A dentist in a sleep medicine specialist team: First results for the treatment of obstructive sleep apnea patients with oral appliances

Abstract

The effectiveness of Oral Appliances (OA) in the treatment of Obstructive Sleep Apnea (OSA) has been widely recognized during the last decades. However, the presence of dentists in sleep medicine teams is still uncommon. We aim to describe the first results of such a collaboration in an Italian Sleep Medicine Centre. Fifty-three patients (45 F and 8 M, age 52 ± 10 ys, BMI 26 ± 3), referred from different specialists to the Sleep Center for a suspected OSA, started a treatment for sleep disordered breathing with an OA. Patients were classified according to the Apnea-Hypopnea Index (AHI): simple snorers (AHI < 5) 15%; mild OSA (5 < AHI < 15) 30%; moderate OSA (15 < AHI < 30) 36%, and severe OSA (AHI > 30) 19%. Every patient was monitored by means of both objective (cardiorespiratory monitoring) and subjective parameters (Thornton Snoring Scale (TSS), Epworth Sleepiness Scale (ESS)), before starting the treatment and at the end of OA titration. We adopted a combined method for titration of OA: initial protrusion was set to 50–75% of the maximum comfortable protrusion, according to the OSA severity and temporomandibular joint condition; further titration was adjusted based on both subjective results (patient’s satisfaction and possible side effects) and objective respiratory parameters. Basal and post- treatment data were compared by Wilcoxon t -test. In simple snorers ( n = 8), the patient’s self- evaluation and his/her partner’s evaluation of snoring were considered satisfactory. In OSA patients, at the end of the titration, 97.8% of patients had an AHI < 15; 90.9% had an AHI < 10, and 73.3% had an AHI < 5. The differences of mean AHI before and post-treatment were highly significant (23.5 ± 18 vs 4.3 ± 5; p < 0.001). Subjective parameters were also significantly improved after the treatment (TSS: 5.3 ± 3 vs 1.9 ± 2; ESS: 9.0 ± 5 vs 8.3 ± 4; p < 0.001). Optimal results (AHI < 5) were achieved in 100% of patients with mild OSA and 89.5% with moderate OSA. Patients with severe OSA obtained less favorable results, as expected, but anyway 9/10 of them got a final AHI < 15. In comparison with other data reported in the current literature for similar treatments, our results seem very good. Possible reasons might be: an accurate selection of patients by the sleep team; a considerable mandibular advancement at the end of titration (mean value: 10.3 mm), carefully monitored in order to avoid side-effects; an accurate choice of the device for every individual patient or situation. We thanks: P. Pozzi, MD; A.C. Ogliari, MD; S. Barbera, MD; I. Tovaglieri, MD; E. Romagnoli, DDS; L. Gigante, DDS; S. Mattiello, PhD, for sending the patients.