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Characterizing site and severity or upper airway collapse to guide patient selection for oral appliance therapy for obstructive sleep apnea

Grant number: 15/26502-8
Support Opportunities:Scholarships in Brazil - Doctorate (Direct)
Effective date (Start): September 01, 2016
Effective date (End): September 30, 2018
Field of knowledge:Health Sciences - Medicine
Principal Investigator:Pedro Rodrigues Genta
Grantee:Melania Dirce Oliveira Marques
Host Institution: Instituto do Coração Professor Euryclides de Jesus Zerbini (INCOR). Hospital das Clínicas da Faculdade de Medicina da USP (HCFMUSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil


Obstructive Sleep Apnea (OSA) is characterized by recurrent pharyngeal collapse during sleep. Continuous positive airway pressure is the gold standard treatment for OSA but adherence varies (30 to 60%). Therefore, improvement of alternative treatment options is necessary. Oral Appliance (OA) therapy with mandibular advancement is increasingly being indicated for OSA treatment due its good tolerance. However, individual variability in response to OA treatment represents a significant clinical challenge. Sleep endoscopy involves a dynamic assessment of the pharynx during sleep. Sleep endoscopy has been used to visualize the magnitude and patterns of pharyngeal collapse with and without mandibular advancement simulation. The pharyngeal critical closing pressure (Pcrit) is a method to measure upper airway collapsibility. The purpose of this study are to correlate the structure of pharyngeal collapse to the improvement in pharyngeal collapsibility with OA therapy. In addition, a Pcrit threshold associated with a positive response to OA will be determined for each pharyngeal structure involved in collapse. Our hypothesis is that the two major baseline determinants of OA success are the structure and severity of upper airway collapse (Pcrit). Forty OSA patients (Apnea/hypopnea index>5 events/hour) of both genders aged from 18 to 70 years will be recruited. Patients will undergo upper airway endoscopy assessment during natural sleep to identify the pharyngeal structures causing collapse. Pcrit and apnea-hypopnea index will be determined with and without mandibular advancement. (AU)

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Academic Publications
(References retrieved automatically from State of São Paulo Research Institutions)
MARQUES, Melania Dirce Oliveira. Upper airway anatomy characteristics for obstructive sleep apnea personalized treatment. 2018. Doctoral Thesis - Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD) São Paulo.

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