Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome<b><sup>,</sup></b>

Prescinotto, Renato; Haddad, Fernanda Louise Martinho; Fukuchi, Ilana; Gregório, Luiz Carlos; Cunali, Paulo Afonso; Tufik, Sérgio; Bittencourt, Lia Rita Azeredo

doi:10.1016/j.bjorl.2015.08.005

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Brazilian Journal of Otorhinolaryngology

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ORIGINAL ARTICLES • Braz. j. otorhinolaryngol. 81 (6) • Nov-Dec 2015 • https://doi.org/10.1016/j.bjorl.2015.08.005 copy

Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome^☆ ☆ Please cite this article as: Prescinotto R, Haddad FLM, Fukuchi I, Gregório LC, Cunali PA, Tufik S, et al. Impact of upper airway abnormalities on the success and adherence to mandibular advancement device treatment in patients with Obstructive Sleep Apnea Syndrome. Braz J Otorhinolaryngol. 2015;81:663-70. ^,^{^☆☆} 3 ☆☆ Institution: Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

INTRODUCTION:

The mandibular advancement device (MAD) is a option to treat patients with Obstructive Sleep Apnea Syndrome (OSAS).

OBJECTIVE:

To assess the influence of upper airway abnormalities on the success of and adherence to MAD in patients with OSAS.

METHODS:

Prospective study with 30 patients with mild to moderate OSAS and indications for MAD. The protocol included questionnaires addressing sleep and nasal complaints, polysomnography, and upper airway assessment. The analyzed parameters of patients who showed therapeutic success and failure and those who exhibited good and poor treatment adherence were compared.

RESULTS:

28 patients completed the protocol; 64.3% responded successfully to treatment with MAD, and 60.7% exhibited good adherence to treatment. Factors associated with greater success rates were younger age (p = 0.02), smaller cervical circumference (p = 0.05), and lower AHI at baseline (p = 0.05). There was a predominance of patients without nasal abnormalities among patients treated successfully compared to those with treatment failure (p = 0.04), which was not observed in relation to adherence. Neither pharyngeal nor facial skeletal abnormalities were significantly associated with either therapeutic success or adherence.

CONCLUSION:

MAD treatment success was significantly lower among patients with nasal abnormalities; however, treatment adherence was not influenced by the presence of upper airway or facial skeletal abnormalities.

Keywords:
Obstructive sleep apnea; Removable orthodontic appliances; Physical examination; Nose

	Good adherence (n = 17)	Poor adherence (n = 11)	t	df	p
Age (years)	47.9 ± 10	50.3 ± 12	-0.5	26	0.59
BMI (kg/m²)	28.5 ± 3	25.7 ± 3	1.9	26	0.06
NC (cm)	37.1 ± 3	35.1 ± 2	1.6	26	0.10

	Good adherence (n = 17)		Poor adherence (n = 11)		p (group and time interaction)
	Basal	With MAD	Basal	With MAD
ESS	13.6 ± 6	12.1 ± 6^a	12.0 ± 6	9.6 ± 6^a	0.74
AHI (events/hour)	14.7 ± 7	7.5 ± 5^a	23.2 ± 9^b	11.3 ± 6^a	0.18
SE (%)	87.2 ± 5	87.6 ± 5	88.3 ± 9	86.0 ± 9	0.15
N3 (%)	18.1 ± 5	17.7 ± 7	18.2 ± 5	21.2 ± 11	0.32
REM (%)	18.9 ± 3	19.3 ± 4	20.0 ± 6	22.3 ± 6	0.66
AI (events/hour)	13.3 ± 6	9.2 ± 4^a	20.7 ± 4^b	11.6 ± 5^a	0.09
SpO₂ MIN (%)	86.3 ± 3	87.4 ± 5	85.2 ± 4	88.4 ± 2	0.34
SpO₂ <90% (%)	0.4 ± 1	0.04 ± 0.1^a	1.3 ± 1.9	0.1 ± 0.2^a	0.18

	Successful (n = 18)	Unsuccessful (n = 10)	t	df	p
Age (years)	44.8 ± 9	56 ± 10	-2.8	26	<0.001
BMI (kg/m²)	27.1 ± 4	28 ± 3	-0.6	26	0.54
NC (cm)	36.3 ± 3	36.4 ± 2	-0.07	26	0.94

	Successful (n = 18)		Unsuccessful (n = 10)		p (group and time interaction)
	Basal	With MAD	Basal	With MAD
ESS	13.8 ± 4	11.9 ± 5^a	11.8 ± 8	10.0 ± 7^a	0.95
AHI (events/hour)	15.2 ± 8	5.2 ± 2^a	22.3 ± 8	15.8 ± 5^a,b	0.26
SE (%)	89.0 ± 5	89.3 ± 5	85.0 ± 9	82.8 ± 8	0.34
N3 (%)	17.5 ± 6	20.2 ± 8	19.4 ± 4	16.3 ± 10	0.09
REM (%)	19.4 ± 5	20.7 ± 4	19.1 ± 4	19.6 ± 7	0.71
AI (events/hour)	14.7 ± 6	7.7 ± 3^a	17.9 ± 6	14.5 ± 5^a,b	0.22
SpO₂ MIN (%)	86.2 ± 3	88.9 ± 2	85.4 ± 3	85.6 ± 6	0.27
SpO₂ <90% (%)	0.6 ± 1	0.03 ± 0.05^a	0.9 ± 1	0.1 ± 0.2^a	0.71

Individual variables	Good adherence (n = 17)	Poor adherence (n = 11)	p
Soft palate webbing	11 (64.7%)	9 (81.8%)	0.30
Posterior soft palate	6 (35.3%)	5 (45.4%)	0.44
Thick soft palate	3 (17.6%)	1 (9%)	0.48
Thick uvula	10 (58.8%)	7 (63.6%)	0.56
Long uvula	10 (58.8%)	5 (45.4%)	0.38
Pharyngeal alteration	9 (52.9%)	6 (54.5%)	0.62
MMI class III/IV	16 (94.1%)	10 (90.9%)	0.64
Grade III/IV palatine tonsils	1 (5.9%)	0 (0.0%)	0.60
Class II dental occlusion	1 (5.9%)	1 (9%)	0.64
Retrognathia	1 (5.9%)	2 (18.2%)	0.34
Craniofacial alteration	11 (64.7%)	6 (54.5%)	0.44
Ogival hard palate	9 (52.9%)	4 (36.4%)	0.32
Frequent nasal obstruction	11 (64.7%)	4 (36.4%)	0.14
Frequent rhinopathy complaint	10 (58.8%)	5 (45.4%)	0.38
Grade I septal deviation	8 (47%)	4 (36.4%)	0.43
Grade II/III septal deviation	3 (17.6%)	2 (18.2%)	0.67
Inferior nasal turbinate hypertrophy	10 (58.8%)	4 (36.4%)	0.22
Nasal alteration	10 (58.8%)	5 (45.5%)	0.38

Individual variables	Successful (n = 18)	Unsuccessful (n = 10)	p
Soft palate webbing	13 (72.2%)	7 (70%)	0.61
Posterior soft palate	6 (33.3%)	5 (50%)	0.32
Thick soft palate	3 (16.7%)	1 (10%)	0.55
Thick uvula	13 (72.2%)	4 (40%)	0.10
Long uvula	11 (61.1%)	4 (40%)	0.25
Pharyngeal alteration	12 (66.7%)	3 (30%)	0.07
MMI class III/IV	16 (88.9%)	10 (100%)	0.40
Grade III/IV palatine tonsils	1 (5.5%)	0 (0.0%)	0.64
Class II dental occlusion	2 (11.1%)	0 (0%)	0.40
Retrognathia	1 (5.5%)	2 (20%)	0.28
Ogival hard palate	9 (50%)	4 (40%)	0.46
Craniofacial alteration	11 (61.1%)	6 (60%)	0.66
Frequent nasal obstruction	10 (55.5%)	5 (50%)	0.54
Frequent rhinopathy complaint	10 (55.5%)	5 (50%)	0.54
Grade I septal deviation	8 (44.4%)	4 (40%)	0.57
Grade II/III septal deviation	1 (5.5%)	4 (40%)	0.04^a
Inferior nasal turbinate hypertrophy	7 (38.9%)	7 (70%)	0.12
Nasal alteration	7 (38.9)	8 (80%)	0.04^a

	B	p	Exp (B) - OR	95% CI for Exp (B)
				Minimum	Maximum
Age	-0.298	0.02	0.74	0.58	0.95
NC	-0.730	0.05	0.48	0.23	1.00
AHI pre	-0.285	0.05	0.75	0.57	1.00

Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Sede da Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico Facial, Av. Indianópolia, 1287, 04063-002 São Paulo/SP Brasil, Tel.: (0xx11) 5053-7500, Fax: (0xx11) 5053-7512 - São Paulo - SP - Brazil
E-mail: revista@aborlccf.org.br

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[1] * Corresponding author. E-mail:prescinotto@hotmail.com (R. Prescinotto).