OrthoApnea : Clinical Effects
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Oral appliances of Orthoapnea modify the permeability of the upper airway during sleep enhanced by the expansion of size and / or decreased collapsibility (eg, improve the muscle tone of the upper airway). Orthoapnea has demonstrated the ability to extend the UA at various points, both on the soft palate and the base of the tongue. There is a predominant lateral expansion of the UA, but there has also been expansion in antero-posterior region. Thus, the language makes more space and moves forward. Pharyngeal collapse disappears and the critical pressure decreases. Intraoral devices essentially perform a movement or propulsion advancement and clockwise rotation of the mandible or, because the condyle rotates and moves earlier in the glenoid, this creates an increase in the portion of the UA, although involving other neuromuscular pathophysiological mechanisms. While during sleep occurs more jaw back dropping with the same influencing posterotacion increasing the resistance of the UA. In fact, 69% of the time patients with sleep apnea sleep with an open mouth of more than 5 mm, a figure significantly higher than in healthy individuals (11%), and this opening of the mouth can produce a posterorotación with increased resistance of the UA.
|The action of the mandibular advancement prosthesis|
|They tense the soft tissues of the pharynx's lateral walls.|
|Total or partial reduction of soft tissue vibration that causes snoring.|
|Activation of the genioglossus muscle and increases muscle tone of the tongue.|
|Changes in pharyngeal pressures to normalize the physiological properties of the UA.|
|Changes in the position of the hyoid bone towards a more advanced position.|
This phenomenon helps explaining, how to produce a significant improvement with little overtaking of the mandibule even without major changes in the airways by simply avoiding the retroposition of the mandible to be stabilized by the device Orthoapnea.
Other changes that occur is the velopharyngeal level, consisting of increased rigidity and widening between the anterior and posterior pillars (m. palatofaringeo and m. palatoglossus) of the pharynx, and generated increase in lateral pharyngeal wall that is larger than the increasing of the pharyngeal lumen in the anteroposterior direction, a displacement of the soft palate forward and an increased caliber of the velopharyngeal level significantly reducing snoring or make it disappear.
At lingual nivel, anterior rotation of the mandible and increased vertical dimension have the consequence, that the muscle, which plays the major role, the m. genioglossus, is tensed and activated. It has been found by Electromyographic, that the genioglossus muscle tone increases after application of intraoral appliances. In this way the tongue occupies a more anterior position avoiding subsequent fall and thus the obstruction of the airway. The various pressures at the level of pharyngeal light play a role in the collapse of the area, the equipment of Orthoapnea certainly change this balance of pressures facilitating the permeability of the UA.
It can also considered, that there is a correlation between the degree of mandibular advancement and improvement or disappearance of apneic events and oxygen desaturation, to some extent this is true and has been shown in some studies. There are clear short-term reductions in the number of sleep apneas, the oxygen desaturation and subjective sleepiness in patients with apnea. Snoring decreased in frequency and intensity. In the long term snoring and apnea / hypopnea is reduced to levels comparable with results in cases treated surgically.