Sleep Breath 2000; 4(4): 163-168
DOI: 10.1055/s-2000-12547
Copyright © 2000 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Effect of Jaw and Head Position on Airway Resistance in Obstructive Sleep Apnea

Jae-Kap Choi1 , Michael Goldman2 , Sankar Koyal2 , Glenn Clark3
  • 1Department of Oral Medicine, School of Dentistry, Kyungpook National University, Taegu, Korea
  • 2Pulmonary Section, West Los Angeles Veterans Administration Medical Center, Los Angeles, California
  • 3 UCLA School of Dentistry, Section of Oral Medicine and Orofacial Pain Los Angeles, California
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Publikationsverlauf

Publikationsdatum:
31. Dezember 2000 (online)

ABSTRACT

This study evaluated whether changes in jaw and neck position caused substantial airway resistance (Raw) changes in normal controls and obstructive sleep apnea (OSA) subjects. Subject groups included 12 male nocturnal polysomnographically diagnosed OSA patients and 16 healthy male control subjects. Raw was assessed plethysmographically and measured under the following conditions: neutral head posture with 0/3, 1/3, 2/3, or 3/3 of the subjects maximum forward jaw position; normal jaw (0/3 forward) with fully flexed, extended, right or left rotated head position. Both groups showed a similar significant decrease in Raw upon jaw protrusion. OSA patients showed a significantly higher baseline (normal jaw, neutral head posture). Raw and both subject groups also had a clear increase in their airway resistance with flexion and to a lesser extent with neck rotation and extension. These data document that airway resistance can be significantly influenced by head and jaw positioning with protrusion of the jaw reducing Raw and flexing the neck increasing Raw.

REFERENCES

  • 1 Rivlin J, Hoffstein V, Kalbfleisch J. Upper airway morphology in patients with idiopathic obstructive sleep apnea.  Am Rev Respir Dis . 1984;  129 355-360
  • 2 Safar P, Escarraga L A, Chang F. Upper airway obstruction in the unconscious patient.  J Appl Physiol . 1959;  14 760-764
  • 3 Powell N, Guilleminault C, Riley R, Smith L. Mandibular advancement and obstructive sleep apnea syndrome.  Bull Eur Physiopath Resp . 1983;  19 607-610
  • 4 Kuo P C, West R A, Bloomquist D S, McNeil R W. The effect of mandibular osteotomy in 3 patients with hypersomnia and sleep apnea.  Oral Surg Oral Med Oral Pathol . 1979;  48 385-392
  • 5 Bear S E, Priest J H. Sleep apnea syndrome: correction with surgical advancement of the mandible.  J Oral Surg . 1980;  38 543-549
  • 6 Robin P. Glossoptosis due to atresia and hypotrophy of the mandible.  Am J Dis Child . 1934;  48 541-547
  • 7 Cartwright R D, Samelson C F. The effect of a nonsurgical treatment for obstructive sleep apnea. The tongue-retaining device.  J Am Med Assoc . 1982;  248 705-709
  • 8 Cartwright R D. Predicting response to the tongue retaining device for sleep apnea syndrome.  Arch Otolaryngol . 1985;  111 385-388
  • 9 Cartwright R, Stefoski D, Caldarelli D. Toward a treatment logic for sleep apnea: the place of the tongue retaining device.  Behav Res Ther . 1988;  26 121-126
  • 10 Clark G T, Arand D, Chung E, Tong D. The effect of an anterior mandibular positioning appliance on obstructive sleep apnea.  Am Rev Respir Dis . 1993;  147 624-629
  • 11 Clark G T, Blumenfeld I, Yoffe N, Peled E, Lavie P. A cross-over study comparing the efficacy of continuous positive air pressure (CPAP) with anterior mandibular positioning (AMP) devices on obstructive sleep apnea patients.  Chest . 1996;  109 1477-1483
  • 12 George P T. A modified functional appliance for treatment of obstructive sleep apnea.  J Clin Orthod . 1987;  11 171-175
  • 13 George P T. Treatment of snoring and obstructive sleep apnea with a dental device.  General Dent . 1993;  41 294-298
  • 14 Rider E A. Removable Herbst appliance for treatment of obstructive sleep apnea.  J Clin Orthod . 1988;  12 256-257
  • 15 Schmidt-Nowara W W, Meade T E, Hays M B. Treatment of snoring and obstructive sleep apnea with a dental orthosis.  Chest . 1991;  99 1378-1385
  • 16 Masumi S, Nishigawa K, Yan-Go F L, Williams A J, Clark G T. Effect of jaw position and posture on forced inspiratory airflow.  Chest . 1996;  109 1484-1489
  • 17 Coverdale S GM, Read D JC, Woolcock A J, Schoeffel R E. The importance of suspecting sleep apnea as a common cause of excessive daytime sleepiness: further experience from the diagnosis and management of 19 patients.  Aust N Z J Med . 1980;  10 284-288
  • 18 Hensley M J, Read D JC. Intermittent obstruction of the upper airway during sleep causing profound hypoxaemia. A neglected mechanism exacerbating chronic respiratory failure.  Aust N Z J Med . 1976;  6 481-486
  • 19 Suratt P M, Gal T J, Hooe D M. Effect of head flexion on airway resistance measured in a body plethysmograph.  Br J Dis Chest . 1981;  75 204-206
  • 20 Liistro G, Stanescu D, Dooms G, Rodenstein D, Veriter C. Head position modifies upper airway resistance in men.  J Appl Physiol . 1988;  64 1285-1288
  • 21 Spann R W, Hyatt R E. Factors affecting upper airway resistance in conscious man.  J Appl Physiol . 1971;  31 708-712
  • 22 Leiter J C, Knuth S L, Bartlett Jr D. Dependence of pharyngeal resistance on genioglossal EMG activity, nasal resistance, and airflow.  J Appl Physiol . 1992;  73 584-590
  • 23 DuBois A B, Botelho S Y, Comroe Jr H J. A new method for measuring airway resistance in man using a body plethysmograph: values in normal subjects and in patients with respiratory disease.  J Clin Invest . 1956;  35 327-335
  • 24 Reed W R, Roberts J L, Thach B T. Factors influencing regional patency and configuration of the human infant upper airway.  J Appl Physiol . 1985;  58 635-644
  • 25 Morikawa S, Safar P, Decarlo J. Influence of the head-jaw position upon upper airway patency.  Anesthesiol . 1961;  22 265-270
  • 26 Rubinstein I, McClean P A, Boucher R, Zamel N, Fredberg J J, Hoffstein V. Effect of mouthpiece, noseclips, and head position on airway area measured by acoustic reflections.  J Appl Physiol . 1987;  63 1469-1474
  • 27 Shelton Jr L R, Bosma J F. Maintenance of the pharyngeal airway.  J Appl Physiol . 1962;  17 209-214
  • 28 Anch A M, Remmers J E, Bunce III H. Supraglottic airway resistance in normal subjects and patients with occlusive sleep apnea.  J Appl Physiol . 1982;  53 1158-1163
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