医学
安慰剂
舌头
麻醉
方差分析
重复措施设计
磁刺激
咽肌
咬肌
阻塞性睡眠呼吸暂停
口腔矫治器
气道
内科学
解剖
刺激
统计
替代医学
数学
病理
作者
Yuri Martins Costa,Hidetoshi Hayakawa,Eduardo Castrillón,Dyna Mara Araújo Oliveira Ferreira,Takashi Iida,Mohit Kothari,Peter Svensson
摘要
Abstract Background Neuroplasticity induced by mandibular advancement appliance (MAD) in patients with obstructive sleep apnoea (OSA) is poorly documented. Objective This randomised placebo‐controlled crossover mechanistic study assessed the effects of short‐term use of a MAD on corticomotor excitability of the masseter and tongue in patients with OSA. Methods Adults ( n = 28) with mild or moderate OSA were randomly allocated to sleep with a MAD for 2‐weeks with 40% of the maximal protrusion (MAD active position) and without any jaw protrusion (MAD placebo position). The outcomes were assessed at baseline, and after 2 and 6 weeks, with a 2‐week washout period. The primary outcome was the amplitude of motor evoked potential (MEP) assessed on the right masseter, right side of tongue and right first dorsal interosseous with transcranial magnetic stimulation. Corticomotor map volume of the same muscles was also assessed. Repeated‐measures ANOVAs followed by Tukey test were applied to the data ( p < .050). Results There was a significant increase in the MEP amplitude of the masseter and tongue following the MAD active position compared with the baseline and MAD placebo (Tukey: p < .001). There were no significant MEP amplitude differences between the baseline and placebo positions ( p > .050). Moreover, there was a significant increase in corticomotor map volume for the masseter and tongue muscles following the MAD active position compared with baseline and MAD placebo (Tukey: p < .003). Conclusion Excitability of the masseter and tongue motor pathways is, at least transiently, increased in patients with OSA following a short‐term use of MAD. This novel finding of MAD‐induced neuroplasticity in corticomotor pathways may contribute to a further understanding of the mechanisms of oral appliances for treating OSA.
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