PHARYNGEAL AIRWAY FUNCTION

咽部气道功能

• 批准号: 6625279
• 负责人: SAMUEL T. KUNA
• 金额: $ 30.1万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-12-01 至 2004-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6625279
• 关键词: assistive device /technology; biomechanics; biomedical equipment development; clinical research; human subject; human therapy evaluation; magnetic resonance imaging; mandible /maxilla; nasopharynx; physical model; prognosis; respiratory airflow disorder; respiratory airway pressure; respiratory function; sleep; sleep apnea

Obstructive sleep apnea (OSA) is characterized by the repetitive closure and/or pathologic narrowing of the pharyngeal airway during sleep. Oral devices worn during sleep have been developed to maintain pharyngeal airway patency by moving the mandible and attached pharyngeal tissues forward. However, oral devices have failed to gain widespread acceptance because our understanding of the mechanical effects of mandibular advancement on pharyngeal airway function is inadequate, and predicting which patients will respond prior to construction of a device has not been possible. This research proposal addresses these limitations. We have developed an anatomic model to explain the beneficial effects of mandibular advancement on the pharyngeal airway and will test this model using a unique oral appliance that progressively advances the mandible. In Aim 1 magnetic resonance imaging of the upper airway in anesthetized normal adult subjects will determine the effect of progressive mandibular advancement on pharyngeal airway size and configuration. Based on our anatomic model, we hypothesize that the lower pharyngeal airway will have the greatest increase in size. Aim 2 will test the hypothesis that progressive mandibular advancement stiffens the pharyngeal airway in OSA subjects as measured by: critical airway pressure during NREM sleep and the pressure-area relationship at different levels of the pharyngeal airway under passive conditions. Advancement of the mandible requires some amount of bite opening for the lower incisors to clear the upper incisors. Aim 3 will study the effect of bite opening on pharyngeal airway mechanics during mandibular advancement. Based on our model, we predict that bite opening will stiffen the nasopharyngeal airway. For Aim 4 we have modified our progressive mandibular advancement device into a disposable, universally applicable appliance. This device will be used during a single night's sleep study in OSA subjects to titrate the optimal amount of advancement needed to maintain pharyngeal airway patency. We hypothesize that this titration device will identify those OSA patients who will respond to chronic treatment with an oral device and provide the optimal advancement setting needed in each patient. Aim 4 will also test our hypothesis that the response of OSA patients to oral device treatment is related to the site of pharyngeal airway closure and Pcrit measurements with and without advancement. Understanding the effects of mandibular advancement on pharyngeal airway function will lead to improved design of oral devices and identify physiologic parameters that predict which OSA patients will respond favorably to this potentially important treatment.

阻塞性睡眠呼吸暂停（OSA）的特征是重复性闭合 和/或睡眠期间咽气道的病理性狭窄。 口服 已经开发了在睡眠期间佩戴的装置 通过移动下颌骨和附着的咽组织来保持气道通畅 性新 然而，口腔装置未能获得广泛的应用， 接受，因为我们对机械效应的理解 下颌前移对咽气道功能的影响不足， 在构建器械之前预测哪些患者会做出反应 是不可能的本研究旨在解决这些问题 局限性。 我们已经建立了一个解剖模型来解释 下颌前移对咽气道的有益作用 并将使用一种独特的口腔矫正器来测试这个模型， 逐渐推进下颌骨 In Aim 1磁共振 麻醉的正常成人受试者的上气道成像将 确定渐进式下颌前移对咽部的影响 气道大小和配置。 基于我们的解剖模型，我们 假设下咽气道将具有最大的 尺寸增大。 目标2将检验渐进式 下颌前移使阻塞性睡眠呼吸暂停患者咽部气道变硬 如通过以下测量的：NREM睡眠期间的临界气道压力和 咽气道不同水平压力-面积关系 在被动的条件下。 下颌骨的前移需要一定程度的咬合打开， 下门牙来清理上门牙 目标3将研究其效果 下颌骨开度对咽气道力学的影响 进步。 根据我们的模型，我们预测咬开将 关闭鼻咽通气道。 对于目标4，我们修改了我们的 渐进式下颌前移装置变成一次性的、通用的 适用的器具。 这个装置将在一个晚上的 OSA受试者的睡眠研究，以滴定最佳的进展量 保持咽部气道通畅 我们假设这 滴定装置将识别那些将对 长期治疗与口腔设备，并提供最佳的 每个患者都需要进行推进设置。 Aim 4还将测试我们的 假设OSA患者对口腔器械治疗的反应 与咽部气道关闭部位和Pcrit有关 测量有和没有进步。了解的影响 下颌前移对咽气道功能的影响 改进口腔装置的设计并识别生理参数， 预测哪些OSA患者会对这种潜在的 重要的治疗。