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MODERATE AND SEVERE OBSTRUCTIVE SLEEP APNEA (OSA) TREATMENT WITH MANDIBULAR ADVANCEMENT DEVICE: SERIES OF 3 CASES
OSA is a highly prevalent sleep-related breathing disorder characterized by periods of recurrent cessation of breathing caused by partial or complete collapse of the upper airway. The mandibular advancement device (MAD) is indicated for primary snoring and mild OSA, as well as patients with moderate to severe OSA who refuse other treatment, such as positive airway pressure, or the treatment failed.
To present three cases of patients diagnosed with moderate or severe apnea that were treated with MAD.
Anamnesis, clinical examination, PSG, dental examination, radiological exams, and treatment with MAD.
All patients were evaluated in HCFMUSP (between 2018 and 2020) and had been diagnosed with sleep apnea through a polysomnography (PSG) and referred to the Dentistry Division at the same hospital for treatment with MAD. Patient 1: Male, diagnosed with severe OSA (AHI 57.5 e/h). He was submitted to tonsillectomy, septoplasty and lateral pharyngoplasty without improvement of AHI (55.3 e/h). Patients 2 and 3 were female and diagnosed with moderate OSA (IAH 27.3 e/h and IAH 20.4 e/h, respectively). Both
complained of daytime sleepiness and intense snoring. The appliance design used was Monobloc with 70% of retrusion and protrusion. Patient 1 advanced 13mm, and patients 2 and 3 advanced 9mm and 6mm.The efficacy of the oral appliance was determined by an overnight PSG using their MAD. The PSG results evaluated AHI (e/h), microarousal index (MI e/h) and oxygen saturation average. Patient 1: AHI from 53.3 e/h to 1.1 e/h, MI from 53.9 e/h to 14.2 e/h and oxygen saturation from 72% to 90%. Patient 2: AHI from 27.6 e/h to 8.6 e/h, MI from 19.3e/h to 24.8 and oxygen saturation from 59% to 85%. Patient 3: AHI from 20.4 e/h to 10.8 e/h, MI from 14.2 e/h to 11.7 e/h and oxygen saturation from 74% to 86%. They reported improvement on subjective sleepiness and snoring.
Although MAD is not considered a first line treatment for severe and moderate OSA, it seems to have satisfactory results. The objective of a treatment is to offer a good therapeutic option to improve patients’ clinical condition, however, it is not always possible to provide the ideal treatment, considering patient condition. The Dentistry Division of our Hospital can offer MAD treatment for some patients and seems to be a great option for improving patients’ condition. The best treatment is the one that is possible.
OSA, oral appliance, apnea treatment.
Relato de Caso
Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo - São Paulo - Brasil
Rita Cassia Bonatto Vilarim, Andrea Ceclilia Toscanini, Rosa Hasan, Alexandre PInto Azevedo, Daniel Suzuki, Gilberto Guanaes Formigoni, Michel Burihan Cahali, Pedro Rodrigues Genta, Geraldo Lorenzi Filho, Jose Tadeu Tesseroli Siqueira