Dados do Trabalho

Título

Intraoral mandibular advancement device treatment for severe sleep apnea: a clinical analysis

Introdução

Intraoral mandibular advancement device is a good treatment in association with CPAP or complaining of primary snoring. The use of the device alone in patients with severe obstructive sleep apnea is not yet well established in the literature, and may be a treatment option for patients unable to undergo gold standard treatments.

Objetivo

To analyze the shortcomings of using a titratable mandibular advancement oral appliance, through PSG and ESS, in patients with severe OSA, as well as to analyze possible factors related to therapy success

Métodos

Six patients who presented with Severe Obstructive Sleep Apnea (OSA), that is, an apnea-hypopnea index (AHI) > 30, diagnosed through type 1 or 3 polysomnography (PSG), used a titratable mandibular advancement oral appliance. Medical records were reviwed, data from medical history, physical examination and evolution of the clinical picture before and after the intervention through the Epworth Sleepiness Scale (ESS) and PSG types 1 and 3.

Resultados

Six patients were included, aged 22 to 80 years, with a median age of 52 years. Of these, 4 (66%) were male and 2 (33%) were female. The primary complaint was excessive daytime sleepiness (83%), which was graded according to the ESS, with all patients showing abnormal sleepiness (ESS > 9) and an AHI > 30 in all cases, with a median of 34.3 events/hour. BMI ranged from 22.5 to 55, with a median of 30.25. Voluntary mandibular advancement, measured with a mandibular advancement measurement tool (Gauge ruler), ranged from 3 to 12 mm. The post-treatment AHI had a mean reduction of 23.4 events/hour, with values ranging from 4.3 to 29.3. Meanwhile, the ESS had a mean reduction of 15.7.
Two patients (33%) showed a reduction in AHI of > 50% from baseline and < 5 events per hour, who had a BMI between 35.6 and 55, with a mandibular advancement of 7 and 11 mm, and a reduction in ESS of 20 and 23.
Four patients (66%) showed a reduction of < 50% from baseline AHI, indicating treatment failure, with a mean ESS reduction of 5.

Conclusões

Mandibular advancement oral appliances do not have well-established benefits in the treatment of severe OSAHS, but they can be a viable option with potential for good outcomes in specific cases, and therefore, their use should be individualized. The presence of factors that preclude first-line treatments makes oral appliances a more attractive option, even though objective criteria for success in severe OSA cases are not yet well-established

Palavras -chave

Sleep apneia, Sleep Quality, Polysomnography