Obstructive sleep apnea treatment with dental appliance

Reimão, Rubens; Gouveia, Marcia Maria de; Pestana, Maria da Conceição de Gouveia; Lopes, Sandra Regina; Papaiz, Élio Giacomo; Papaiz, Luiz Fernando

doi:10.1590/S0004-282X1994000400018

Abstracts

The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS) is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS). Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.

sleep apnea syndrome; apnea; dental appliance; treatment; cephalometry; polysomnography

É relatado o caso de um paciente do sexo masculino, de 40 anos de idade, com síndrome de apnéia do sono tipo obstrutivo, tratado por meio de aparelho dentário. Esta terapêutica, alvo de pesquisas recentes, visa, no caso aqui descrito, modificar a posição da mandíbula e consequentemente da língua, aumentando o espaço aéreo posterior faríngeo. Cefalometria contribuiu na escolha do caso para uso de aparelho dentário pois evidenciou incremento do espaço aéreo posterior faríngeo atingindo dimensões normais ao se realizar o deslocamento anterior da mandíbula. Controles clínico e polissonográfico mostraram redução subjetiva da sonolência excessiva diurna e objetiva da severidade das apnéias e do ronco, levando-os a níveis normais. Em seguimento realizado por 8 meses, a melhora manteve-se inalterada.

síndrome de apnéia do sono; apnéia; aparelho dentário; tratamento; cefalometria; polissonografia

Obstructive sleep apnea treatment with dental appliance

Apnéia do sono tipo obstrutiva: tratamento com aparelho dentário

Rubens Reimão^I; Marcia Maria de Gouveia^II; Maria da Conceição de Gouveia Pestana^III; Sandra Regina Lopes^IV; Élio Giacomo Papaiz^V; Luiz Fernando Papaiz^VI

^IDepartment of Neurology, Hospital das Clínicas, University of São Paulo (USP) Medical School and Sleep Disorders Center, Reimão Clinic, São Paulo

^IIDepartment of Surgery, Buco-maxilo-facial Traumatology, Hospital Universitário, USP

^IIIDentist surgeon

^IVIntegrated Dentistry Clinic, Discipline of Endodonty, University of Mogi das Cruzes, São Paulo

^VDepartment of Radiology, Dentistry School, University of São Francisco, Bragança Paulista, São Paulo

^VIFellow in Radiology, São Paulo Dentistry Association

SUMMARY

The case of a 40-year-old male patient with obstructive sleep apnea syndrome (OSAS) is reported, with emphasis on treatment with a dental appliance. This therapeutic approach, which has been focused on recent research, has as its objective, the posturing of the mandibule and, consequently, the tongue more anteriorly, thus in turn leading to an increase in the posterior oropharyngeal airway space (PAS). Cephalometry contributed determining in this case whereby enlargement limits were observed in the PAS with mandibular displacement. Clinical and polysomnographic controls showed subjective reduction of the excessive daytime sleepiness and objective decrease in apneas intensity to normal limits. Eight months follow-up evidenced the steady improvement.

Key words: sleep apnea syndrome, apnea, dental appliance, treatment, cephalometry, polysomnography.

RESUMO

É relatado o caso de um paciente do sexo masculino, de 40 anos de idade, com síndrome de apnéia do sono tipo obstrutivo, tratado por meio de aparelho dentário. Esta terapêutica, alvo de pesquisas recentes, visa, no caso aqui descrito, modificar a posição da mandíbula e consequentemente da língua, aumentando o espaço aéreo posterior faríngeo. Cefalometria contribuiu na escolha do caso para uso de aparelho dentário pois evidenciou incremento do espaço aéreo posterior faríngeo atingindo dimensões normais ao se realizar o deslocamento anterior da mandíbula. Controles clínico e polissonográfico mostraram redução subjetiva da sonolência excessiva diurna e objetiva da severidade das apnéias e do ronco, levando-os a níveis normais. Em seguimento realizado por 8 meses, a melhora manteve-se inalterada.

Palavras-chave: síndrome de apnéia do sono, apnéia, aparelho dentário, tratamento, cefalometria, polissonografia.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 31-maio-1994.

Dr. Rubens Reimão - Rua Glicineas 128 - 04048-050 São Paulo SP - Brasil.

1. Aubert G. Alternative therapeutic approaches in sleep apnea syndrome. Sleep 1992, 15: S69-S72.
2. Bonham PE, Currier GF, Orr WC, Othman J, Nanda RS. The effect of a modified functional appliance on obstrucive sleep apnea. Am J Orthod Dentofac Orthop 1988, 94: 384-392.
3. Chedak A, Lipson E, Demirozu MC, Kiel M. The second generation of nasal continuous positive airway pressure devices: are they created equal? Sleep 1993, 16: 662-667.
4. Clark GT. OSA and dental appliances. Can Dent Assoc J 1988, 16: 26-33.
5. Clark GT, Nakano M. Dental appliances for the treatment of obstructive sleep apnea. J Am Dent Assoc 1989, 118: 611-619.
6. Debery-Borowicki B, Kukawa A, Banks R. Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 1988, 98: 226-234.
7. Elizabetsky M, Reimão R, Joo SH. Considerações sobre 95 uvulopalatofaringoplastias. XXXI Congr Bras Otorrinolaringologia: Programa e Temas Livres. São Paulo, 1992, p74.
8. George PT. A modified functional appliance for treatment of obstructive sleep apnea. J Clin Orthodont 1987, 21: 171-175.
9. George PT, Pearce JW, Kapuniai LE, Crowell DH. Stabilization of mandibule in the prevention of snoring and obstructive sleep apnea (OSA). Sleep Res 1992, 21: 202.
10. Graber TM, Neumann B. Aparelhos ortodônticos removíveis. São Paulo: Panamericana, 1987, p 691.
11. Guilleminault C, Riley R, Powel N. Sleep apnea and cephalometric measurements. Chest 1984, 86: 793-794.
12. Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 1986, 9: 469-477.
13. Lydiatt DD, Huerter JVJr, Yonkers A J. Surgical treatment of obstructive sleep apnea syndrome. Nebr Med J 1991, 76: 63-66.
14. Nino-Murcia G, Crowe C, Bliwise D. Nasal CRAP: follow up of compliance and adverse effects. Sleep 1987, 16: 398-401.
15. Rauscher H, Formanek D, Popp W, Zwick H. Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest 1993, 103: 1675-1680.
16. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. Los Angeles: Brain Information Service, University of California, 1968.
17. Reimão R. Análise do espectro de potência do eletrencefalograma durante o sono: estudo de pacientes com sonolência excessiva diurna. Tese. Faculdade de Medicina da Universidade de São Paulo. São Paulo, 1989.
18. Reimão R, Lemmi H, Akiskal H, Cocke E. Obstructive sleep apnea treated with uvulopalatopharyngoplasty: a systematic follow-up study. South Med J 1986, 79: 1064-1066.
19. Riley RW, Guilleminault C, Herran J. Cephalometric analysis and flow volume loops in obstructive sleep apnea patients. Sleep 1983, 6: 304-317.
20. Soil BA, George PT. Treatment of obstructive sleep apnea with a nocturnal airway patency appliance. N Engl J Med 1985, 313: 386-387.
21. Velluti R. Fisiologia do sono. In Reimão R (ed). Sono: aspectos atuais. São Paulo: Atheneu, 1990, p 1-16.

Publication Dates

Publication in this collection
19 Jan 2011
Date of issue
Dec 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Aubert G. Alternative therapeutic approaches in sleep apnea syndrome. Sleep 1992, 15: S69-S72.

[2] 2. Bonham PE, Currier GF, Orr WC, Othman J, Nanda RS. The effect of a modified functional appliance on obstrucive sleep apnea. Am J Orthod Dentofac Orthop 1988, 94: 384-392.

[3] 3. Chedak A, Lipson E, Demirozu MC, Kiel M. The second generation of nasal continuous positive airway pressure devices: are they created equal? Sleep 1993, 16: 662-667.

[4] 4. Clark GT. OSA and dental appliances. Can Dent Assoc J 1988, 16: 26-33.

[5] 5. Clark GT, Nakano M. Dental appliances for the treatment of obstructive sleep apnea. J Am Dent Assoc 1989, 118: 611-619.

[6] 6. Debery-Borowicki B, Kukawa A, Banks R. Cephalometric analysis for diagnosis and treatment of obstructive sleep apnea. Laryngoscope 1988, 98: 226-234.

[7] 7. Elizabetsky M, Reimão R, Joo SH. Considerações sobre 95 uvulopalatofaringoplastias. XXXI Congr Bras Otorrinolaringologia: Programa e Temas Livres. São Paulo, 1992, p74.

[8] 8. George PT. A modified functional appliance for treatment of obstructive sleep apnea. J Clin Orthodont 1987, 21: 171-175.

[9] 9. George PT, Pearce JW, Kapuniai LE, Crowell DH. Stabilization of mandibule in the prevention of snoring and obstructive sleep apnea (OSA). Sleep Res 1992, 21: 202.

[10] 10. Graber TM, Neumann B. Aparelhos ortodônticos removíveis. São Paulo: Panamericana, 1987, p 691.

[11] 11. Guilleminault C, Riley R, Powel N. Sleep apnea and cephalometric measurements. Chest 1984, 86: 793-794.

[12] 12. Jamieson A, Guilleminault C, Partinen M, Quera-Salva MA. Obstructive sleep apneic patients have craniomandibular abnormalities. Sleep 1986, 9: 469-477.

[13] 13. Lydiatt DD, Huerter JVJr, Yonkers A J. Surgical treatment of obstructive sleep apnea syndrome. Nebr Med J 1991, 76: 63-66.

[14] 14. Nino-Murcia G, Crowe C, Bliwise D. Nasal CRAP: follow up of compliance and adverse effects. Sleep 1987, 16: 398-401.

[15] 15. Rauscher H, Formanek D, Popp W, Zwick H. Self-reported vs measured compliance with nasal CPAP for obstructive sleep apnea. Chest 1993, 103: 1675-1680.

[16] 16. Rechtschaffen A, Kales A. A manual of standardized terminology, techniques and scoring systems for sleep stages of human subjects. Los Angeles: Brain Information Service, University of California, 1968.

[17] 17. Reimão R. Análise do espectro de potência do eletrencefalograma durante o sono: estudo de pacientes com sonolência excessiva diurna. Tese. Faculdade de Medicina da Universidade de São Paulo. São Paulo, 1989.

[18] 18. Reimão R, Lemmi H, Akiskal H, Cocke E. Obstructive sleep apnea treated with uvulopalatopharyngoplasty: a systematic follow-up study. South Med J 1986, 79: 1064-1066.

[19] 19. Riley RW, Guilleminault C, Herran J. Cephalometric analysis and flow volume loops in obstructive sleep apnea patients. Sleep 1983, 6: 304-317.

[20] 20. Soil BA, George PT. Treatment of obstructive sleep apnea with a nocturnal airway patency appliance. N Engl J Med 1985, 313: 386-387.

[21] 21. Velluti R. Fisiologia do sono. In Reimão R (ed). Sono: aspectos atuais. São Paulo: Atheneu, 1990, p 1-16.