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Mechanism of action and therapeutic indication of prosthetic mandibular advancement in obstructive sleep apnea syndrome
Author(s) -
ISHIDA MASAE,
INOUE YUICHI,
SUTO YUJI,
OKAMOTO KAZUMI,
RYOKE KAZUO,
HIGAMI SHIGERU,
SUZUKI TAKEO,
KAWAHARA RYUZO
Publication year - 1998
Publication title -
psychiatry and clinical neurosciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.609
H-Index - 74
eISSN - 1440-1819
pISSN - 1323-1316
DOI - 10.1111/j.1440-1819.1998.tb01045.x
Subject(s) - obstructive sleep apnea , medicine , therapeutic effect , apnea , airway , anesthesia , hypopnea , airway obstruction , sleep apnea , continuous positive airway pressure , mandible (arthropod mouthpart) , dentistry , polysomnography , genus , botany , biology
Prosthetic mandibular advancement (PMA) was applied to nine patients with obstructive sleep apnea syndrome (OSAS) and its therapeutic usefulness, mechanism of action, and clinical indication were discussed based on polysomnographic findings and serial examination of upper airway before and during PMA treatment. Apnea hypopnea index significantly decreased during PMA treatment compared with the value before treatment ( P < 0.01) and the rate of the treatment responder counted 78.1%. Cephalometric variables indicated forward and inferior advancement of mandible in our subjects. Magnetic resonance imaging of the upper airway during sleep revealed a marked improvement of velopharyngeal obstruction in most subjects. In addition, intraesophageal negative pressure during sleep decreased significantly. Our results confirmed the high therapeutic efficacy of PMA for OSAS and indicated forward advancement of the mandible and decrease of negative pressure loading on upper airway with PMA might suppress velopharyngeal collapse. Thus, PMA was regarded as one of the treatments of choice for OSAS occurring based on with velopharyngeal narrowing.