Abstract
Mandibular advancement device (MAD) is a valid treatment for obstructive sleep apnea (OSA). However there is no reliable criteria predicting treatment efficacy. Upper airway muscle mechanical properties (UAMP) are important pathophysiological determinants of the occurrence of OSA that could be involved in MAD treatment response. The aim of this study was to investigate UAMP in the response to MAD in OSA patients. 9 subjects were recruited to perform either a soft palate fatigue protocol (SPFP, n=4) or a tongue fatigue protocol (TFP, n=5) before initiating MAD treatment. In SFPF, subjects were asked to develop sustained maximal bulging pressure for 5 seconds every 10 seconds until the peak pressure failed to reach 85% of baseline maximal pressure for 2 consecutive times. In TFP, subjects had to press an air filled bulb with the tongue against the hard palate. Endurance time, recovery time, and mean maximum pressure were measured. Sleep studies were performed before the beginning of MAD treatment and after the titration period. Characteristics of subjects for SFPF group were 1 female, age 54 ± 8 y, BMI 29.1 ± 3.1 kg/m2. Characteristics of TFP were 1 female, age 62 ± 2, BMI 26.8 ± 2.8 kg/m2. Baseline AHI was 22.8 ± 8.7/h for SPFP and 36.7 ± 13.1/h for TFP. MAD AHI was 10.4 ± 8.2/h for SFPF and 18.2 ± 12.8/h for TFP. 2 TFP and 2 SPFP subjects were responders (AHI decrease greater than 50% with a final MAD AHI < 15/h). No difference was found in endurance time and recovery time between responders (5.1 ± 6.8 and 4.0 ± 2.8 min respectively) and non-responders (11.2 ± 6.1 and 6.8 ± 4.6 min), but difference in mean maximum pressure was borderline significant (34.8±13.6 and 60.0±10.7 kPa respectively, p=0.07). Our pilot results suggest that mechanical strength but not fatigue may differentiate MAD responders/non-responders. Supported by Le fonds de recherche et enseignement sur les troubles respiratoires du sommeil de la Fondation IUCPQ.
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