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

Rémi Valentin (1, 2, 3) , Marie-Cécile Niérat (1) , Nicolas Wattiez (1) , Olivier Jacq (1) , Maxens Decavèle (1, 3) , Isabelle Arnulf (4) , Thomas Similowski (1, 3) , Valérie Attali (1, 2, 3)

1 UMRS 1158 - Neurophysiologie Respiratoire Expérimentale et Clinique
2 IBHGC - Institut de Biomécanique Humaine Georges Charpak
3 CHU Pitié-Salpêtrière [AP-HP]
4 ICM - Institut du Cerveau = Paris Brain Institute

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.

Mots clés: OSA; dyspnea; electroencephalography; neurophysiology; respiratory drive.

Domaines: Neurosciences

Rémi Valentin, Marie-Cécile Niérat, Nicolas Wattiez, Olivier Jacq, Maxens Decavèle, et al.. Neurophysiological basis of respiratory discomfort improvement by mandibular advancement in awake OSA patients. Physiological Reports, 2024, ⟨10.14814/phy2.15951⟩. ⟨hal-04471365⟩