Treatment of snoring and sleep apnea syndrome with a removable mandibular advancement device in patients without TMD

Eduardo Rollo Duarte,Maria Luiza M. A. Frigério,Carlos Henrique Ferreira Martins,Maurício Serejo Ribeiro,Maria Rita de Cássia M. Costa,Éderson A. G. Betiol,Paulo César Razuk,Orivaldo Tavano

doi:10.1590/s2176-94512012000200017

Abstract

INTRODUCTION: Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air flow in the airway. This syndrome is associated with increased morbidity and mortality in apneic individuals. OBJECTIVE: It was the objective of this paper to evaluate a removable mandibular advancement device as it provides a noninvasive, straightforward treatment readily accepted by patients. METHODS: In this study, 15 patients without temporomandibular disorders (TMD) and with excessive daytime sleepiness or snoring were evaluated. Data were collected by means of: Polysomnography and placement of an intraoral appliance, analysis of TMD signs and symptoms using a patient history questionnaire, muscle and TMJ palpation. RESULTS: After treatment, the statistical analysis (t-test, and the before and after test) showed a mean reduction of 77.6% (p=0.001) in the apnea-hypopnea index, an increase in lowest oxyhemoglobin saturation (p=0.05), decrease in desaturation (p=0.05), decrease in micro-awakenings or EEG arousals (p=0.05) and highly significant improvement in daytime sleepiness (p=0.005), measured by the Epworth Sleepiness Scale. No TMD appeared during the monitoring period. CONCLUSION: The oral device developed in this study was considered effective for mild to moderate OSAHS.

Highlights

Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air flow in the airway
A partial obstruction in the upper airway causes snoring while a complete obstruction leads to sleep apnea, which is the total cessation of airflow
It is noteworthy that Anamnesis Index (AI) variation was not sufficient to affect the Temporomandibular Disorders (TMD) classification of any patient, i.e., it did not increase over 15

Summary

Introduction

Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air flow in the airway. This syndrome is associated with increased morbidity and mortality in apneic individuals. A partial obstruction in the upper airway causes snoring while a complete obstruction leads to sleep apnea, which is the total cessation of airflow These events comprise what is known as Sleep Apnea and Hypopnea Syndrome (OSHAS) and lead to serious consequences such as systemic and pulmonary hypertension, excessive daytime sleepiness, impaired memory, irritability, depression, decreased libido, impotence, burnout, headache and a proneness to workplace and car accidents.

Methods

Results

Discussion

Conclusion