Abstract
The question of why ‘central’ apnea is seen is a recurring theme. The term ‘diaphragmatic’ apnea is a better term than ‘central’ apnea as the latter indicates a dysfunction in the medulla, which is rare. The short response to the question raised is: ‘because the upper airway is not completely open’. This is a very common consequence when dental appliances are used to treat sleep-disordered breathing, but the response needs an explanation. Long-term studies on the outcome of dental appliances have mostly been poor. We reviewed 25 obstructive sleep apnea (OSA) patients monitored between 4 and 12 months post-fitting with commercially available dental appliances (unpublished observations). All subjects presented at least one standard deviation higher amount of cyclic alternating pattern (CAP), with higher CAP rate and higher amount of phase A2 [1]) and A3 [1]) than their ageand gender-matched controls, indicating persistence of some degree of sleep disturbance and instability of non-rapid eye movement (NREM) sleep in these patients. The reasons why dental appliances may not completely relieve a patient are multiple, from problems involving soft tissues attached to the maxilla and advancing the mandible, to a narrow airway at the base of the tongue and difficulty shifting the hyoid bone forward even with nasal continuous positive airway pressure (CPAP). The more interesting question is why we see persistence of diaphragmatic apneas with dental appliances, a similar finding sometimes when CPAP pressure level is not high enough when performing CPAP titration. During wakefulness, chemosensitivity plays little role in quiet breathing due to the non-specific stimuli that
Published Version
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