Adela Martínez, Alfonso López Muñiz, Eduardo Soudah, Juan Calvo, Alberto Álvarez Suárez, Teresa Cobo
Abstract: Mandibular Advancement Devices (MAD) have emerged as an accepted substitute of continuous positive airway pressure for the treatment of mild to moderate sleep apnea-hypopnea syndrome (SAHS). These devices bring the mandible forward and back enlarging the upper airway(s) area avoiding its collapsibility. However, to determine the mechanism of MAD positioning is relatively complex and remains a clinical challenge. If the MAD is not adjusted/titrated correctly, it may not have the desired results, and consequently, a reduced treatment response. Therefore, it is of great interest and importance to provide further data/evidence to the clinician by assessing the characteristics of the clinical response of the MAD titration. In this research, we combine computed tomography images and computational fluid dynamics to understand that the effects that the use of MAD has on the upper airway (UA). To achieve this, 10 patients suffering mild-to-moderate apnea were analyzed using MAD in two different scenarios (mandibular antepulsion and open mouth). The purpose of this study is to determine differences in effectiveness between two positioning of the same mandibular advancement device. For both scenarios the total volume, cross-sectional areas, velocities and pressure of the upper airways were studied and compared with the rest position (without MAD). The methodology used in this study may prove valuable in predicting which SAHS patients will benefit from treatment with oral appliances like MAD and may be also used as a potential clinical procedure to understand its titration and use.
Keywords: Computational Fluid Dynamics (CFD), sleep apnea, mandibular advancement Device (MAD)
Date Published: November 25, 2019 DOI: TBAView Article