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MULTIPROFESSIONAL TREATMENT OF OBSTRUCTIVE SLEEP APNEA: CASE REPORT
Obstructive sleep apnea (OSA), also known as obstructive sleep apnea-hypopnea or obstructive sleep apnea syndrome (OSAS) is a syndrome of upper airway dysfunction (UAS) during sleep. It is characterized by snoring and/or increased respiratory effort secondary to increased upper airway resistance and pharyngeal collapsibility. Excessive daytime sleepiness is one of the symptoms, and OSA may increase the risk for cardiovascular and cerebrovascular diseases (hypertension, acute myocardial infarction, and stroke). CPAP is highly efficacious in resolving the breathing disruptions associated with OSA. However, it is often poorly tolerated. For patients with mild or moderate OSAS who refuse or do not adhere to positive airway pressure therapy, an oral appliance (OA) is an alternative to CPAP. Recently introduced as a treatment option for OSAS, orofacial myofunctional therapy (OMT) is applied to individuals with orofacial myofunctional disorders (OMDs). There is also scope to combine existing therapies with a multiprofessonal approach to treat OSA in appropriately selected patients.
The aim of this study was to report the efficacy of combined oral appliance therapy (OA) and orofacial myofunctional therapy (OMT) in a patient with moderate OSAS from the analysis of polysomnography (PSG) variables (AHI, blood oxygenation) before and after interventions. Until now there aren’t studies in the literature showing this type of combined treatment, we think it is relevant to present the case.
Information was obtained through a review of the medical record, interview with the patient, photographic record of diagnostic methods, treatments performed and literature review. Female patient, 49 years old, married, BMI of 33.8 kg/m2. She reported nocturnal snoring and occasional awakenings. Dental approach was performed using the PLP appliance for mandibular advancement, and speech therapy approach was performed in 10 sessions.
The AHI decreased from 23.3 events/hour to 4.4 events/hour, the minimum saturation remained the same at 87%, but the oxygen desaturation index decreased from 13.5 to 3.8/hour. The patient improved her sleep quality and controlled her snoring.
OA and OMT combined is capable of achieving satisfactory results in the treatment of OSAS.
Sleep Apnea Syndromes; Snoring; Oral appliance; Myofunctional Therapy; Therapeutics.
Relato de Caso
Maria de Lourdes Rabelo Guimarães, Ana Paula Gasparini Braga, Claudia Pena Galvão dos Anjos