title: A pilot study of quantitative assessment of mandible advancement using pressure-flow relationship during midazolam sedation.
abstract: It has been proposed that a titration of the mandibular positioner would be a promising method for predicting the outcome of nasal continuous positive airway pressure (CPAP) therapy. This study was carried out to test the hypothesis that mandible advancement could be evaluated by analysis of inspiratory flow limitation using a titration procedure. To explore its effect, we examined upper airway pressure-flow relationships using a titrated mandible positioner during midazolam sedation. Non-flow limited inspiration occurred when the mandible was advanced 7.1 +/- 1.2 mm from centric occlusion position. In the centric occlusion position (0 mm advancement), Pcrit was -1.9 +/- 2.9 cmH2O and Rua was 23.3 +/- 4.5 cmH2O L(-1) s(-1). In the eMAP position, Pcrit was -7.3 +/- 1.9 cmH2O and Rua was 27.8 +/- 3.3 cmH2O L(-1) s(-1). Essentially no CPAP was required to overcome flow limitation in eMAP position, whereas 3.7 +/- 2.2 cmH2O CPAP was required in centric occlusion position. We conclude that assessing inspiratory flow limitation using a titrated mandible positioner was effective for estimating individual-matched mandible positions.
authors.affiliation: Division of Clinical Physiology, Course of Medical and Dental Sciences, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. ayuse@net.nagasaki-u.ac.jp
authors.forename: T
authors.initials: T
authors.lastname: Ayuse
authors.forename: Y
authors.initials: Y
authors.lastname: Hoshino
authors.forename: T
authors.initials: T
authors.lastname: Inazawa
authors.forename: K
authors.initials: K
authors.lastname: Oi
authors.forename: H
authors.initials: H
authors.lastname: Schneider
authors.forename: A R
authors.initials: AR
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D045422:Continuous Positive Airway Pressure; D003768:Dental Occlusion, Centric; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D001239:Inhalation; D008297:Male; D019186:Mandibular Advancement / Q000379:methods*; D008874:Midazolam / Q000627:therapeutic use*; D010865:Pilot Projects; D017286:Polysomnography / Q000379:methods; D012137:Respiratory System / Q000503:physiopathology; D012891:Sleep Apnea Syndromes; D012913:Snoring / Q000503:physiopathology
chemical_list: D006993:Hypnotics and Sedatives; D008874:Midazolam