal upper airway mechanics. We studied respiratory sensations in OSAS patients without and with mandibular advancement device (MAD).Fifty-seven moderate to severe non obese OSAS patients were asked about breathing discomfort using visual analogue scales (VAS) in the sitting position (VAS-1), after lying down (VAS-2), then with MAD (VAS-3). Awake critical closing pressure (awake Pcrit) was measured in 15 patients without then with MAD.None of the patients reported breathing discomfort when sitting but 19 patients (33%) did when lying (VAS-2: -20% or less). A feeling of "easier breathing" with MAD was observed and was more marked in patients reporting breathing discomfort when supine (VAS-3: +66.0% [49.0; 89.0]) than in those not doing so (VAS-3: +28.5% [1.0; 56.5], p=0.007). MAD-induced change in awake Pcrit was correlated to VAS-3.In conclusion, MAD revealed "latent dyspnea" related to the severity of upper airways mechanics abnormalities in OSAS patients.

Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients

“…Patients suffering from obstructive sleep apneas (OSA) do not complain of dyspnea during awake resting breathing, notwithstanding abnormalities in upper airway mechanics representing an inspiratory load (Attali et al., 2019 ). Yet, despite this absence of respiratory complaints, the placement of a mandibular advancement device (MAD), known to improve upper airway mechanics (Gakwaya et al., 2014 ), can lead to a sense of improved respiratory comfort (Attali et al., 2019 ), hereafter termed “pseudo‐relief”. The intensity of this sensation correlates with the degree of mechanical improvement brought about by the MAD (Attali et al., 2019 ).…”

Functional analysis of the human rib cage over the vital capacity range in standing position using biplanar X-ray imaging

“…OSAS patients [30] remains putative and needs to be further explored. However, the present study showed that the proposed method could be integrated in routine clinical practice, because of the low dose of radiation delivered to the patient and an examination protocol that can easily be reproduced.…”

Catering Work Profession and Medico-Oral Health: A Study on 603 Subjects

“…The study also underlined that the maxillomandibular advancement surgery is a safe and very effective treatment option to OSAS. According to Attali et al 2019 [ 35 ], MAD revealed “latent dyspnea” related to the severity of upper airways mechanics abnormalities in OSAS patients. Similar findings were illustrated by Marty et al 2017 [ 36 ] stating that custom-fitted MAD improved respiratory and somnolence parameters, with response rates similar to those published in the literature with other devices.…”