title: Impact of CPAP interface and mandibular advancement device on upper airway mechanical properties assessed with phrenic nerve stimulation in sleep apnea patients.
abstract: Oronasal mask (ONM) can be used when mouth leaks impair nasal-CPAP effectiveness. However, ONM's constraint on the chin and straps' traction may alter upper airway (UA) mechanical properties. In contrast, mandibular advancement device associated with nasal-CPAP (NM+MAD) may reduce UA resistance. The aim of this exploratory study was to compare the effects of ONM, NM, and NM+MAD on UA mechanical properties. The three interface modalities were assessed in 11 OSAS patients at 6, 8, 10 cmH(2)O CPAP using a phrenic nerve magnetic stimulation (PNMS) protocol. PNMS-twitches' related flow, pharyngeal pressures (nasopharynx, velopharynx, oropharynx) and UA resistances were determined. Regardless of CPAP level, twitch-induced maximum flow was higher with NM+MAD than with ONM. Velopharyngeal resistance was higher with ONM than with NM+MAD. Oropharyngeal resistance was higher with ONM than with NM. In conclusion, NM+MAD reduced velopharyngeal resistance compared to those measured with ONM and NM alone. We hypothesize that this strategy may help reducing the effective pressure level and thus further limit the risk for mouth leaks.
authors: Unité de recherche en pneumologie, Centre de recherche, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Québec, QC, Canada.
authors: Jean-Christian
authors: JC
authors: Borel
authors: Simon
authors: S
authors: Gakwaya
authors: Jean-François
authors: JF
authors: Masse
authors: Cesar Augusto
authors: CA
authors: Melo-Silva
authors: Frédéric
authors: F
authors: Sériès
mesh_terms: D000328:Adult; D000403:Airway Resistance / Q000502:physiology; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D006801:Humans; D055909:Magnetic Field Therapy; D008297:Male; D019186:Mandibular Advancement / Q000295:instrumentation*; D008875:Middle Aged; D050177:Overweight / Q000503:physiopathology; D010791:Phrenic Nerve / Q000503:physiopathology*; D012134:Respiratory Protective Devices; D012137:Respiratory System / Q000503:physiopathology*; D020181:Sleep Apnea, Obstructive / Q000628:therapy*