Avaliação de um novo tipo de aparelho intraoral para o tratamento de casos graves de síndrome de apneia obstrutiva do sono
s´´erie de casos
DOI:
https://doi.org/10.7308/aodontol/2018.54.e03Palavras-chave:
Apneia obstrutiva do sono, Aparelhos ortopédicos, Relatos de casosResumo
Aim: This study aimed to evaluate the respiratory parameters among patients diagnosed with severe obstructive sleep apnea (OSA) syndrome treated with a novel design of an oral appliance (OA): a lingual orthosis.
Methods: A case series study was conducted with 11 patients suffering from severe OSA, apnea-hypopnea index (AHI) > 30 events/h. All patients underwent pre- and post-treatment overnight polysomnography and were diagnosed by a physician based on polysomnography indexes. All selected patients had a history of nonadherence to continuous positive airway pressure devices.
Results: Before treatment, the mean AHI of the sample was 65.9 ± 30.5. After reaching the optimal OA titration, the polysomnography (PSG) showed an average AHI of 10.1 ± 5.5 (p<0.001). There was a significant reduction in obstructive events that decreased from 60.0 ± 31.7 to 8.5 ± 3.8 events/hour (p<0.001). The minimal oxyhemoglobin saturation showed significant improvement after the OA treatment, increasing from 74.3 ± 7.8 to 83.4 ± 4.9 (p<0.05).
Conclusion: Lingual orthosis was effective in resolving severe OSAS, showing satisfactory results within the present sample. Further studies are needed in order to broaden the knowledge regarding the effectiveness of this oral appliance.
Downloads
Referências
Marin JM, Carrizo SJ, Vicente E, Agusti AG. Long-term cardiovascular outcomes in men with obstructive sleep apnea-hypopnea with or without treatment with continuous positive airway pressure: an observational study. Lancet. 2005;365:1046-53.
Young T, Peppard P, Palta M, Hla KM, Finn L, Morgan B, et al. Population-based study of sleep-disordered breathing as a risk factor for hypertension. Arch Intern Med. 1997; 157:1746-52.
Bittencourt LRA. Diagnóstico e tratamento da síndrome da apneia obstrutiva do sono (SAOS) - Guia prático. São Paulo: Médica Paulista; 2008.
Li W, Xiao L, Hu J. The comparison of CPAP and AO in treatment of patients with OSA: a systematic review and meta-analysis. Respir Care. 2013 Jul;58(7):1184-95.
Pépin JL, Krieger J, Rodenstein D, Cornette A, Sforza E, Delguste P, et al. Effective compliance during the first 3 months of continuous positive airway pressure. A European prospective study of 121 patients. Am J Respir Crit Care Med. 1999 Oct;160(4):1124-9.
Haddad F, Bittencourt L. Recomendações para o diagnóstico e tratamento da síndrome da apneia obstrutiva do sono no adulto. São Paulo: Estação Brasil; 2013.
Ahrens A, McGrath C, Hägg U. A systematic review of the efficacy of oral appliance design in the management of obstructive sleep apnea. Eur J Orthod. 2011 Jun;33(3):318-24.
Almeida FR, Lowe AA. Principles of oral appliance therapy for the management of snoring and sleep disordered breathing. Oral Maxillofac Surg Clin North Am. 2009 Nov;21(4):413-20.
Caram JM, Quintela MM. A órtese lingual – uma nova proposta de aparelho intraoral para apneia do sono grave – relato de casos. Orthod Sci Pract. 2013;6:110-7.
Cartwright RD, Samelson CF. The effects of a nonsurgical treatment for obstructive sleep apnea. The tongue-retaining device. JAMA. 1982 Aug 13;248(6):705-9.
Ferguson KA, Cartwright R, Rogers R, Schmidt-Nowara W. Oral appliances for snoring and obstructive sleep apnea: a review. Sleep. 2006 Feb;29(2):244-62.
Lazard DS, Blumen M, Lévy P, Chauvin P, Fragny D, Buchet I, Chabolle F. The tongue-retaining device: efficacy and side effects in obstructive sleep apnea syndrome. J Clin Sleep Med. 2009 Oct 15;5(5):431-8.
Quintela MM, Lima Jr A,Sallum RA, Pacheco Filho F, Flório FM, Motta RHL. Avaliação da eficácia de um aparelho de avanço mandibular semiflexível na apneia obstrutiva do sono: estudo clínico e polissonografico. Ortodontia. 2013;46:255-8.
Sutherland K, Deane SA, Chan ASL, Schwab RJ, Ng AT, Darendeliler A, Cistulli PA. Comparative effects of two oral appliances on upper airway structure in obstructive sleep apnea. Sleep. 2011 Apr 1;34(4):469-77.
Nuckton TJ, Glidden DV, Browner WS, Claman DM. Physical examination: Mallampati score as an independent predictor of obstructive sleep apnea. Sleep. 2006 Jul;29(7):903-8.
Iber C, Ancoli-Israel S, Chesson AL, Quan SF. The AASM manual for the scoring of sleep and associated events: rules, terminology, and technical specifications. Westchester, IL: American Academy of Sleep Medicine; 2007.
Guimarães MLR, Hermont AP, Azevedo PG, Bastos PL, Oliveira MTP, Melo IM, et al. Severe obstructive sleep apnea treatment with oral appliance: the impact on obstructive, central and mixed events. Sleep Breath. 2018 Mar;22(1):91-8.
Barnes M, McEvoy RD, Banks S, Tarquinio N, Murray CG, Vowles N, Pierce RJ. Efficacy of positive airway pressure and oral appliance in mild to moderate obstructive sleep apnea. Am J Respir Crit Care Med. 2004 Sep 15;170(6):656-64.
Almeida FR1, Lowe AA, Otsuka R, Fastlicht S, Farbood M, Tsuiki S. Long-term sequallae of oral appliance therapy in obstructive sleep apnea patients. Part 2. Study model analysis. Am J Orthod Dentofacial Orthop. 2006 Feb;129(2):205-13.
Cunali PA, Almeida FR, Santos DC, Valdrighi NY, Nascimento LS, Dal-Fabbro C, et al. Prevalence of temporomandibular disorders in obstructive sleep apnea patients referred for oral appliance therapy. J Orofac Pain. 2009 Fall;23(4):339-44.
Cohen-Levy J, Pételle B, Pinguet J, Limerat E, Fleury B. Forces created by mandibular advancement devices in OSAS patients: a pilot study during sleep. Sleep Breath. 2013 May;17(2):781-9.
Pliska BT, Nam H, Chen H, Lowe AA, Almeida FR. Obstructive sleep apnea and mandibular advancement splints: occlusal effects and progression of changes associated with a decade of treatment. J Clin Sleep Med. 2014 Dec 15;10(12):1285-91
Almeida FR, Lowe AA, Tsuiki S, Otsuka R, Wong M, Fastlicht S, et al. Long-term compliance and side effects of oral appliance used for the treatment of snoring and obstructive sleep apnea syndrome. J Clin Sleep Med. 2005 Apr 15;1(2):143-52.
