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J Appl Physiol 100: 349-356, 2006. First published August 25, 2005; doi:10.1152/japplphysiol.00560.2005
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HIGHLIGHTED TOPICS
Physiology and Pathophysiology of Sleep Apnea

Mandibular advancement decreases pressures in the tissues surrounding the upper airway in rabbits

Kristina Kairaitis,1,2 Rosie Stavrinou,2 Radha Parikh,2 John R. Wheatley,1,2 and Terence C. Amis1,2

1Ludwig Engel Centre for Respiratory Research, Department of Respiratory Research, Westmead Hospital, Westmead; and 2University of Sydney, Camperdown, New South Wales, Australia

Submitted 12 May 2005 ; accepted in final form 17 August 2005

The pharyngeal airway can be considered as an airway luminal shape formed by surrounding tissues, contained within a bony enclosure formed by the mandible, skull base, and cervical vertebrae. Mandibular advancement (MA), a therapy for obstructive sleep apnea, is thought to increase the size of this bony enclosure and to decrease the pressure in the upper airway extraluminal tissue space (ETP). We examined the effect of MA on upper airway airflow resistance (Rua) and ETP in a rabbit model. We studied 11 male, supine, anesthetized, spontaneously breathing New Zealand White rabbits in which ETP was measured via pressure transducer-tipped catheters inserted into the tissues surrounding the lateral (ETPlat) and anterior (ETPant) pharyngeal wall. Airflow, measured via surgically inserted pneumotachograph in series with the trachea, and tracheal pressure were recorded while graded MA at 75° and 100° to the horizontal was performed using an external traction device. Data were analyzed using a linear mixed-effects statistical model. We found that MA at 100° increased mouth opening from 4.7 ± 0.4 to 6.6 ± 0.4 (SE) mm (n = 7; P < 0.004), whereas mouth opening did not change from baseline (4.0 ± 0.2 mm) with MA at 75°. MA at both 75° and 100° decreased mean ETPlat and ETPant by ~0.1 cmH2O/mm MA (n = 7–11; all P < 0.0005). However, the fall in Rua (measured at 20 ml/s) with MA was greater for MA at 75° (~0.03 mmH2O·ml–1·s·mm–1) than at 100° (~0.01 mmH2O·ml–1·s·mm–1; P < 0.02). From these findings, we conclude that MA decreases ETP and is more effective in reducing Rua without mouth opening.

upper airway extraluminal tissue pressure; upper airway patency


Address for reprint requests and other correspondence: K. Kairaitis, Ludwig Engel Centre for Respiratory Research, Dept. of Respiratory Research, Westmead Hospital, Hawkesbury Rd., Westmead, NSW 2145, Australia (e-mail: kristinak{at}westgate.wh.usyd.edu.au)




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