Critical Issues in Dental and Medical Management of Obstructive Sleep Apnea.

This critical review focuses on obstructive sleep apnea (OSA) and its management from a dental medicine perspective. OSA is characterized by ≥10-s cessation of breathing (apnea) or reduction in airflow (hypopnea) ≥5 times per hour with a drop in oxygen and/or rise in carbon dioxide. It can be associated with sleepiness and fatigue, impaired mood and cognition, cardiometabolic complications, and risk for transportation and work accidents. Although sleep apnea is diagnosed by a sleep physician, its management is interdisciplinary. The dentist's role includes 1) screening patients for OSA risk factors (e.g., retrognathia, high arched palate, enlarged tonsils or tongue, enlarged tori, high Mallampati score, poor sleep, supine sleep position, obesity, hypertension, morning headache or orofacial pain, bruxism); 2) referring to an appropriate health professional as indicated; and 3) providing oral appliance therapy followed by regular dental and sleep medical follow-up. In addition to the device features and provider expertise, anatomic, behavioral, demographic, and neurophysiologic characteristics can influence oral appliance effectiveness in managing OSA. Therefore, OSA treatment should be tailored to each patient individually. This review highlights some of the putative action mechanisms related to oral appliance effectiveness and proposes future research directions.

The anion transport inhibitor DIDS increases rat hepatocyte K+ conductance via uptake through the bilirubin pathway.

1. In confluent primary cultures of rat hepatocytes, membrane effects of the anion transport inhibitor 4,4'-diisothiocyanatostilbene-2,2'-disulphonic acid (DIDS) were recorded with conventional microelectrodes. In addition, cell pH and cell Ca2+ were monitored by use of the fluorescent dyes BCECF and fluo-3, respectively. Uptake of DIDS was determined by measuring intracellular DIDS fluorescence between 470 and 520 nm (excitation wavelength 390 nm). 2. In the presence of 0.2 mM DIDS, membrane voltages hyperpolarized from -44.0 +/- 1.8 to -73.1 +/- 1.9 mV (n = 16). This change was monophasic and occurred with a time constant of 170 +/- 25 s. The effect was only partly reversible. 3. Cable analysis revealed a concomitant decrease in the specific cell membrane resistance from 3.2 to 1.5 k omega cm2. 4. In ion substitution experiments, a 10-fold elevation of external K+ (from 2.5 to 25 mM) depolarized cell membranes by 6.2 +/- 1.5 mV (n = 5). In the presence of 0.2 mM DIDS, this membrane response was increased 5-fold to 32.2 +/- 4.1 mV. 5. Replacement of Cl- by 99% with gluconate depolarized the cells by 9.3 +/- 1.9 mV. In contrast, with 0.2 mM DIDS present, Cl- removal led to a membrane hyperpolarization of 5.9 +/- 0.9 mV (n = 4). 6. DIDS had no effect on cytosolic pH or Ca2+. 7. To determine the sidedness of the DIDS effect, i.e. to analyse if the increase in K+ conductance is mediated by uptake of the compound, DIDS was added in the presence of different substrates of hepatocellular anion transport. Taurocholate (50 microM) and frusemide (0.5 mM), which are both taken up via the sinusoidal multi-specific bile acid transporter, did not change DIDS-induced membrane hyperpolarization. 8. In contrast, 0.5 mM bromosulphthalein (BSP), a substrate of the bilirubin transporter, competitively inhibited the membrane hyperpolarization elicited by various concentrations of DIDS (0.1-1.0 mM). 9. Hepatocellular uptake of BSP is known to be, in part, Cl- dependent and to be competitively inhibited by Indocyanine Green. When 0.2 mM DIDS was added to a superfusate, in which 99% of Cl- had been exchanged by gluconate, the velocity of membrane hyperpolarization was decreased by 45%. In the presence of Indocyanine Green (0.1 mM) DIDS-induced membrane hyperpolarization was reduced to approximately 20%. 10. Addition of 0.2 mM DIDS to hepatocyte monolayers led to a time-dependent increase in cell fluorescence which was absent at 4 degrees C and which was completely blocked by 0.5 mM BSP.(ABSTRACT TRUNCATED AT 400 WORDS)

Osmolarity reduction transiently increases K+ conductance of confluent rat hepatocytes in primary culture.

Rat hepatocytes in confluent primary cultures were impaled with conventional microelectrodes. Reducing extracellular osmolarity by 80 mosmol/l leads to a transient hyperpolarization of cell membranes (maximum after 5 min) from -40 +/- 4 to -51 +/- 2 mV (n = 7). This hyperpolarization is blocked by 1 mmol/l Ba2+ and 0.5 mmol/l quinine. In ion substitution experiments, increasing K+ 10-fold (from 2.7 to 27 mmol/l) depolarizes membrane voltage by 9 +/- 2 mV in normosmotic solutions. In hyposmotic solutions this depolarization is increased to 20 +/- 1 mV at the time of maximum hyperpolarization and decreases thereafter to 8 +/- 2 mV (n = 4). Cable analysis reveals a transient decrease of specific membrane resistance that exactly parallels the increase in membrane voltage response to high K+. In addition, electrical coupling between cells continuously decreases under hyposmotic conditions, indicating that intercellular communication is affected. Reducing Cl- 100-fold (from 116.5 to 1.2 mmol/l; HCO(3-)-free solutions) depolarizes hepatocytes by 24 +/- 3 mV under normosmotic conditions. In hyposmotic solutions, this effect is increased to 39 +/- 4 mV at maximum hyperpolarization and decreases again to 26 +/- 3 mV (n = 8). This transient increase in the voltage response to Cl- removal is abolished by 0.5 mmol/l quinine (n = 5) and 1 mmol/l Ba2+ (n = 5), suggesting that it is indirect via changes in K+ conductance. This concept is corroborated by ion substitution experiments (HCO(3-)-free conditions), which show that under hyposmotic conditions voltage response to high K+ is considerably decreased in low Cl- solutions.(ABSTRACT TRUNCATED AT 250 WORDS)

[Classes of nuclear size of human hepatocytes in aging]. / Die Kerngrössenklassen menschlicher Hepatozyten im Alternsgang.

The objective of these studies was to follow the development in human liver parenchyma of the size classes of nuclei and determine the variations with age in the volumes and numbers of individual classes. A total of 400 parenchymal liver cell nuclei were measured on each one of 8 micron thick sections of 10 livers obtained from subjects of all age groups. For this, we used the Pictoval type of micro-projection apparatus (VEB Carl Zeiss Jena) at a magnification of 3000 times. The largest and smallest diameters of nuclear sections were determined, and the volumes in micron3 were ascertained using a table published by Marzotko (1966). The decomposition of mixed distributions was by the graphic method of Daeves and Beckel (1958). The results obtained can be summarized as follows: 1. Whereas the nuclei in a seven-year-old boy contained the diploid or normal double complement of chromosomes, the proportion of this "regular class" was seen to drop to 70 percent in old age. 2. The proportion of the tetraploid size class was observed to increase to 20 percent. 3. Hypertetraploid nuclei were clearly seen to increase in proportion (to about 10 percent) even in old age. 4. Diploid nuclei increased in size up to the time of life between youth and old age. There was observed real nuclear growth. In old age, they are subject to shrinkage. 5. Tetraploid nuclei also seem to grow smaller in old age. 6. In the discussion an attempt is made to explain the process of formation of nuclear size classes and show the functional importance of polyploidization of parenchymal liver cell nuclei. The latter seems to be a quantitative increase of the genetic possibilities.

[The suitability of the graphic decomposition methods of Daeves and Beckel for mixed distributions in nuclear variation statistics]. / Zur Eignung des graphischen Dekompositionsverfahrens von Mischverteilungen nach Daeves und Beckel in der Kernvariationsstatistik.

The object of these studies was to determine the value of the graphic method of DAEVES and BECKEL (1958) for decomposition of mixed distributions in karyometry and to compare this method with a numerical one, published by HEROLD (1971). The former is as good as the latter, the only disadvantage of the graphic method is the loss of time by reason of the fact that employment of computers is not possible.