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Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity

¹ Dept of Oral Health Sciences, Faculty of Dentistry, and ² Division of Respiratory Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada, and ³ Maxillofacial Orthognathics, Graduate School, Tokyo Medical and Dental University, Tokyo, and ⁴ Dept of Oral and Maxillofacial Prosthodontics, Field of Oral and Maxillofacial Rehabilitation, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan

CORRESPONDENCE: A.A. Lowe, Dept of Oral Health Sciences, Faculty of Dentistry, The University of British Columbia, 2199 Wesbrook Mall, Vancouver BC, Canada, V6T 1Z3. Fax: 1 6048223562. E-mail: alowe@interchange.ubc.ca

Keywords: airway curvature, mandibular advancement, obstructive sleep apnoea, titratable oral appliance

Received: October 16, 2002
Accepted September 2, 2003

Part of this study was supported by Grants-in-Aid for Scientific Research Projects (15659469) from the Japanese Ministry of Education, Culture. F.R. Almeida was supported by a scholarship from CNP₉-Brazil, Brazil.

In a curved tube, the amount of airflow appears to be influenced by the amount of curvature. The purpose of this study was to investigate changes in obstructive sleep apnoea (OSA) severity and awake velopharyngeal curvature in response to an anteriorly titrated mandibular position in 20 male OSA patients.

Baseline supine cephalometry was obtained before the initial insertion of a titratable oral appliance and follow-up supine cephalometry was undertaken after titration of the mandibular position with the appliance in place.

The mean apnoea/hypopnea index (AHI) before treatment (31.6±13.0 events·h^–1) was significantly reduced (9.8±7.4 events·h^–1) after titration of the mandibular position in all 20 patients. There was a significant increase in the anteroposterior calibre and the radius of the curvature of the anterior wall of the velopharynx in 14 good responders who exhibited an AHI reduction to 15. Similar observations were not found in six poor responders.

To conclude, an anteriorly titrated mandibular position reduced obstructive sleep apnoea severity, enlarged the velopharynx and diminished the curvature of the anterior velopharyngeal wall in good responders. It is proposed that this change in the upper airway curvature associated with mandibular advancement may effect obstructive sleep apnoea severity through its effect on airflow dynamics.

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