Conservative Treatment Effectiveness in Obstructive Sleep-Related Breathing Disorders and Upper Airway Pressure Analysis

Abstract

We evaluated upper airway patency in conservative treatment of sleep-related obstructive breathing disorders. Subjects numbered 51−44 men and 7 women with a mean age of 55.3±10.2 years, a mean body mass index (BMI) of 26.9±3.2 kg/m2—with obstructive sleep apnea or snoring. All underwent daytime polysomnography with simultaneous upper airway and intraesophageal pressure monitoring. Nine lost weight, going from a baseline BMI of 30.1±2.9 kg/m2 to 26.8±3.4 kg/m2 after one year. Weight loss significantly reduced the apnea+hypopnea index from 80.7±30.3/h to 43.9±35.9/h and improved mesopharyngeal and intraesophageal pressure. Good response—defined as at least 50% reduction in the initial apnea+hypopnea index—was 50% (4/8) in patients using TheraSnore, and 58.8% (10/17) in patients using custom-made prosthetic mandibular advancement. Good responders were 40% (6/15) in patients with SNOR-X, and 57.1% (4/7) in patients with a custom-made tongue-retention device. Mesopharyngeal, hypopharyngeal, and intraesophageal pressure significantly improved with oral appliances. Pressure differences between the epipharynx and mesopharynx and between the mesopharynx and hypoparynx also significantly improved with oral appliances. We concluded that upper airway patency after conservative treatment is confirmed by simultaneous upper airway and intraesophageal pressure monitoring during polysomonography.