Obstructive sleep apnea in adults

Obstructive Sleep Apnea and Hypopnea Syndrome (OSAS) is a highly prevalent disease with serious consequences for the patients’ lives. The treatment of the condition is mandatory for the improvement of the quality of life, as well as the life expectancy of the affected individuals. The most frequent treatments provided by dentistry are mandibular advancement devices (MAD) and orthognathic surgery with maxillomandibular advancement (MMA). This is possibly the only treatment option which offers high probability of cure.

Objective:

The present article provides a narrative review of OSAS from the perspective of 25 years of OSAS treatment clinical experience.

Conclusion:

MADs are a solid treatment option for primary snoring and mild or moderate OSAS. Patients with severe apnea who are non-adherent to CPAP may also be treated with MADs. Maxillomandibular advancement surgery is a safe and very effective treatment option to OSAS.

Keywords:
Obstructive sleep apnea; Snoring; Orthognathic surgery; Dentistry; Maxillomandibular advancement

Authorship

Jorge Faber

Private practice (Brasília/DF, Brazil).Private practice (Brasília/DF, Brazil).BrazilBrasília, DF, BrazilPrivate practice (Brasília/DF, Brazil).

Universidade de Brasília, Programa de Pós-Graduação em Odontologia (Brasília/DF, Brazil).Universidade de BrasíliaBrazilBrasília, DF, BrazilUniversidade de Brasília, Programa de Pós-Graduação em Odontologia (Brasília/DF, Brazil).

http://orcid.org/0000-0003-0564-406X

Carolina Faber

Universidade Católica de Brasília, Graduação em Odontologia (Brasília/DF, Brazil).Universidade Católica de BrasíliaBrazilBrasília, DF, BrazilUniversidade Católica de Brasília, Graduação em Odontologia (Brasília/DF, Brazil).

http://orcid.org/0000-0003-1798-2728

Ana Paula Faber

Private practice (Brasília/DF, Brazil).Private practice (Brasília/DF, Brazil).BrazilBrasília, DF, BrazilPrivate practice (Brasília/DF, Brazil).

http://orcid.org/0000-0002-6044-6720

Contact address:
Carolina Faber E-mail: carolhfaber@gmail.com

Conception or design of the study: JF, APF. Data acquisition, analysis or interpretation: JF, CF, APF. Critical revision of the article: JF, CF, APF. Final approval of the article: JF, CF, APF. Overall responsibility: CF.

SCIMAGO INSTITUTIONS RANKINGS

Private practice (Brasília/DF, Brazil).Private practice (Brasília/DF, Brazil).BrazilBrasília, DF, BrazilPrivate practice (Brasília/DF, Brazil).

Figures

Figures (8)

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Figure 1
Segments of the polysomnographies of the patient presented in Figure 5, before and after orthognathic surgery. The hypnograms show the patient awake (W), and in the sleep stages of REM, 1 2 and 3. The respiratory events (apneas + hypopneas) are marked by vertical lines, as well as the microarousals (Arousals). Note that prior to surgery there is a certain association between microarousal and respiratory events. Also, blood oxygen saturation (SpO₂) is associated with respiratory events; the red arrow points to one of the desaturation events that occurred after a respiratory event (blue arrow). The patient had important improvements in number of respiratory events, number of microarousals, blood oxygen saturation, and sleep quality with surgery.

Thumbnail

Figure 2
The MAD projects the mandible: A) without projection, B) with projection. Airway space volume (AS) increases (arrows) and/or an improvement in pharyngeal wall tone occurs. This is due to the advancement of the tongue (T) and other para-mandibular soft tissues; even the collapse of the soft palate (SP) undergoes improvement. The overjet (C, in red) decreases over the years (D), by projection of the lower teeth and retraction of the upper ones (arrows).

Thumbnail

Figure 3
Examples of MADs: different devices can be used to adjust the mandibular position. The arrows point to screws that control the magnitude of the mandibular advancement and allow adjustments.

Thumbnail

Figure 4
Patient without (A) and with (B) an intraoral device. In this case, the patient has implant-supported dentures. The front (C) and lateral (D) views show the advanced mandible.

Thumbnail

Figure 5
Initial photographs of patients with AHI = 19.7 who underwent surgical orthodontic treatment with the Surgery First protocol. There was a maxillomandibular deficiency (A to C), in addition to a Class II malocclusion (D to F).

Thumbnail

Figure 6
Cephalometric radiographs: initial (A) and immediately after surgery (B). Note that the mandibular advancement was greater than the maxillary advancement, leading to an anterior crossbite (C). This relationship was corrected by means of skeletal anchorage miniplates, which provided the necessary anchorage for lower arch retraction (arrows in B, D and F). The right lower first molar was removed before surgery (E). Panoramic radiographs: initial (E) and immediately after surgery (F).

Thumbnail

Figure 7
Final photographs of the treatment. A to C show the extraoral views: good aesthetic results were obtained. No counterclockwise rotation of the occlusal plane was performed, to provide good incisor exposure when smiling (C). Good occlusion was achieved at the end of treatment (D to F).

Thumbnail

Figure 8
Photograph of a patient with severe OSAS who uses a CPAP with a nasal mask - the CPAP can be seen next to the bed.

Figure 1 Segments of the polysomnographies of the patient presented in Figure 5, before and after orthognathic surgery. The hypnograms show the patient awake (W), and in the sleep stages of REM, 1 2 and 3. The respiratory events (apneas + hypopneas) are marked by vertical lines, as well as the microarousals (Arousals). Note that prior to surgery there is a certain association between microarousal and respiratory events. Also, blood oxygen saturation (SpO₂) is associated with respiratory events; the red arrow points to one of the desaturation events that occurred after a respiratory event (blue arrow). The patient had important improvements in number of respiratory events, number of microarousals, blood oxygen saturation, and sleep quality with surgery.

Figure 2 The MAD projects the mandible: A) without projection, B) with projection. Airway space volume (AS) increases (arrows) and/or an improvement in pharyngeal wall tone occurs. This is due to the advancement of the tongue (T) and other para-mandibular soft tissues; even the collapse of the soft palate (SP) undergoes improvement. The overjet (C, in red) decreases over the years (D), by projection of the lower teeth and retraction of the upper ones (arrows).

Figure 3 Examples of MADs: different devices can be used to adjust the mandibular position. The arrows point to screws that control the magnitude of the mandibular advancement and allow adjustments.

Figure 4 Patient without (A) and with (B) an intraoral device. In this case, the patient has implant-supported dentures. The front (C) and lateral (D) views show the advanced mandible.

Figure 5 Initial photographs of patients with AHI = 19.7 who underwent surgical orthodontic treatment with the Surgery First protocol. There was a maxillomandibular deficiency (A to C), in addition to a Class II malocclusion (D to F).

Figure 6 Cephalometric radiographs: initial (A) and immediately after surgery (B). Note that the mandibular advancement was greater than the maxillary advancement, leading to an anterior crossbite (C). This relationship was corrected by means of skeletal anchorage miniplates, which provided the necessary anchorage for lower arch retraction (arrows in B, D and F). The right lower first molar was removed before surgery (E). Panoramic radiographs: initial (E) and immediately after surgery (F).

Figure 7 Final photographs of the treatment. A to C show the extraoral views: good aesthetic results were obtained. No counterclockwise rotation of the occlusal plane was performed, to provide good incisor exposure when smiling (C). Good occlusion was achieved at the end of treatment (D to F).

Figure 8 Photograph of a patient with severe OSAS who uses a CPAP with a nasal mask - the CPAP can be seen next to the bed.

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Obstructive sleep apnea in adults

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[1] Contact address:
Carolina Faber E-mail: carolhfaber@gmail.com