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Mandibular advancement oral appliance (OAm) is a safe and effective treatment option for adults with Down syndrome
Among several phenotypes of Down syndrome (DS), generalized hypotonia and major craniofacial alterations (eg: such as narrow maxilla, hypoplasia of the middle third of the face) directly contribute to the occurrence of obstructive sleep apnea (OSA). OSA, if left untreated, is associated to cardiometabolic diseases and cognitive alterations, which are already commonly present in this population.
The aim of this work was to evaluate the effect of AOm in adults with Down syndrome, in the treatment of OSA and other sleep factors, through a type II Polysomnography (PSG II).
Seven adults with DS were underwent to a medical anamnesis, clinical examination and dental inspection. Stop-bang and Epworth Sleep Scale were answered by parents. A portable PSG II system (Embla Embletta MPR+PG ST+Proxy, Natus, California-USA) was used to perform a full-sleep study at patients' home, before and after 4 months of OAm usage. The OAm used was the PMPositioner with a thermosensitive microchip embedded.
The sample presented a mean age 21.74.3 (females). Prevalence of OSA and SB were 93.8%. PSG data showed an improvement of AHI (apnea index), SBI (sleep bruxism index) and desaturation index (IDO) from 16.5/13.8 to 9.6/ 8.2, 19.3/43.0 to 6.8/15.0, and 13.9/11.9 to 9.6/5.6, respectively. OAm was very well tolerated and the mean usage was 92%, confirmed through thermosensitive micro sensor embedded in the OAm. Initial questionnaire data did not correspond to PSG results, showing that parents seem not to be aware about the presence of OSA.
The use of OAm was effective to reduce OSA, IDO and SB. The OAm compliance was objectively proven, and this therapy is a safe and well accepted option to treat OSA in this population.
Agradecimento: FAPESP n. 2017/06838-5
sleep apnea; sleep bruxism; Down syndrome; mandibular advancement oral appliance
Lilian C Giannasi, Marignes T S Dutra, Leticia M Nazario, Elaine Filitaz-Bacigalupo, Sergio R Nacif, Ezequiel F Oliveira, Luis Vicente F Oliveira, Jose Benedito O Amorim, Miguel A C Salgado, Monica F Gomes