Oral appliance effectively reverses Muller’s maneuver-induced upper airway collapsibility in obstructive sleep apnea and hypopnea syndrome

Abstract

To verify the effects of oral appliance (OA) on upper airway morphology under intraluminal pressure, identify specific sites of upper airway collapsibility that can be reversed by OAs, and determine the relationship between OA efficacy and dynamic upper airway changes using computed tomography (CT) with Muller's maneuver. Nineteen adult Chinese patients with symptomatic mild-to-moderate sleep apnea were recruited from our sleep center. Each patient was fitted with a two-piece OA. Dynamic changes in the retropalatal and retroglossal airway were evaluated using CT at end-expiration and during Muller's maneuver, both with and without an OA. Upper airway changes in the end-expiration phase before OA placement did not significantly differ from those after OA placement. However, under intraluminal pressure induced by Muller's maneuver, OA effectively expanded the upper airway at multiple levels. In addition, OA counteracted negative intraluminal pressure more effectively in the retropalatal region than in the retroglossal region, with 95.65, 68.75, 72.41, and 78.38% improvements in the collapsibility index of the anteroposterior dimension, transverse dimension, minimum cross-sectional area, and volume of the retropalatal region, respectively. Both nonresponders and responders to OA treatment were sensitive to the intraluminal pressure induced by Muller's maneuver. However, the collapsibility of the retropalatal airway improved significantly only in the responders, not in the nonresponders. OA effectively treats OSAHS by improving upper airway collapsibility.