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Título

TRANSDISCIPLINARY TREATMENT OF SERIOUS OBSTRUCTIVE SLEEP APNEA: CASE REPORT

Introdução

Obstructive Sleep Apnea (OSA) is a disease characterized by pauses in breathing during sleep, leading to a drop in blood oxygen saturation and sleep fragmentation. Clinical treatment may involve behavioral measures; use of continuous positive airway pressure (CPAP) with continuous positive pharyngeal pressure; Mandibular Avancement Devices (MAD) that repositions the tongue and mandible anteriorly in order to prevent the collapse between the base of the tongue and the pharyngeal wall, speech therapy, which aims to readjust anatomical-morphological and anatomical-functional aspects of Organs Phonoarticulatory organs and other.

Objetivo

Report a case of transdisciplinary treatment of severe OSA.

Métodos

male patient, fifty-two years old, BMI: 26.3 with severe OSA (HAI; 32.8/h). He had reported snoring for 10 years, witnessed respiratory arrest, restless sleep, tiredness, excessive daytime sleepiness and frequent body aches. Controlled diabetic and without joint or muscle TMD. He presents mandibular retrusion and major obstruction of the upper airway (UA) seen on cephalometric radiography. Patient did not adapt to CPAP. He underwent surgery for septal deviation and nasal concha reduction, treatment with AIO-AM and treatment of orofacial motricity. The MAD used was the type II PM positioner and the therapeutic protrusion was 13 mm (maximum advance recorded in the initial consultation). During myofunctional treatment, the Epworth Sleepiness Scale (ESS), Mallampati classification and speech-language evaluation were applied at two moments: before treatment and after 5 months. The patient's ESS had a score of 20 points and Mallampati type IV classification. The therapy was based on performing exercises to strengthen the orofacial and pharyngeal region with weekly sessions of 40 minutes, during a period of 5 months.

Resultados

After otorhinolaryngological surgical treatment, treatment with MAD and speech therapy intervention with improvement in tongue tone, soft palate with adequate mobility and adequate mastication, there was a reduction in the AHI from 32.8 events/hour to 1.1 events/hour, a reduction of awakenings from 45 to 28.2/h. In addition to the report of improvement in clinical signs and symptoms (daytime sleepiness, concentration, memory and snoring).

Conclusões

The multifactorial character of OSA requires a multidisciplinary investigation and treatment for successful treatment, especially in severe cases of the disease.

Palavras-chave

OSA, Sleep apnea, Oral appliance, Speech Therapy, Myofunctional Therapy

Área

Relato de Caso

Autores

Raí dos Santos Santiago, Veronica Antunes da SIlva, Vinicius Rasseli Dalla Bernardina, Rowdley Robert Pereira Rossi