Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients.

Publisher: published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society Country of Publication: United States NLM ID: 101607800 Publication Model: Print Cited Medium: Internet ISSN: 2051-817X (Electronic) Linking ISSN: 2051817X NLM ISO Abbreviation: Physiol Rep Subsets: MEDLINE

Original Publication: [Malden MA] : published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society, 2013-

Mandibular Advancement*/methods ; Sleep Apnea, Obstructive*/therapy; Humans ; Wakefulness ; Respiration ; Dyspnea ; Treatment Outcome

Patients with obstructive sleep apneas (OSA) do not complain from dyspnea during resting breathing. Placement of a mandibular advancement device (MAD) can lead to a sense of improved respiratory comfort ("pseudo-relief") ascribed to a habituation phenomenon. To substantiate this conjecture, we hypothesized that, in non-dyspneic awake OSA patients, respiratory-related electroencephalographic figures, abnormally present during awake resting breathing, would disappear or change in parallel with MAD-associated pseudo-relief. In 20 patients, we compared natural breathing and breathing with MAD on: breathing discomfort (transitional visual analog scale, VAS-2); upper airway mechanics, assessed in terms of pressure peak/time to peak (TTP) ratio respiratory-related electroencephalography (EEG) signatures, including slow event-related preinspiratory potentials; and a between-state discrimination based on continuous connectivity evaluation. MAD improved breathing and upper airway mechanics. The 8 patients in whom the EEG between-state discrimination was considered effective exhibited higher Peak/TTP improvement and transitional VAS ratings while wearing MAD than the 12 patients where it was not. These results support the notion of habituation to abnormal respiratory-related afferents in OSA patients and fuel the causative nature of the relationship between dyspnea, respiratory-related motor cortical activity and impaired upper airway mechanics in this setting.
(© 2024 The Authors. Physiological Reports published by Wiley Periodicals LLC on behalf of The Physiological Society and the American Physiological Society.)

Erratum in: Physiol Rep. 2024 Jul;12(14):e16167. doi: 10.14814/phy2.16167. (PMID: 39048526)

Clin Sci (Lond). 2003 Aug;105(2):243-50. (PMID: 12737619)
Exp Physiol. 2020 Feb;105(2):370-378. (PMID: 31742793)
Clin Physiol Funct Imaging. 2009 Jan;29(1):10-7. (PMID: 18803640)
Front Psychol. 2015 Jun 02;6:748. (PMID: 26082746)
Psychophysiology. 2011 Jun;48(6):808-12. (PMID: 21039587)
Physiol Rep. 2024 Feb;12(4):e15951. (PMID: 38373738)
Soc Cogn Affect Neurosci. 2013 Jan;8(1):15-26. (PMID: 22689216)
ERJ Open Res. 2023 Mar 13;9(2):. (PMID: 36923564)
J Clin Invest. 1992 May;89(5):1571-9. (PMID: 1569196)
Thorax. 2016 Jun;71(6):543-8. (PMID: 26892395)
J Appl Physiol (1985). 2015 Apr 15;118(8):1023-30. (PMID: 25663669)
IEEE Trans Biomed Eng. 2017 May;64(5):1138-1148. (PMID: 28129143)
J Physiol. 2007 Nov 15;585(Pt 1):135-46. (PMID: 17916615)
J Neurosci Methods. 2018 Oct 1;308:309-316. (PMID: 30114382)
Eur Respir J. 2016 Jun;47(6):1818-28. (PMID: 27076590)
Front Med (Lausanne). 2020 Feb 07;7:30. (PMID: 32118015)
J Physiol. 1991 Aug;439:545-58. (PMID: 1895244)
Sci Rep. 2019 Nov 12;9(1):16572. (PMID: 31719608)
PLoS One. 2014 Sep 30;9(9):e107850. (PMID: 25268234)
Am J Respir Crit Care Med. 2008 Feb 15;177(4):440-9. (PMID: 18048808)
Respir Physiol Neurobiol. 2010 Apr 15;171(1):54-60. (PMID: 20117253)
Clin Neurophysiol. 2011 Aug;122(8):1562-8. (PMID: 21306946)
Chest. 2009 Feb;135(2):455-461. (PMID: 19201712)
PLoS One. 2014 Jan 24;9(1):e84534. (PMID: 24475031)
Am J Respir Crit Care Med. 2000 Jun;161(6):1830-5. (PMID: 10852753)
Magn Reson Med. 2018 Apr;79(4):2306-2314. (PMID: 28856715)
Respir Physiol Neurobiol. 2014 Jan 1;190:131-6. (PMID: 24140506)
Nat Rev Neurosci. 2018 Jun;19(6):351-367. (PMID: 29740175)
J Appl Physiol (1985). 1997 Feb;82(2):480-90. (PMID: 9049727)
PLoS One. 2013 Apr 16;8(4):e62258. (PMID: 23614046)
Am J Respir Crit Care Med. 2023 Jul 1;208(1):39-48. (PMID: 36973007)
Am J Respir Crit Care Med. 1998 Jan;157(1):144-8. (PMID: 9445292)
J Appl Physiol. 1961 Jan;16:15-20. (PMID: 13699604)
J Appl Physiol (1985). 2022 Jan 1;132(1):95-105. (PMID: 34818073)
Sleep. 2015 Nov 01;38(11):1743-9. (PMID: 26158887)
Lancet. 2014 Feb 22;383(9918):736-47. (PMID: 23910433)
J Neurophysiol. 2016 Apr;115(4):2214-23. (PMID: 26864771)
J Physiol. 2018 Dec;596(24):6173-6189. (PMID: 29971827)
Respir Physiol Neurobiol. 2019 May;263:47-54. (PMID: 30872167)
Respir Res. 2007 Sep 06;8:61. (PMID: 17822538)
J Appl Physiol (1985). 2006 Feb;100(2):579-86. (PMID: 16195387)
J Physiol. 2007 Jan 15;578(Pt 2):569-78. (PMID: 17110415)
Respir Physiol Neurobiol. 2014 Dec 1;204:64-70. (PMID: 25048677)

APHP; Institut Carnot APHP

Keywords: OSA; dyspnea; electroencephalography; neurophysiology; respiratory drive

Date Created: 20240219 Date Completed: 20240221 Latest Revision: 20240724

20240726

PMC10984610

10.14814/phy2.15951

38373738