scholarly journals Tongue Pressure Sensing Array Integrated with a System-on-Chip Embedded in a Mandibular Advancement Splint

Micromachines ◽  
2018 ◽  
Vol 9 (7) ◽  
pp. 352 ◽  
Author(s):  
Yun-Ting Chen ◽  
Kun-Ying Yeh ◽  
Szu-Han Chen ◽  
Chuang-Yin Wang ◽  
Chao-Chi Yeh ◽  
...  
Keyword(s):  
Polymer Films ◽  
Conductive Polymer ◽  
Upper Airway ◽  
System On Chip ◽  
Mandibular Advancement ◽  
Tongue Pressure ◽  
Electrode Pair ◽  
Pressure Sensing ◽  
Obstructive Sleep ◽  
On Chip

Obstructive sleep apnea (OSA), which is caused by obstructions of the upper airway, is a syndrome with rising prevalence. Mandibular advancement splints (MAS) are oral appliances for potential treatment of OSA. This work proposes a highly-sensitive pressure sensing array integrated with a system-on-chip (SoC) embedded in a MAS. The device aims to measure tongue pressure distribution in order to determine the efficacy of the MAS for treating OSA. The flexible sensing array consists of an interdigital electrode pair array assembled with conductive polymer films and an SoC capable of retrieving/storing data during sleep, and transmitting data for analysis after sleep monitoring. The surfaces of the conductive polymer films were patterned with microdomed structures, which effectively increased the sensitivity and reduced the pressure sensing response time. The measured results also show that the crosstalk effect between the sensing elements of the array was negligible. The sensitivity of the sensing array changed minimally after the device was submerged in water for up to 100 h.

Using Two-Way Fluid-Structure Interaction to Study the Collapse of the Upper Airway of OSA Patients

2014 ◽  
Vol 553 ◽  
pp. 275-280 ◽  
Author(s):  
Mo Yin Zhao ◽  
Tracie J. Barber ◽  
Peter A. Cistulli ◽  
Kate Sutherland ◽  
Gary Rosengarten
Keyword(s):  
Computational Models ◽  
Treatment Success ◽  
Fluid Structure Interaction ◽  
Maximum Velocity ◽  
Upper Airway ◽  
Post Treatment ◽  
Mandibular Advancement ◽  
Fluid Structure ◽  
Structure Interaction ◽  
Obstructive Sleep

Obstructive Sleep Apnea (OSA) is a common sleep disorder characterized by repetitive collapse of the upper airway (UA) during sleep. Treatment options for OSA include mandibular advancement splints (MAS), worn intra-orally to protrude the lower jaw to stabilize the airway. However not all patients will respond to MAS therapy and individual effects on the upper airway are not well understood. Simulations of airway behavior represent a non-invasive means to understand this disorder and treatment responses in individual patients. The aims of this study was to perform analysis of upper airway (UA) occlusion and flow dynamics in OSA using the fluid structure interaction (FSI) method, and secondly to observe changes associated with MAS usage. Magnetic resonance imaging (MRI) scans were obtained with and without mandibular advance splint (MAS) treatment in a patient known to be a treatment responder. Computational models of the anatomically correct UA geometry were reconstructed for both pre-and post-treatment (MAS) conditions. By comparing the simulation results, the treatment success of MAS was demonstrated by smaller UA structure deformation (maximum 2mm) post-treatment relative to the pre-treatment fully collapsed (maximum 6mm) counterpart. The UA collapse was located at the oropharynx and the low oropharyngeal pressure (-51 Pa to-39 Pa) was induced by the velopharyngeal jet flow (maximum 10 m/s). The results support previous OSA computational fluid dynamics (CFD) studies by indicating similar UA pressure drop and maximum velocity values. These findings lay a firm platform for the application of computational models for the study of the biomechanical properties of the upper airway in the pathogenesis and treatment of OSA.

Novel avenues to approach non-CPAP therapy and implement comprehensive OSA care

2021 ◽  
pp. 2101788
Author(s):  
Jean-Louis Pépin ◽  
Peter Eastwood ◽  
Danny J. Eckert
Keyword(s):  
Treatment Success ◽  
Clinical Manifestations ◽  
Upper Airway ◽  
Sleep Apnoea ◽  
Mandibular Advancement ◽  
Individual Risk ◽  
Future Research ◽  
Success Rates ◽  
Recent Advances ◽  
Obstructive Sleep

Recent advances in obstructive sleep apnoea (OSA) pathophysiology and translational research have opened new lines of investigation for OSA treatment and management. Key goals of such investigations are to provide efficacious, alternative treatment and management pathways that are better tailored to individual risk profiles to move beyond the traditional, continuous positive airway pressure (CPAP)-focused, “one size fits all”, trial and error approach which is too frequently inadequate for many patients. Identification of different clinical manifestations of OSA (clinical phenotypes) and underlying pathophysiological phenotypes (endotypes), that contribute to OSA have provided novel insights into underlying mechanisms and have underpinned these efforts. Indeed, this new knowledge has provided the framework for precision medicine for OSA to improve treatment success rates with existing non-CPAP therapies such as mandibular advancement devices and upper airway surgery, and newly developed therapies such as hypoglossal nerve stimulation and emerging therapies such as pharmacotherapies and combination therapy. These concepts have also provided insight into potential physiological barriers to CPAP adherence for certain patients. This review summarises the recent advances in OSA pathogenesis, non-CPAP treatment, clinical management approaches and highlights knowledge gaps for future research. OSA endotyping and clinical phenotyping, risk stratification and personalised treatment allocation approaches are rapidly evolving and will further benefit from the support of recent advances in e-health and artificial intelligence.

Interacting effects of genioglossus stimulation and mandibular advancement in sleep apnea

2009 ◽  
Vol 106 (5) ◽  
pp. 1668-1673 ◽  
Author(s):  
Ron Oliven ◽  
Naveh Tov ◽  
Majed Odeh ◽  
Luis Gaitini ◽  
Uri Steinfeld ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Airway Pressure ◽  
Upper Airway ◽  
Combined Effect ◽  
Mandibular Advancement ◽  
Cross Sectional ◽  
Airway Patency ◽  
Obstructive Sleep ◽  
Critical Closing Pressure ◽  
Stimulation Of

Both mandibular advancement (MA) and stimulation of the genioglossus (GG) have been shown to improve upper airway patency, but neither one achieves the effect of continuous positive airway pressure (CPAP) treatment. In the present study we assessed the combined effect of MA and GG stimulation on the relaxed pharynx in patients with obstructive sleep apnea (OSA). We evaluated responses of upper airway pressure-flow relationships and endoscopically determined pharyngeal cross-sectional area to MA and electrical stimulation of the GG in 14 propofol-anesthetized OSA patients. Measurements were undertaken at multiple levels of CPAP, enabling calculation of the critical closing pressure (Pcrit), upstream resistance (Rus), and pharyngeal compliance. GG stimulation, MA, and the combination of both shifted the pressure:flow relationships toward higher flow levels, resulting in progressively lower Pcrit (from baseline of 2.9 ± 2.2 to 0.9 ± 2.5, −1.4 ± 2.9, and −4.2 ± 3.3 cmH2O, respectively), without significant change in Rus. ΔPcrit during GG stimulation was significantly larger during MA than under baseline conditions (−2.8 ± 1.4 vs. −2.0 ± 1.4 cmH2O, P = 0.011). Combining the effect of GG stimulation with MA lowered Pcrit below 0 in all patients and restored pharyngeal patency to a level that enabled flow above the hypopnea level in 10/14 of the patients. Velopharyngeal compliance was not affected by either manipulation. We conclude that the combined effect of MA and GG stimulation is additive and may act in synergy, preventing substantial flow limitation of the relaxed pharynx in most OSA patients.

scholarly journals 1272 Control of Sleep-Associated Respiratory Distress with a Mandibular Advancement Oral Appliance in an Unusual Case of a Patient with a Mild Rather Persistent Nocturnal Baseline Hypoventilation/Hypoxia

SLEEP ◽  
2020 ◽  
Vol 43 (Supplement_1) ◽  
pp. A483-A484
Author(s):  
I Manetta ◽  
A Almeida ◽  
D Schwartz ◽  
M Meira e Cruz
Keyword(s):  
Unusual Case ◽  
Upper Airway ◽  
Oral Appliance ◽  
Interesting Case ◽  
Normal Weight ◽  
Mandibular Advancement ◽  
Therapeutic Success ◽  
Sleep Related Breathing Disorders ◽  
Respiratory Parameters ◽  
Obstructive Sleep

Abstract Introduction Normal respiratory function is crucial for adequate sleep. Sleep Related Breathing Disorders, namely Obstructive Sleep Apnea (OSA) are frequent conditions among a large spectrum of obstructive events in the upper airway which are often linked to significant sleep related oxyhemoglobin dessaturation levels compared to those observed in baseline PSG-oximetry recorded. On the other hand, low baseline oxygen saturation (LBOS) is commonly linked to symptomatic cardiorespiratory disturbances which may adversely impact respiratory outcomes either awake or during sleep. Therefore it is relevant to be aware of the baseline ventilatory status in order to optimize the therapeutic care. Report of Case We present an unusual case of a patient with moderate OSA which was successfully controlled with a Mandibular Advancement Oral Appliance (OAm). Despite the control with the OAm, the patient still maintained a nocturnal pattern of hypoventilation/hypoxia. The 53 yo female patient with normal weight/height ratio (BMI=25,2) complaining of non restorative sleep, tiredness, impaired memory, excessive diurnal sleepiness (Epworth Sleepiness Scale - ESS=10 and bruxism with a PSG diagnosis of moderate OSA (BaselineO2Sat=94%; IAH=17,4 ev/h; ODI=32,9 ev/h; T90=34,7% of TST) was referred for treatment with a OAm. A PM Type 1 positioner was inserted and titrated until 12 mm of advancement (80% of maximal measured protrusion). Within 6 months follow up and after clinical titration, there was a clear symptomatic and objective improvement with resolution of all major complaints including sleepiness (ESS=5). Titration PSG showed a normalization in all parameters (IAH=1,4 ev/h;ODI=4 ev/h;T90=0,1% of TST). Baseline O2 Sat however remained low (93%) in the titration PSG even though no symptoms or signs of a disorder existed even after discounting for Ph related metabolic changes (normal levels of HCO3) Conclusion This is an interesting case of an unusual patient who presented with a LBOS level in the diagnostic PSG. Despite the therapeutic success of the OAm in controlling the sleep related respiratory condition, measured by all otherwise normalized PSG based sleep and respiratory parameters, maintained a LBOS in the titration PSG without any signs or symptoms of disease.

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