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Liu C, Zhang S, Zhu D, Fan D, Zhu Y, Kang W, Lu H, Wang J. A mandibular advancement device attenuates the abnormal morphology and function of mitochondria from the genioglossus in obstructive sleep apnea-hypopnea syndrome rabbits. J Oral Rehabil 2024; 51:1555-1565. [PMID: 38736104 DOI: 10.1111/joor.13724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 01/11/2024] [Accepted: 04/26/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Obstructive sleep apnea hypopnea syndrome (OSAHS) is a serious and potentially life-threatening disease. Mandibular advancement device (MAD) has the characteristics of non-invasive, comfortable, portable and low-cost, making it the preferred treatment for mild-to-moderate OSAHS. Our previous studies found that abnormal contractility and fibre type distribution of the genioglossus could be caused by OSAHS. However, whether the mitochondria participate in these tissue changes is unclear. The effect of MAD treatment on the mitochondria of the genioglossus in OSAHS is also uncertain. OBJECTIVE To examine the morphology and function of mitochondria from the genioglossus in a rabbit model of obstructive sleep apnea-hypopnea syndrome (OSAHS), as well as these factors after insertion of a mandibular advancement device (MAD). METHODS Thirty male New Zealand white rabbits were randomised into three groups: control, OSAHS and MAD, with 10 rabbits in each group. Animals in Group OSAHS and Group MAD were induced to develop OSAHS by injection of gel into the submucosal muscular layer of the soft palate. The rabbits in Group MAD were fitted with a MAD. The animals in the control group were not treated. Further, polysomnography (PSG) and cone-beam computed tomography (CBCT) scan were used to measure MAD effectiveness. CBCT of the upper airway and PSG suggested that MAD was effective. Rabbits in the three groups were induced to sleep for 4-6 h per day for eight consecutive weeks. The genioglossus was harvested and detected by optical microscopy and transmission electron microscopy. The mitochondrial membrane potential was determined by laser confocal microscopy and flow cytometry. Mitochondrial complex I and IV activities were detected by mitochondrial complex assay kits. RESULTS OSAHS-like symptoms were induced successfully in Group OSAHS and rescued by MAD treatment. The relative values of the mitochondrial membrane potential, mitochondrial complex I activity and complex IV activity were significantly lower in Group OSAHS than in the control group; however, there was no significant difference between Group MAD and the control group. The OSAHS-induced injury and the dysfunctional mitochondria of the genioglossus muscle were reduced by MAD treatment. CONCLUSION Damaged mitochondrial structure and function were induced by OSAHS and could be attenuated by MAD treatment.
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Affiliation(s)
- Chunyan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Shilong Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Dechao Zhu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Dengying Fan
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Yahui Zhu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Wenjing Kang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Haiyan Lu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
| | - Jie Wang
- Department of Oral Pathology, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology & Hebei Clinical Research Center for Oral Diseases, Shijiazhuang, PR China
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Johal A, Hamoda MM, Almeida FR, Marklund M, Tallamraju H. The role of oral appliance therapy in obstructive sleep apnoea. Eur Respir Rev 2023; 32:220257. [PMID: 37343962 DOI: 10.1183/16000617.0257-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/12/2023] [Indexed: 06/23/2023] Open
Abstract
There is now widespread recognition within the world of sleep medicine of the increasing importance of dental sleep medicine and, in particular, the role of oral appliance therapy (OAT) in the management of adults with obstructive sleep apnoea (OSA). For the purpose of this review, the term OAT refers to a custom-made intra-oral appliance, which acts to posture the mandible in a forward and downward direction, away from its natural resting position. Whilst nasally applied continuous positive airway pressure remains the "gold standard" in nonsurgical OSA management, OAT remains the recognised alternative treatment.This review of OAT aims to provide an evidence-based update on our current understanding of their mode of action, exploring the potential anatomical and physiological impact of their use in preventing collapse of the upper airway; the current clinical practice guidelines, including the recently published National Institute of Clinical Excellence 2021 guidance, in conjunction with the American Academy of Sleep Medicine and American Academy of Dental Sleep Medicine; optimal design features, comparing the role of custom-made versus noncustom OAT devices and the importance of titration in achieving a dose-dependent effect; patient predictors, preference and adherence to OAT; its impact on a range of both patient- and clinician-centred health outcomes, with a comparison with CPAP; the limitations and side-effects of providing OAT; and, finally, a look at future considerations to help optimise the delivery and outcomes of OAT.
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Affiliation(s)
- Ama Johal
- Oral Bioengineering, Institute of Dentistry, Queen Mary, University of London, London, UK
| | - Mona M Hamoda
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Fernanda R Almeida
- Department of Oral Health Sciences, Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada
| | - Marie Marklund
- Department of Otontology, Medical Faculty, Umea University, Umea, Sweden
| | - Harishri Tallamraju
- Oral Bioengineering, Institute of Dentistry, Queen Mary, University of London, London, UK
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Zhu D, Kang W, Zhang S, Qiao X, Liu J, Liu C, Lu H. Effect of mandibular advancement device treatment on HIF-1α, EPO and VEGF in the myocardium of obstructive sleep apnea-hypopnea syndrome rabbits. Sci Rep 2020; 10:13261. [PMID: 32764565 PMCID: PMC7414037 DOI: 10.1038/s41598-020-70238-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 07/22/2020] [Indexed: 11/09/2022] Open
Abstract
The aim of this study was to investigate the effects of mandibular advancement device (MAD) therapy for obstructive sleep apnea-hypopnea syndrome (OSAHS) on hypoxia-inducible factor-1α (HIF-1α), erythropoietin (EPO) and vascular endothelial growth factor (VEGF) in myocardial tissue. New Zealand rabbits were used to develop OSAHS and MAD models. Cone beam computed tomography (CBCT) of the upper airway and polysomnography (PSG) recordings were performed with the animals in the supine position. All of the animals were induced to sleep in a supine position for 4-6 h each day and were observed continuously for 8 weeks. The myocardial tissue of the three groups was dissected to measure the expression of HIF-1α, EPO and VEGF. The results showed that there was higher expression of HIF-1α, EPO and VEGF in the OSAHS group than those in the MAD and control groups. MAD treatment significantly downregulated the expression of HIF-1α, EPO and VEGF in the OSAHS animals. We concluded that MAD treatment could significantly downregulate the increased expression of HIF-1α, EPO and VEGF in OSAHS rabbits, improving their myocardial function.
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Affiliation(s)
- Dechao Zhu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Wenjing Kang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Shilong Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Xing Qiao
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Jie Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China
| | - Chunyan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China.
| | - Haiyan Lu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, No. 383, East Zhongshan Road, Shijiazhuang, 050017, Hebei, People's Republic of China.
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Liu C, Kang W, Zhang S, Qiao X, Yang X, Zhou Z, Lu H. Mandibular Advancement Devices Prevent the Adverse Cardiac Effects of Obstructive Sleep Apnea-Hypopnea Syndrome (OSAHS). Sci Rep 2020; 10:3394. [PMID: 32098974 PMCID: PMC7042252 DOI: 10.1038/s41598-020-60034-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 02/03/2020] [Indexed: 01/21/2023] Open
Abstract
Although considerable research highlights the interactions between obstructive sleep apnea-hypopnea syndrome (OSAHS) and cardiovascular diseases, the effect of mandibular advancement device (MAD) treatment on cardiovascular complications in OSAHS patients remains unclear. We evaluated the effect of OSAHS treatment with MADs on the myocardium. All methods in this study were in accordance with relevant guidelines and regulations of the medical ethics committee in Hospital of Stomatology, Hebei Medical University approved the work. Thirty New Zealand rabbits were randomized into three groups: the control group, Group OSAHS, and Group MAD. Hydrophilic polyacrylamide gel was injected into the soft palate of the rabbits to induce OSAHS. In Group MAD, a MAD was positioned after OSAHS induction. All animals were induced to sleep in a supine position for 4–6 h/day for 8 weeks. Echocardiography was used to determine the structure and function of the heart. The histological changes were detected by optical microscopy and transmission electron microscopy (TEM). The levels of ET-1(endothelin-1) and Ang II (Angiotensin II) in the plasma were measured by an enzyme-linked immunosorbent assay (ELISA). The expression of ET-1 mRNA in heart tissue was detected by RT-PCR. Histological abnormalities, left ventricular hypertrophy, and left ventricular dysfunctions were demonstrated in Group OSAHS, and the abnormities were rescued with MAD treatment. Higher levels of plasma ET-1 and Ang II and elevated expression of ET-1 mRNA in cardiac tissue were detected in Group OSAHS compared with Group MAD and the control group. The blood oxygen saturation was negatively correlated with the levels of ET-1 and Ang II. OSAHS-induced elevated levels of ET-1 and Ang II may be attributed to myocardial structural abnormalities and dysfunction. Early treatment of MADs may play an important role in preventing myocardial damage in OSAHS rabbit model.
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Affiliation(s)
- Chunyan Liu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China.,Department of Periodontology and Dental Hygiene, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA
| | - Wenjing Kang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China
| | - Shilong Zhang
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China
| | - Xing Qiao
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China
| | - Xiuchun Yang
- Department of Cardiology, The Second Hospital of Hebei Medical University; Hebei Province, Shijiazhuang, China
| | - Zheng Zhou
- Department of Periodontology and Dental Hygiene, School of Dentistry, University of Detroit Mercy, Detroit, MI, USA.
| | - Haiyan Lu
- Department of Orthodontics, School and Hospital of Stomatology, Hebei Medical University & Hebei Key Laboratory of Stomatology, Shijiazhuang, 050017, P.R. China.
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Benderro GF, Gamble J, Schiefer MA, Baskin JZ, Hernandez Y, Strohl KP. Hypoglossal nerve stimulation in a pre-clinical anesthetized rabbit model relevant to OSA. Respir Physiol Neurobiol 2018; 250:31-38. [PMID: 29410358 DOI: 10.1016/j.resp.2018.01.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/27/2018] [Accepted: 01/29/2018] [Indexed: 01/06/2023]
Abstract
We tested the functional effects of hypoglossal (CNXII) stimulation in the anesthetized rabbit before and after injections of saline into the tongue base to obstruct the airway. Data (n = 6) show little or no effect of CN XII trunk stimulation; however, medial branch stimulation (20-100 Hz; 50-500 μs pulse width, and incremental increases from 10 μA) reduced upper airway resistance. Medial branch stimulation was less effective in reducing resistance than anterior advancement of the hyoid. Endoscopic viewing (n-3) of the retropalate showed this region as the narrowest and dynamically changed by anterior hyoid displacement, with less evident effects than CNXII stimulation. We conclude that under these conditions CNXII medial branch stimulation reduces airway resistance, especially after induced obstruction.
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Affiliation(s)
- Girriso F Benderro
- Department of Medicine, Division of Puelmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Jenniffer Gamble
- Department of Medicine, Division of Puelmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States; Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Matthew A Schiefer
- Department of Medicine, Division of Puelmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States; Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Jonathan Z Baskin
- Department of Medicine, Division of Puelmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States; Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Yeritza Hernandez
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States
| | - Kingman P Strohl
- Department of Medicine, Division of Puelmonary, Critical Care, and Sleep Medicine, Case Western Reserve University, Cleveland, OH, United States; Louis Stokes Cleveland VA Medical Center, Cleveland, OH, United States.
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Upper Airway Neurostimulation to Treat Obstructive Sleep Apnea. Neuromodulation 2018. [DOI: 10.1016/b978-0-12-805353-9.00108-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lu HY, Wang W, Zhou Z, Liu CY, Liu Y, Xiao W, Dong FS, Wang J. Treatment of obstructive sleep apnoea–hypopnea syndrome by mandible advanced device reduced neuron apoptosis in frontal cortex of rabbits. Eur J Orthod 2017; 40:273-280. [DOI: 10.1093/ejo/cjx060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Hai-yan Lu
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Wen Wang
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Zheng Zhou
- Department of Periodontology, University of Detroit Mercy, Detroit, MI, USA
| | - Chun-yan Liu
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Ye Liu
- Department of Orthodontics, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Wei Xiao
- Department of Stomatology, FengTai Hospital, Beijing, P.R. of China
| | - Fu-sheng Dong
- Department of Oral and Maxillofacial Surgery, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
| | - Jie Wang
- Department of Oral Pathology, College of Stomatology, Hebei Medical University; The Key Laboratory of Stomatology, Hebei Province, Shijiazhuang, Hebei, P.R. of China
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García-Campos E, Labra A, Galicia-Polo L, Sánchez-Narváez F, Haro R, Jiménez U, Poblano A. Decrease of respiratory events in patients with obstructive sleep apnea-hypopnea syndrome using a mandibular advancement device assessed with split night polysomnography. Sleep Sci 2017; 9:221-224. [PMID: 28123665 PMCID: PMC5241605 DOI: 10.1016/j.slsci.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/09/2016] [Accepted: 10/14/2016] [Indexed: 11/21/2022] Open
Abstract
Introduction Mandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients. Objective The aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP) Method We performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results. Results SNP show significant changes with use of MAD (p<0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points). Conclusion Our data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.
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Affiliation(s)
- Emma García-Campos
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, Mexico
| | - Alberto Labra
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, Mexico
| | - Lourdes Galicia-Polo
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, Mexico
| | | | - Reyes Haro
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, Mexico
| | - Ulises Jiménez
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, Mexico
| | - Adrián Poblano
- Clinic of Sleep Disorders, National University of Mexico (UNAM), Mexico City, Mexico
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