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Lynne E Bilston - One of the best experts on this subject based on the ideXlab platform.

  • dose dependent effects of Mandibular Advancement on upper airway collapsibility and muscle function in obstructive sleep apnea
    Sleep, 2019
    Co-Authors: Ahmad A Bamagoos, Lynne E Bilston, Peter A Cistulli, Kate Sutherland, Joachim Ngiam, Peter G R Burke
    Abstract:

    STUDY OBJECTIVES Mandibular Advancement splints (MAS) are the leading treatment alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). However, not all patients experience clinical benefit and treatment prediction remains challenging. Understanding the effects of Mandibular Advancement on pharyngeal collapsibility and muscle function may provide valuable information on the mechanisms of MAS, and thereby help to develop novel approaches for patient selection. Thus, we aimed to determine dose-dependent effects of Mandibular Advancement on pharyngeal collapsibility and muscle function concurrently in OSA patients undergoing MAS therapy. METHODS Twelve (11 male) MAS-naive patients underwent a detailed physiology sleep study (polysomnography) to quantify pharyngeal collapsibility (PCRIT), pharyngeal muscle responsiveness to negative pharyngeal pressure (via genioglossus intramuscular electromyography and an epiglottic pressure sensor) and effectiveness to restore airflow and minute ventilation (Vi) after 1-minute transient CPAP reductions (induced airflow-limitation) at three Mandibular Advancement positions: 0% (habitual bite), 50% and 100% of the maximum comfortable Mandibular Advancement. Standard clinical polysomnography after MAS therapy optimization was performed to determine treatment outcome. RESULTS Overall, participants were obese with severe OSA (mean ± SD: BMI = 31 ± 4 kg/m2, apnea-hypopnea index [AHI] = 33 ± 14 events/hour). PCRIT decreased with Mandibular Advancement in a dose-dependent manner (1.8 ± 3.9 vs. -0.9 ± 2.9 vs. -4.0 ± 3.6 cmH2O; p < 0.001). There was no systematic change in genioglossus muscle responsiveness (p = 0.09) or effectiveness to restore peak airflow (p = 0.4) or Vi (p = 0.7) with Mandibular Advancement. CONCLUSIONS Mandibular Advancement reduces pharyngeal collapsibility in a dose-dependent manner without systematically changing genioglossus muscle function in a predominantly obese and severe OSA population. This indicates that the primary mode of action of MAS therapy is via improvement in passive pharyngeal anatomy.

  • Dose-dependent effects of Mandibular Advancement on upper airway collapsibility and muscle function in obstructive sleep apnea
    'Oxford University Press (OUP)', 2019
    Co-Authors: Ahmad A Bamagoos, Lynne E Bilston, Peter A Cistulli, Sutherland K, Ngiam J, Burke Pgr, Je Butler, Dj Eckert
    Abstract:

    © Sleep Research Society 2019. Study Objectives: Mandibular Advancement splints (MAS) are the leading treatment alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). However, not all patients experience clinical benefit and treatment prediction remains challenging. Understanding the effects of Mandibular Advancement on pharyngeal collapsibility and muscle function may provide valuable information on the mechanisms of MAS, and thereby help to develop novel approaches for patient selection. Thus, we aimed to determine dose-dependent effects of Mandibular Advancement on pharyngeal collapsibility and muscle function concurrently in OSA patients undergoing MAS therapy. Methods: Twelve (11 male) MAS-naive patients underwent a detailed physiology sleep study (polysomnography) to quantify pharyngeal collapsibility (PCRIT), pharyngeal muscle responsiveness to negative pharyngeal pressure (via genioglossus intramuscular electromyography and an epiglottic pressure sensor) and effectiveness to restore airflow and minute ventilation (Vi) after 1-minute transient CPAP reductions (induced airflow-limitation) at three Mandibular Advancement positions: 0% (habitual bite), 50% and 100% of the maximum comfortable Mandibular Advancement. Standard clinical polysomnography after MAS therapy optimization was performed to determine treatment outcome. Results: Overall, participants were obese with severe OSA (mean ± SD: BMI = 31 ± 4 kg/m2, apnea-hypopnea index [AHI] = 33 ± 14 events/hour). PCRIT decreased with Mandibular Advancement in a dose-dependent manner (1.8 ± 3.9 vs. -0.9 ± 2.9 vs. -4.0 ± 3.6 cmH2O; p < 0.001). There was no systematic change in genioglossus muscle responsiveness (p = 0.09) or effectiveness to restore peak airflow (p = 0.4) or Vi (p = 0.7) with Mandibular Advancement. Conclusions: Mandibular Advancement reduces pharyngeal collapsibility in a dose-dependent manner without systematically changing genioglossus muscle function in a predominantly obese and severe OSA population. This indicates that the primary mode of action of MAS therapy is via improvement in passive pharyngeal anatomy

  • tongue and lateral upper airway movement with Mandibular Advancement
    Sleep, 2013
    Co-Authors: Elizabeth C Brown, Shaokoon Cheng, David K Mckenzie, Jane E Butler, Simon C Gandevia, Lynne E Bilston
    Abstract:

    STUDY OBJECTIVES: To characterize tongue and lateral upper airway movement and to image tongue deformation during Mandibular Advancement. DESIGN: Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. SETTING: Not-for-profit research institute. PARTICIPANTS: 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). INTERVENTIONS: Subjects were imaged using dynamic tagged magnetic resonance imaging during Mandibular Advancement. Tissue displacements were quantified with the harmonic phase technique. MEASUREMENTS AND RESULTS: Mean Mandibular Advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with Mandibular Advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of Mandibular Advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. CONCLUSIONS: Mandibular Advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular Advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. CITATION: Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with Mandibular Advancement. SLEEP 2013;36(3):397-404.

  • tongue and lateral upper airway movement with Mandibular Advancement
    Sleep, 2013
    Co-Authors: Elizabeth C Brown, Shaokoon Cheng, David K Mckenzie, Jane E Butler, Simon C Gandevia, Lynne E Bilston
    Abstract:

    Study objectives To characterize tongue and lateral upper airway movement and to image tongue deformation during Mandibular Advancement. Design Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. Setting Not-for-profit research institute. Participants 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). Interventions Subjects were imaged using dynamic tagged magnetic resonance imaging during Mandibular Advancement. Tissue displacements were quantified with the harmonic phase technique. Measurements and results Mean Mandibular Advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with Mandibular Advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of Mandibular Advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. Conclusions Mandibular Advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular Advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. Citation Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with Mandibular Advancement. SLEEP 2013;36(3):397-404.

Marie Marklund - One of the best experts on this subject based on the ideXlab platform.

  • non cpap therapies in obstructive sleep apnoea Mandibular Advancement device therapy
    European Respiratory Journal, 2012
    Co-Authors: Marie Marklund, Johan Verbraecken, Winfried Randerath
    Abstract:

    Mandibular Advancement devices (MADs) represent the main non-continuous positive airway pressure (non-CPAP) therapy for patients with obstructive sleep apnoea (OSA). The aim of the European Respira ...

  • predictors of long term orthodontic side effects from Mandibular Advancement devices in patients with snoring and obstructive sleep apnea
    American Journal of Orthodontics and Dentofacial Orthopedics, 2006
    Co-Authors: Marie Marklund
    Abstract:

    Introduction: Orthodontic side effects can complicate the long-term use of Mandibular Advancement devices (MADs) in the treatment of patients with snoring anad obstructive sleep apnea. The aim of t ...

  • Mandibular Advancement devices in 630 men and women with obstructive sleep apnea and snoring tolerability and predictors of treatment success
    Chest, 2004
    Co-Authors: Marie Marklund, Hans Stenlund, Karl A Franklin
    Abstract:

    Study objective: To evaluate the tolerability and to find predictors of treatment success for an individually adjusted, one-piece Mandibular Advancement device in patients with snoring and obstructive sleep apnea. Design: Prospective study. Setting: Departments of Respiratory Medicine and Orthodontics, Umea University. Patients: Six hundred nineteen of 630 patients (98%), who consecutively received treatment for sleep apnea and snoring from February 1989 to August 2000, were followed up. They had a mean apnea-hypopnea index of 16 (range, 0.0 to 76) and a mean body mass index of 28 (range, 19 to 42). Measurements: Interviews, questionnaires, and overnight sleep apnea recordings. Patients with an apnea-hypopnea index of > 10 in the supine and/or lateral position were considered to have obstructive sleep apnea. A lateral apnea-hypopnea index of 10, defined supine-dependent sleep apneas. Results: One hundred forty-eight of the 619 patients (24%) discontinued treatment. Female gender predicted treatment success, defined as an apnea-hypopnea index of < 10 in both the supine and lateral positions, with an odds ratio of 2.4 (p 0.01). In the women, the odds ratios for treatment success were 12 for mild sleep apnea (p 0.04), and 0.1 for complaints of nasal obstruction (p 0.03). In the men, the odds ratios for treatment success were 6.0 for supinedependent sleep apneas (p < 0.001), 2.5 for mild sleep apnea (p 0.04), 1.3 for each millimeter of Mandibular Advancement (p 0.03), and 0.8 for each kilogram of weight increase (p 0.001). Conclusions: The Mandibular Advancement device is recommended for women with sleep apnea, for men with supine-dependent sleep apneas defined by a lateral apnea-hypopnea index of < 10, and for snorers without sleep apnea. Men who increase in weight during treatment reduce their chance of treatment success and are advised to be followed up with a new sleep apnea recording with the device. (CHEST 2004; 125:1270 –1278)

  • orthodontic side effects of Mandibular Advancement devices during treatment of snoring and sleep apnoea
    European Journal of Orthodontics, 2001
    Co-Authors: Marie Marklund, Karl A Franklin, Maurits Persson
    Abstract:

    The aims of this study were to investigate possible orthodontic side-effects following the use of Mandibular Advancement devices (MAD) in adults with snoring and sleep apnoea. A second objective was to analyse the effect of the appliance design. Seventy-five patients treated with MAD and 17 reference patients were studied at follow-up after 2.5 +/- 0.5 years. In the test group, 47 patients were provided with soft elastomeric devices, while the remaining 28 patients received hard acrylic devices. The treatment induced a change in overjet of -0.4 +/- 0.8 mm (mean +/- SD) and a change in overbite of -0.4 +/- 0.7 mm (mean +/- SD). These changes were larger than those found in the reference group (P < 0.01). The odds ratio (OR) for the largest quartile of reduction in overjet was 3.8 in patients using hard acrylic devices compared with those using soft elastomeric devices (P < 0.05). A large reduction in overjet in patients using the hard acrylic devices was unrelated to the degree of Mandibular protrusion by the device. The OR for a large reduction in overjet in patients using the soft elastomeric devices with a protrusion of 6 mm or above was 6.8 compared with smaller Mandibular protrusions (P < 0.05). The results indicate that the orthodontic side-effects are small during the treatment of adult subjects with MAD for snoring and sleep apnoea, especially in patients using soft elastomeric devices with Mandibular protrusions of less than 6 mm. The follow-up of patients treated with MAD is recommended, as individual patients may experience marked orthodontic side-effects.

  • treatment success with a Mandibular Advancement device is related to supine dependent sleep apnea
    Chest, 1998
    Co-Authors: Marie Marklund, Maurits Persson, Karl A Franklin
    Abstract:

    Study objective To evaluate the effect of a Mandibular Advancement device in patients with supine-dependent sleep apnea and patients with non-supine-dependent sleep apnea. Design Prospective study. Setting Department of Respiratory Medicine, University Hospital, Umea, Sweden. Patients Twenty-six patients with obstructive sleep apnea. Intervention Individually fabricated and adjusted Mandibular Advancement devices. Measurements Overnight polysomnographic sleep recordings with and without the device. Supine-dependent sleep apnea was defined when the supine apnea-hypopnea index was ≥ 10, together with a lateral apnea-hypopnea index of Results In 12 patients with supine-dependent sleep apnea, the device reduced the supine apnea-hypopnea index from a median of 41 (range, 16 to 70) to 5.9 (range, 0.0 to 15) (p Conclusion Successful apnea reduction with a Mandibular Advancement device is highly related to supine-dependent sleep apnea.

Peter A Cistulli - One of the best experts on this subject based on the ideXlab platform.

  • dose dependent effects of Mandibular Advancement on upper airway collapsibility and muscle function in obstructive sleep apnea
    Sleep, 2019
    Co-Authors: Ahmad A Bamagoos, Lynne E Bilston, Peter A Cistulli, Kate Sutherland, Joachim Ngiam, Peter G R Burke
    Abstract:

    STUDY OBJECTIVES Mandibular Advancement splints (MAS) are the leading treatment alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). However, not all patients experience clinical benefit and treatment prediction remains challenging. Understanding the effects of Mandibular Advancement on pharyngeal collapsibility and muscle function may provide valuable information on the mechanisms of MAS, and thereby help to develop novel approaches for patient selection. Thus, we aimed to determine dose-dependent effects of Mandibular Advancement on pharyngeal collapsibility and muscle function concurrently in OSA patients undergoing MAS therapy. METHODS Twelve (11 male) MAS-naive patients underwent a detailed physiology sleep study (polysomnography) to quantify pharyngeal collapsibility (PCRIT), pharyngeal muscle responsiveness to negative pharyngeal pressure (via genioglossus intramuscular electromyography and an epiglottic pressure sensor) and effectiveness to restore airflow and minute ventilation (Vi) after 1-minute transient CPAP reductions (induced airflow-limitation) at three Mandibular Advancement positions: 0% (habitual bite), 50% and 100% of the maximum comfortable Mandibular Advancement. Standard clinical polysomnography after MAS therapy optimization was performed to determine treatment outcome. RESULTS Overall, participants were obese with severe OSA (mean ± SD: BMI = 31 ± 4 kg/m2, apnea-hypopnea index [AHI] = 33 ± 14 events/hour). PCRIT decreased with Mandibular Advancement in a dose-dependent manner (1.8 ± 3.9 vs. -0.9 ± 2.9 vs. -4.0 ± 3.6 cmH2O; p < 0.001). There was no systematic change in genioglossus muscle responsiveness (p = 0.09) or effectiveness to restore peak airflow (p = 0.4) or Vi (p = 0.7) with Mandibular Advancement. CONCLUSIONS Mandibular Advancement reduces pharyngeal collapsibility in a dose-dependent manner without systematically changing genioglossus muscle function in a predominantly obese and severe OSA population. This indicates that the primary mode of action of MAS therapy is via improvement in passive pharyngeal anatomy.

  • Dose-dependent effects of Mandibular Advancement on upper airway collapsibility and muscle function in obstructive sleep apnea
    'Oxford University Press (OUP)', 2019
    Co-Authors: Ahmad A Bamagoos, Lynne E Bilston, Peter A Cistulli, Sutherland K, Ngiam J, Burke Pgr, Je Butler, Dj Eckert
    Abstract:

    © Sleep Research Society 2019. Study Objectives: Mandibular Advancement splints (MAS) are the leading treatment alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA). However, not all patients experience clinical benefit and treatment prediction remains challenging. Understanding the effects of Mandibular Advancement on pharyngeal collapsibility and muscle function may provide valuable information on the mechanisms of MAS, and thereby help to develop novel approaches for patient selection. Thus, we aimed to determine dose-dependent effects of Mandibular Advancement on pharyngeal collapsibility and muscle function concurrently in OSA patients undergoing MAS therapy. Methods: Twelve (11 male) MAS-naive patients underwent a detailed physiology sleep study (polysomnography) to quantify pharyngeal collapsibility (PCRIT), pharyngeal muscle responsiveness to negative pharyngeal pressure (via genioglossus intramuscular electromyography and an epiglottic pressure sensor) and effectiveness to restore airflow and minute ventilation (Vi) after 1-minute transient CPAP reductions (induced airflow-limitation) at three Mandibular Advancement positions: 0% (habitual bite), 50% and 100% of the maximum comfortable Mandibular Advancement. Standard clinical polysomnography after MAS therapy optimization was performed to determine treatment outcome. Results: Overall, participants were obese with severe OSA (mean ± SD: BMI = 31 ± 4 kg/m2, apnea-hypopnea index [AHI] = 33 ± 14 events/hour). PCRIT decreased with Mandibular Advancement in a dose-dependent manner (1.8 ± 3.9 vs. -0.9 ± 2.9 vs. -4.0 ± 3.6 cmH2O; p < 0.001). There was no systematic change in genioglossus muscle responsiveness (p = 0.09) or effectiveness to restore peak airflow (p = 0.4) or Vi (p = 0.7) with Mandibular Advancement. Conclusions: Mandibular Advancement reduces pharyngeal collapsibility in a dose-dependent manner without systematically changing genioglossus muscle function in a predominantly obese and severe OSA population. This indicates that the primary mode of action of MAS therapy is via improvement in passive pharyngeal anatomy

  • influence of oral and craniofacial dimensions on Mandibular Advancement splint treatment outcome in patients with obstructive sleep apnea
    Chest, 2011
    Co-Authors: Peter A Cistulli, Kate Sutherland, Ali M Darendeliler, Whitney Mostafiz, Oyku Dalci, Atul Malhotra, Vasanth Srinivasan
    Abstract:

    Background Mandibular Advancement splints (MASs) can effectively treat obstructive sleep apnea (OSA); however, no validated and reliable prediction method for treatment outcome currently exists. The efficacy of MAS may relate to anatomic factors, including craniofacial size and upper-airway soft-tissue volume and anatomic balance between them. We aimed to assess whether craniofacial and oral measurements are associated with MAS treatment outcome. Methods Dental impressions and lateral cephalometric radiographs were obtained from patients with OSA prior to commencing MAS treatment. Intertooth distances and palatal depths were measured on dental casts, and standard cephalometric analysis was performed with the addition of cross-sectional area (CSA) of the tongue and bony oral enclosure. Treatment outcome was determined by polysomnography. Results Of 53 patients, 25 were complete responders (posttreatment apnea-hypopnea index [AHI] Conclusions Oral dimensions do not appear to differ between patients who respond and those who do not respond to MAS treatment. However, the larger tongue for a given oral cavity size in responders suggests that MAS may help to correct anatomic imbalance. Further research to assess whether the ratio between tongue and bony oral enclosure size may be useful in selecting patients for MAS treatment is warranted.

  • a follow up study of dental and skeletal changes associated with Mandibular Advancement splint use in obstructive sleep apnea
    American Journal of Orthodontics and Dentofacial Orthopedics, 2007
    Co-Authors: Roger J Hammond, Peter A Cistulli, Peter Petocz, Helen Gotsopoulos, G Shen, Ali M Darendeliler
    Abstract:

    Introduction: Mandibular Advancement splints (MAS) are a recognized therapeutic option in the treatment of obstructive sleep apnea (OSA). This study aimed to investigate side effects and possible changes in the dentofacial complex associated with long term use of MAS. Methods: The sample included 64 patients with OSA who had been using MAS on average for 25.1 ± 11.8 months (range, 10.7-64.5 months). A specifically designed questionnaire was used to investigate the patients’ self-assessment of the side effects of wearing MAS; cephalometric analyses and dental cast measurements were conducted to identify objectively dental and skeletal changes caused by MAS over time. Results: The most commonly reported side effects were jaw discomfort, tooth tenderness, excessive salivation, and dry mouth. Subjectively, snoring improved in 56 patients (88%), and daytime sleepiness (Epworth sleepiness scale) scores significantly decreased from pretreatment to follow-up (11.4-7.1, P P P P Conclusions: Side effects of MAS use over long periods are common but mild and well tolerated by most patients, and dentofacial changes are negligible.

  • a randomized controlled study of a Mandibular Advancement splint for obstructive sleep apnea
    American Journal of Respiratory and Critical Care Medicine, 2001
    Co-Authors: Atul Mehta, Ali M Darendeliler, Peter Petocz, Jin Qian, Peter A Cistulli
    Abstract:

    Although there is increasing interest in the use of oral appliances to treat obstructive sleep apnea (OSA), the evidence base for this is weak. Furthermore, the precise mechanisms of action are uncertain. We aimed to systematically investigate the efficacy of a novel Mandibular Advancement splint (MAS) in patients with OSA. The sample consisted of 28 patients with proven OSA. A randomized, controlled three-period (ABB/BAA) crossover study design was used. After an acclimatization period, patients underwent three polysomnographs with either a control oral plate, which did not advance the mandible (A), or MAS (B), 1 wk apart, in either the ABB or BAA sequence. Complete response (CR) was defined as a resolution of symptoms and a reduction in Apnea/Hypopnea Index (AHI) to or = 50% reduction in AHI, but remaining > or = 5/h. Twenty-four patients (19 men, 5 women) completed the protocol. Subjective improvements with the MAS were reported by the majority of patients (96%). There were significant improvements in AHI (30 +/- 2/h versus 14 +/- 2/h, p < 0.0001), MinSa(O(2)) (87 +/- 1% versus 91 +/- 1%, p < 0.0001), and arousal index (41 +/- 2/h versus 27 +/- 2/h, p < 0.0001) with MAS, compared with the control. The control plate had no significant effect on AHI and MinSa(O(2)). CR (n = 9) or PR (n = 6) was achieved in 62.5% of patients. The MAS is an effective treatment in some patients with OSA, including those patients with moderate or severe OSA.

Jane E Butler - One of the best experts on this subject based on the ideXlab platform.

  • tongue and lateral upper airway movement with Mandibular Advancement
    Sleep, 2013
    Co-Authors: Elizabeth C Brown, Shaokoon Cheng, David K Mckenzie, Jane E Butler, Simon C Gandevia, Lynne E Bilston
    Abstract:

    STUDY OBJECTIVES: To characterize tongue and lateral upper airway movement and to image tongue deformation during Mandibular Advancement. DESIGN: Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. SETTING: Not-for-profit research institute. PARTICIPANTS: 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). INTERVENTIONS: Subjects were imaged using dynamic tagged magnetic resonance imaging during Mandibular Advancement. Tissue displacements were quantified with the harmonic phase technique. MEASUREMENTS AND RESULTS: Mean Mandibular Advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with Mandibular Advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of Mandibular Advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. CONCLUSIONS: Mandibular Advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular Advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. CITATION: Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with Mandibular Advancement. SLEEP 2013;36(3):397-404.

  • tongue and lateral upper airway movement with Mandibular Advancement
    Sleep, 2013
    Co-Authors: Elizabeth C Brown, Shaokoon Cheng, David K Mckenzie, Jane E Butler, Simon C Gandevia, Lynne E Bilston
    Abstract:

    Study objectives To characterize tongue and lateral upper airway movement and to image tongue deformation during Mandibular Advancement. Design Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. Setting Not-for-profit research institute. Participants 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). Interventions Subjects were imaged using dynamic tagged magnetic resonance imaging during Mandibular Advancement. Tissue displacements were quantified with the harmonic phase technique. Measurements and results Mean Mandibular Advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with Mandibular Advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of Mandibular Advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. Conclusions Mandibular Advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular Advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. Citation Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with Mandibular Advancement. SLEEP 2013;36(3):397-404.

Shaokoon Cheng - One of the best experts on this subject based on the ideXlab platform.

  • tongue and lateral upper airway movement with Mandibular Advancement
    Sleep, 2013
    Co-Authors: Elizabeth C Brown, Shaokoon Cheng, David K Mckenzie, Jane E Butler, Simon C Gandevia, Lynne E Bilston
    Abstract:

    STUDY OBJECTIVES: To characterize tongue and lateral upper airway movement and to image tongue deformation during Mandibular Advancement. DESIGN: Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. SETTING: Not-for-profit research institute. PARTICIPANTS: 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). INTERVENTIONS: Subjects were imaged using dynamic tagged magnetic resonance imaging during Mandibular Advancement. Tissue displacements were quantified with the harmonic phase technique. MEASUREMENTS AND RESULTS: Mean Mandibular Advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with Mandibular Advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of Mandibular Advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. CONCLUSIONS: Mandibular Advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular Advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. CITATION: Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with Mandibular Advancement. SLEEP 2013;36(3):397-404.

  • tongue and lateral upper airway movement with Mandibular Advancement
    Sleep, 2013
    Co-Authors: Elizabeth C Brown, Shaokoon Cheng, David K Mckenzie, Jane E Butler, Simon C Gandevia, Lynne E Bilston
    Abstract:

    Study objectives To characterize tongue and lateral upper airway movement and to image tongue deformation during Mandibular Advancement. Design Dynamic imaging study of a wide range of apnea hypopnea index (AHI), body mass index (BMI) subjects. Setting Not-for-profit research institute. Participants 30 subjects (aged 31-69 y, AHI 0-75 events/h, BMI 17-39 kg/m(2)). Interventions Subjects were imaged using dynamic tagged magnetic resonance imaging during Mandibular Advancement. Tissue displacements were quantified with the harmonic phase technique. Measurements and results Mean Mandibular Advancement was 5.6 ± 1.8 mm (mean ± standard deviation). This produced movement through a connection from the ramus of the mandible to the pharyngeal lateral walls in all subjects. In the sagittal plane, 3 patterns of posterior tongue deformation were seen with Mandibular Advancement-(A) en bloc anterior movement, (B) anterior movement of the oropharyngeal region, and (C) minimal anterior movement. Subjects with lower AHI were more likely to have en bloc movement (P = 0.04) than minimal movement. Antero-posterior elongation of the tongue increased with AHI (R = 0.461, P = 0.01). Mean anterior displacements of the posterior nasopharyngeal and oropharyngeal regions of the tongue were 20% ± 13% and 31% ± 17% of Mandibular Advancement. The posterior tongue compressed 1.1 ± 2.2 mm supero-inferiorly. Conclusions Mandibular Advancement has two mechanisms of action which increase airway size. In subjects with low AHI, the entire tongue moves forward. Mandibular Advancement also produces lateral airway expansion via a direct connection between the lateral walls and the ramus of the mandible. Citation Brown EC; Cheng S; McKenzie DK; Butler JE; Gandevia SC; Bilston LE. Tongue and lateral upper airway movement with Mandibular Advancement. SLEEP 2013;36(3):397-404.