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) 的特点是重复闭合 和/或睡眠期间咽部气道的病理性狭窄。 口服 睡眠期间佩戴的设备已被开发用于维持咽部 通过移动下颌骨和附着的咽部组织来保持气道通畅 向前。 然而，口腔装置未能得到广泛应用 接受是因为我们了解机械效应 下颌前移对咽部气道功能的影响不足，并且 在制造设备之前预测哪些患者会做出反应 不可能。本研究提案解决了这些问题 限制。 我们开发了一个解剖模型来解释 下颌前移对咽部气道的有益影响 并将使用独特的口腔矫治器测试该模型 下颌逐渐前移。 目标 1 磁共振 对麻醉的正常成人受试者进行上呼吸道成像 确定渐进式下颌前移对咽部的影响 气道尺寸和配置。 根据我们的解剖模型，我们 假设下咽部气道具有最大的 尺寸增加。 目标 2 将检验渐进式的假设 下颌前移使 OSA 受试者的咽部气道变硬 测量方法： NREM 睡眠期间的临界气道压力和 咽部气道不同层面的压力-面积关系 被动条件下。 下颌骨的前移需要一定程度的咬合张开 下切牙以清除上切牙。 目标3将研究效果 下颌骨咬合开口对咽部气道力学的影响 进步。 根据我们的模型，我们预测咬合张开度将 使鼻咽气道变硬。 对于目标 4，我们修改了 渐进式下颌前移装置成为一次性通用型 适用的器具。 该设备将在一个晚上使用 OSA 受试者的睡眠研究以确定最佳的进步量 需要保持咽部呼吸道通畅。 我们假设这 滴定装置将识别那些对以下治疗有反应的 OSA 患者 使用口腔装置进行长期治疗并提供最佳的 每个患者所需的进展设置。 目标 4 也将考验我们的 假设 OSA 患者对口腔装置治疗的反应 与咽部气道闭合部位及Pcrit有关 有或没有进步的测量。了解影响 下颌前移对咽部气道功能的影响将导致 改进口腔装置的设计并确定生理参数 预测哪些 OSA 患者会对这种潜在的反应做出积极的反应 重要的治疗。