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The effect of mandibular advancement oral appliance to treat OSA on masticatory muscles in adults with Down syndrome and obstructive sleep apnea


The generalized hypotonia seen in individuals with Down syndrome (DS) has a strong impact on the oropharyngeal musculature, resulting, among several other abnormalities, in masticatory dysfunction and OSA.


The aim of this study was to evaluate the effect of mandibular advancement oral appliance (OAm) to treat OSA on masticatory muscles, bilateral masseter and temporallis, in adults with DS.


Seven adults with DS were enrolled. A portable type II polysomnography (PSG II) system (Embla Embletta MPR+PG ST+Proxy, Natus) was used to perform a full-sleep study at patients’ home, and a surface electromyography (MGSystem-sEMG) of the masseter and temporal muscles was used to evaluate masticatory function, before and after 4 months of OAm usage during sleep. The OAm used was PMPosition. The sEMG was performed at rest, at maximum voluntary clenching effort (MVC) and at maximum habitual intercuspation effort (MHI).


The PSG II showed a reduction in the OSA severity (16.513.8 to 9.68.2). Masticatory function has slightly improved and balanced for MVC and MHI on the right and left temporal and masseter muscles (149,803 13.0 to 153,5011.0; 138,37 23.0 to 183,5219.0; 141,92 17.0 to 145,4021.2; 173,79 18.7 to 169,6822.0) and (107,86 23.0 to 128,3125.0; 116,33 16.0 to 119,0014.3; 108,80 23.8 to 116,7327,3; 89,64 to 90,4023.4), respectively. The rest showed no alteration. Parents reported improvement during chewing and better lip sealing during fluid intake.


The use of OAm was effective for the treatment of OSA. The results of sEMG showed a balance and a slight improvement in the function of the masticatory musculature. Parents reported a significant improvement seen during meals.

Agradecimento: FAPESP n. 2017/06838-5


Down syndrome; masticatory muscle; sleep apnea; mandibular advancement oral appliance


Área Clínica


Lilian C Giannasi, Marignes T S Dutra, Elaine Fillietaz-Bacigalupo, Sergio R Nacif, Ezequiel F Oliveira, Jose Benedito O Amorim, Miguel A C Salgado, Monica F Gomes