title: [Central apnea developing during treatment with a mandibular advancement device].
abstract: BACKGROUND
  Mandibular advancement (MA) has emerged over the last decade as an alternative solution to nasal continuous airway pressure (nCPAP) for the treatment of obstructive sleep apnea syndrome (OSAS).
  
  
  METHODS
  We report the case of a patient with history of chronic atrial fibrillation and moderate supine-dependent OSAS in whom central sleep apneas developed during treatment by a bi-bloc MA device. Central apneas increased with the level of MA and preferentially occurred in the supine position. We hypothesized that mouth opening under excessive mandibular advancement in supine position may have led to pharyngeal narrowing at the base of the tongue and potentially unstable ventilation. Sleep fragmentation that enhanced during progressive MA may also have compromised ventilatory control stability in our patient. Finally, chronic atrial fibrillation may have predisposed to central sleep apneas.
  
  
  CONCLUSIONS
  Our case report highlights the importance of follow-up nocturnal recordings during progressive MA.
authors.affiliation: Département de Pneumologie, CHU, Angers, France.
authors.forename: L
authors.initials: L
authors.lastname: Gindre
authors.forename: F
authors.initials: F
authors.lastname: Gagnadoux
authors.forename: N
authors.initials: N
authors.lastname: Meslier
authors.forename: B
authors.initials: B
authors.lastname: Fleury
authors.forename: J M
authors.initials: JM
authors.lastname: Gustin
authors.forename: J L
authors.initials: JL
authors.lastname: Racineux
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications; D006801:Humans; D008297:Male; D019186:Mandibular Advancement / Q000009:adverse effects* / Q000295:instrumentation; D008875:Middle Aged; D009968:Orthodontic Appliances, Removable / Q000009:adverse effects*; D017286:Polysomnography; D020182:Sleep Apnea, Central / Q000209:etiology*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000628:therapy