Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea
Key points •Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear. •In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy)...
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| Veröffentlicht in: | The Journal of physiology 2019-11, Vol.597 (22), p.5399-5410 |
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| creator | Marques, Melania Genta, Pedro R. Azarbarzin, Ali Taranto‐Montemurro, Luigi Messineo, Ludovico Hess, Lauren B. Demko, Gail White, David P. Sands, Scott A. Wellman, Andrew |
| description | Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.
A major limitation to the administration of oral appliance therapy for obstructive sleep apnoea (OSA) is that therapeutic responses remain unpredictable. In the present study, we tested the hypotheses that oral appliance therapy (i) reduces pharyngeal collapsibility preferentially in patients with posteriorly‐located tongue and (ii) is most efficacious (reduction in apnoea‐hypopnea index; AHI) in patients with a posteriorly‐located tongue and less‐severe baseline pharyngeal collapsibility. Twenty‐five OSA patients underwent upper airway endoscopy during natural sleep to assess tongue position (type I: vallecula entirely visible; type II: vallecula obscured; type III: vallecula and glottis obscured), as well as obstruction as a result of other pharyngeal structures (e.g. epiglottis). Additional sleep studies with and without oral appliance were performed to measure collapsibility (critical closing pressure; Pcrit) and assess treatment efficacy. Overall, oral appliance therapy reduced Pcrit by 3.9 ± 2.4 cmH2O (mean ± SD) and AHI by 69 ± 19%. Therapy lowered Pcrit by an additional 2.7 ± 0.9 cmH2O in patients with posteriorly‐located tongue (types II and III) compared to those without (type I) (P |
| doi_str_mv | 10.1113/JP278164 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8359733</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2288013340</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4392-7640c7c2d455b1d785299a940b81f1ac65b8a547a6d5a8f0523c920ed5c66e7d3</originalsourceid><addsrcrecordid>eNp1kVtrFTEUhYMo9lgFf4EEfPHl1CQ7mSQvghRvpWDB-hwymT1typxkTGYq598b7cUL-JSH9fGxdhYhzzk74pzD65MzoQ3v5AOy4bKzW60tPCQbxoTYglb8gDyp9YoxDszax-QAuGIAAjak_7KUNSxrQerTQCteY4nLnuaRzpe-7NMF-onmvv7CYk50wAXLLiakubTIz_MUfQpIcRxj8GFPY6J1QpxbljL6p-TR6KeKz27fQ_L1_bvz44_b088fPh2_Pd0GCVZsdSdZ0EEMUqmeD9ooYa23kvWGj9yHTvXGK6l9NyhvRqYEBCsYDip0HeoBDsmbG--89jscAqalFXRzibt2iMs-ur-TFC_dRb52BpTVAE3w6lZQ8rcV6-J2sQacJp8wr9UJYUz7QpCsoS__Qa_yWlI7zwngUjJjjfotDCXXWnC8L8OZ-zmcuxuuoS_-LH8P3i3VgKMb4HuccP9fkTs_OeNgmIAfgwSh2Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2314408985</pqid></control><display><type>article</type><title>Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea</title><source>Access via Wiley Online Library</source><source>Free E-Journal (出版社公開部分のみ）</source><source>Wiley Online Library Free Content</source><source>PubMed Central</source><creator>Marques, Melania ; Genta, Pedro R. ; Azarbarzin, Ali ; Taranto‐Montemurro, Luigi ; Messineo, Ludovico ; Hess, Lauren B. ; Demko, Gail ; White, David P. ; Sands, Scott A. ; Wellman, Andrew</creator><creatorcontrib>Marques, Melania ; Genta, Pedro R. ; Azarbarzin, Ali ; Taranto‐Montemurro, Luigi ; Messineo, Ludovico ; Hess, Lauren B. ; Demko, Gail ; White, David P. ; Sands, Scott A. ; Wellman, Andrew</creatorcontrib><description>Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.
A major limitation to the administration of oral appliance therapy for obstructive sleep apnoea (OSA) is that therapeutic responses remain unpredictable. In the present study, we tested the hypotheses that oral appliance therapy (i) reduces pharyngeal collapsibility preferentially in patients with posteriorly‐located tongue and (ii) is most efficacious (reduction in apnoea‐hypopnea index; AHI) in patients with a posteriorly‐located tongue and less‐severe baseline pharyngeal collapsibility. Twenty‐five OSA patients underwent upper airway endoscopy during natural sleep to assess tongue position (type I: vallecula entirely visible; type II: vallecula obscured; type III: vallecula and glottis obscured), as well as obstruction as a result of other pharyngeal structures (e.g. epiglottis). Additional sleep studies with and without oral appliance were performed to measure collapsibility (critical closing pressure; Pcrit) and assess treatment efficacy. Overall, oral appliance therapy reduced Pcrit by 3.9 ± 2.4 cmH2O (mean ± SD) and AHI by 69 ± 19%. Therapy lowered Pcrit by an additional 2.7 ± 0.9 cmH2O in patients with posteriorly‐located tongue (types II and III) compared to those without (type I) (P < 0.008). Posteriorly‐located tongue (p = 0.03) and lower collapsibility (p = 0.04) at baseline were significant determinants of (greater‐than‐average) treatment efficacy. Predicted responders (type II and III and Pcrit < 1 cmH2O) exhibited a greater reduction in the AHI (83 ± 9 vs. 48 ± 8% baseline, P < 0.001) and a lower treatment AHI (9 ± 6 vs. 32 ± 15 events h–1, P < 0.001) than predicted non‐responders. The site and severity of pharyngeal collapse combine to determine oral appliance efficacy. Specifically, patients with a posteriorly‐located tongue plus less‐severe collapsibility are the strongest candidates for oral appliance therapy.
Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.</description><identifier>ISSN: 0022-3751</identifier><identifier>EISSN: 1469-7793</identifier><identifier>DOI: 10.1113/JP278164</identifier><identifier>PMID: 31503323</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>Apnea ; Endoscopy ; Epiglottis ; Pharynx ; Sleep ; Sleep apnea ; Sleep disorders ; Tongue</subject><ispartof>The Journal of physiology, 2019-11, Vol.597 (22), p.5399-5410</ispartof><rights>2019 The Authors. The Journal of Physiology © 2019 The Physiological Society</rights><rights>2019 The Authors. The Journal of Physiology © 2019 The Physiological Society.</rights><rights>Journal compilation © 2019 The Physiological Society</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4392-7640c7c2d455b1d785299a940b81f1ac65b8a547a6d5a8f0523c920ed5c66e7d3</citedby><cites>FETCH-LOGICAL-c4392-7640c7c2d455b1d785299a940b81f1ac65b8a547a6d5a8f0523c920ed5c66e7d3</cites><orcidid>0000-0002-3530-849X ; 0000-0002-4142-9124 ; 0000-0003-1477-5459</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359733/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359733/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,1417,1433,27924,27925,45574,45575,46409,46833,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31503323$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marques, Melania</creatorcontrib><creatorcontrib>Genta, Pedro R.</creatorcontrib><creatorcontrib>Azarbarzin, Ali</creatorcontrib><creatorcontrib>Taranto‐Montemurro, Luigi</creatorcontrib><creatorcontrib>Messineo, Ludovico</creatorcontrib><creatorcontrib>Hess, Lauren B.</creatorcontrib><creatorcontrib>Demko, Gail</creatorcontrib><creatorcontrib>White, David P.</creatorcontrib><creatorcontrib>Sands, Scott A.</creatorcontrib><creatorcontrib>Wellman, Andrew</creatorcontrib><title>Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea</title><title>The Journal of physiology</title><addtitle>J Physiol</addtitle><description>Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.
A major limitation to the administration of oral appliance therapy for obstructive sleep apnoea (OSA) is that therapeutic responses remain unpredictable. In the present study, we tested the hypotheses that oral appliance therapy (i) reduces pharyngeal collapsibility preferentially in patients with posteriorly‐located tongue and (ii) is most efficacious (reduction in apnoea‐hypopnea index; AHI) in patients with a posteriorly‐located tongue and less‐severe baseline pharyngeal collapsibility. Twenty‐five OSA patients underwent upper airway endoscopy during natural sleep to assess tongue position (type I: vallecula entirely visible; type II: vallecula obscured; type III: vallecula and glottis obscured), as well as obstruction as a result of other pharyngeal structures (e.g. epiglottis). Additional sleep studies with and without oral appliance were performed to measure collapsibility (critical closing pressure; Pcrit) and assess treatment efficacy. Overall, oral appliance therapy reduced Pcrit by 3.9 ± 2.4 cmH2O (mean ± SD) and AHI by 69 ± 19%. Therapy lowered Pcrit by an additional 2.7 ± 0.9 cmH2O in patients with posteriorly‐located tongue (types II and III) compared to those without (type I) (P < 0.008). Posteriorly‐located tongue (p = 0.03) and lower collapsibility (p = 0.04) at baseline were significant determinants of (greater‐than‐average) treatment efficacy. Predicted responders (type II and III and Pcrit < 1 cmH2O) exhibited a greater reduction in the AHI (83 ± 9 vs. 48 ± 8% baseline, P < 0.001) and a lower treatment AHI (9 ± 6 vs. 32 ± 15 events h–1, P < 0.001) than predicted non‐responders. The site and severity of pharyngeal collapse combine to determine oral appliance efficacy. Specifically, patients with a posteriorly‐located tongue plus less‐severe collapsibility are the strongest candidates for oral appliance therapy.
Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.</description><subject>Apnea</subject><subject>Endoscopy</subject><subject>Epiglottis</subject><subject>Pharynx</subject><subject>Sleep</subject><subject>Sleep apnea</subject><subject>Sleep disorders</subject><subject>Tongue</subject><issn>0022-3751</issn><issn>1469-7793</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kVtrFTEUhYMo9lgFf4EEfPHl1CQ7mSQvghRvpWDB-hwymT1typxkTGYq598b7cUL-JSH9fGxdhYhzzk74pzD65MzoQ3v5AOy4bKzW60tPCQbxoTYglb8gDyp9YoxDszax-QAuGIAAjak_7KUNSxrQerTQCteY4nLnuaRzpe-7NMF-onmvv7CYk50wAXLLiakubTIz_MUfQpIcRxj8GFPY6J1QpxbljL6p-TR6KeKz27fQ_L1_bvz44_b088fPh2_Pd0GCVZsdSdZ0EEMUqmeD9ooYa23kvWGj9yHTvXGK6l9NyhvRqYEBCsYDip0HeoBDsmbG--89jscAqalFXRzibt2iMs-ur-TFC_dRb52BpTVAE3w6lZQ8rcV6-J2sQacJp8wr9UJYUz7QpCsoS__Qa_yWlI7zwngUjJjjfotDCXXWnC8L8OZ-zmcuxuuoS_-LH8P3i3VgKMb4HuccP9fkTs_OeNgmIAfgwSh2Q</recordid><startdate>20191101</startdate><enddate>20191101</enddate><creator>Marques, Melania</creator><creator>Genta, Pedro R.</creator><creator>Azarbarzin, Ali</creator><creator>Taranto‐Montemurro, Luigi</creator><creator>Messineo, Ludovico</creator><creator>Hess, Lauren B.</creator><creator>Demko, Gail</creator><creator>White, David P.</creator><creator>Sands, Scott A.</creator><creator>Wellman, Andrew</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7QR</scope><scope>7TK</scope><scope>7TS</scope><scope>8FD</scope><scope>FR3</scope><scope>P64</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3530-849X</orcidid><orcidid>https://orcid.org/0000-0002-4142-9124</orcidid><orcidid>https://orcid.org/0000-0003-1477-5459</orcidid></search><sort><creationdate>20191101</creationdate><title>Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea</title><author>Marques, Melania ; Genta, Pedro R. ; Azarbarzin, Ali ; Taranto‐Montemurro, Luigi ; Messineo, Ludovico ; Hess, Lauren B. ; Demko, Gail ; White, David P. ; Sands, Scott A. ; Wellman, Andrew</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4392-7640c7c2d455b1d785299a940b81f1ac65b8a547a6d5a8f0523c920ed5c66e7d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Apnea</topic><topic>Endoscopy</topic><topic>Epiglottis</topic><topic>Pharynx</topic><topic>Sleep</topic><topic>Sleep apnea</topic><topic>Sleep disorders</topic><topic>Tongue</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marques, Melania</creatorcontrib><creatorcontrib>Genta, Pedro R.</creatorcontrib><creatorcontrib>Azarbarzin, Ali</creatorcontrib><creatorcontrib>Taranto‐Montemurro, Luigi</creatorcontrib><creatorcontrib>Messineo, Ludovico</creatorcontrib><creatorcontrib>Hess, Lauren B.</creatorcontrib><creatorcontrib>Demko, Gail</creatorcontrib><creatorcontrib>White, David P.</creatorcontrib><creatorcontrib>Sands, Scott A.</creatorcontrib><creatorcontrib>Wellman, Andrew</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Chemoreception Abstracts</collection><collection>Neurosciences Abstracts</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>The Journal of physiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marques, Melania</au><au>Genta, Pedro R.</au><au>Azarbarzin, Ali</au><au>Taranto‐Montemurro, Luigi</au><au>Messineo, Ludovico</au><au>Hess, Lauren B.</au><au>Demko, Gail</au><au>White, David P.</au><au>Sands, Scott A.</au><au>Wellman, Andrew</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea</atitle><jtitle>The Journal of physiology</jtitle><addtitle>J Physiol</addtitle><date>2019-11-01</date><risdate>2019</risdate><volume>597</volume><issue>22</issue><spage>5399</spage><epage>5410</epage><pages>5399-5410</pages><issn>0022-3751</issn><eissn>1469-7793</eissn><abstract>Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.
A major limitation to the administration of oral appliance therapy for obstructive sleep apnoea (OSA) is that therapeutic responses remain unpredictable. In the present study, we tested the hypotheses that oral appliance therapy (i) reduces pharyngeal collapsibility preferentially in patients with posteriorly‐located tongue and (ii) is most efficacious (reduction in apnoea‐hypopnea index; AHI) in patients with a posteriorly‐located tongue and less‐severe baseline pharyngeal collapsibility. Twenty‐five OSA patients underwent upper airway endoscopy during natural sleep to assess tongue position (type I: vallecula entirely visible; type II: vallecula obscured; type III: vallecula and glottis obscured), as well as obstruction as a result of other pharyngeal structures (e.g. epiglottis). Additional sleep studies with and without oral appliance were performed to measure collapsibility (critical closing pressure; Pcrit) and assess treatment efficacy. Overall, oral appliance therapy reduced Pcrit by 3.9 ± 2.4 cmH2O (mean ± SD) and AHI by 69 ± 19%. Therapy lowered Pcrit by an additional 2.7 ± 0.9 cmH2O in patients with posteriorly‐located tongue (types II and III) compared to those without (type I) (P < 0.008). Posteriorly‐located tongue (p = 0.03) and lower collapsibility (p = 0.04) at baseline were significant determinants of (greater‐than‐average) treatment efficacy. Predicted responders (type II and III and Pcrit < 1 cmH2O) exhibited a greater reduction in the AHI (83 ± 9 vs. 48 ± 8% baseline, P < 0.001) and a lower treatment AHI (9 ± 6 vs. 32 ± 15 events h–1, P < 0.001) than predicted non‐responders. The site and severity of pharyngeal collapse combine to determine oral appliance efficacy. Specifically, patients with a posteriorly‐located tongue plus less‐severe collapsibility are the strongest candidates for oral appliance therapy.
Key points
•Some patients with obstructive sleep apnoea (OSA) respond well to oral appliance therapy, whereas others do not for reasons that are unclear.
•In the present study, we used gold‐standard measurements to demonstrate that patients with a posteriorly‐located tongue (natural sleep endoscopy) exhibit a preferential improvement in collapsibility (lowered critical closing pressure) with oral appliances.
•We also show that patients with both posteriorly‐located tongue and less severe collapsibility (predicted responder phenotype) exhibit greater improvements in severity of obstructive sleep apnoea (i.e. reduction in event frequency by 83%, in contrast to 48% in predicted non‐responders).
•The present study suggests that the structure and severity of pharyngeal obstruction determine the phenotype of sleep apnoea patients who benefit maximally from oral appliance efficacy.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31503323</pmid><doi>10.1113/JP278164</doi><tpages>12</tpages><orcidid>https://orcid.org/0000-0002-3530-849X</orcidid><orcidid>https://orcid.org/0000-0002-4142-9124</orcidid><orcidid>https://orcid.org/0000-0003-1477-5459</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
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| ispartof | The Journal of physiology, 2019-11, Vol.597 (22), p.5399-5410 |
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| language | eng |
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| source | Access via Wiley Online Library; Free E-Journal (出版社公開部分のみ）; Wiley Online Library Free Content; PubMed Central |
| subjects | Apnea Endoscopy Epiglottis Pharynx Sleep Sleep apnea Sleep disorders Tongue |
| title | Structure and severity of pharyngeal obstruction determine oral appliance efficacy in sleep apnoea |
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