PHARYNGEAL AIRWAY FUNCTION

阻塞性睡眠呼吸暂停(OSA)的特点是反复闭合 和/或睡眠期间咽部呼吸道病理性狭窄。口头的 在睡眠时佩戴的设备已经被开发出来以维持咽部 通过移动下颌骨和附着的咽部组织实现呼吸道通畅 往前走。然而，口腔设备并没有得到广泛的应用 接受是因为我们对机械效应的理解 下颌前移对咽部呼吸道功能的影响不充分， 在构建设备之前预测哪些患者会有反应 是不可能的。这项研究提案解决了这些问题 限制。我们已经开发了一个解剖学模型来解释 下颌前移对咽部呼吸道的有益影响 并将使用一种独特的口腔矫治器来测试这一型号 逐步推进下颌骨。在AIM 1中的磁共振 麻醉的正常成人受试者的上呼吸道成像将 确定下颌骨进行性前移对咽部的影响 呼吸道的大小和形态。基于我们的解剖模型，我们 假设咽下呼吸道将有最大 大小增加。目标2将检验递进的假设 阻塞性睡眠呼吸暂停综合征患者下颌前移使咽部呼吸道僵硬 由以下指标衡量：NREM睡眠期间的临界气道压和 咽部不同水平气道的压力-面积关系 在被动的条件下。 下颌骨的前移需要一定量的咬合开口量 下门牙以清理上门牙。目标3将研究这一影响 下颌咬合口张开对咽部呼吸道力学的影响 进步。基于我们的模型，我们预测咬合开口处 使鼻咽部的呼吸道变硬。对于目标4，我们已经修改了我们的 渐进式下颌前移装置成为一次性、通用的装置 适用的设备。这款设备将在一夜之间使用 阻塞性睡眠呼吸暂停综合征受试者的睡眠研究以确定最佳进展量 需要维持咽部呼吸道通畅。我们假设这是 滴定装置将识别哪些OSA患者对 使用口腔设备进行慢性治疗，并提供最佳的 每名患者都需要进行进展期设置。AIM 4还将测试我们的 假设阻塞性睡眠呼吸暂停患者对口腔器械治疗的反应 与咽部呼吸道闭合部位和Pcrit有关 有前进和没有前进的测量。了解以下方面的影响 下颌前移对咽部呼吸道功能的影响 改进了口腔器械的设计，并确定了可 预测哪些OSA患者可能会对此做出积极反应 重要的治疗。

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.