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

Article dans une revue avec comité de lecture
Auteur
VALENTIN, Rémi
353778 CHU Pitié-Salpêtrière [AP-HP]
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]
NIÉRAT, Marie‐Cécile
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
WATTIEZ, Nicolas
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
JACQ, Olivier
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
DECAVÈLE, Maxens
413221 Sorbonne Université [SU]
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
ARNULF, Isabelle
353778 CHU Pitié-Salpêtrière [AP-HP]
542029 Institut du Cerveau = Paris Brain Institute [ICM]
SIMILOWSKI, Thomas
353778 CHU Pitié-Salpêtrière [AP-HP]
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
ATTALI, Valérie
353778 CHU Pitié-Salpêtrière [AP-HP]
542093 Neurophysiologie Respiratoire Expérimentale et Clinique [UMRS 1158]
1001017 Institut de Biomécanique Humaine Georges Charpak [IBHGC]

URI
http://hdl.handle.net/10985/25102
DOI
10.14814/phy2.15951
Date
2024-02
Journal
Physiological Reports

Résumé

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.

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2024-08-20
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