ORAL APPLIANCE TREATMENT: POLISSONOGRAPHIC AND RESONANCE MAGNETIC IMAGE RESULTS IN 9 MILD TO SEVERE OSAS SUBJECTS
Ricardo C. Barbosa*; Flavio Aloe†; Gabriel Gattas¨ ; Stella M. Tavares§ †.
* Psychiatry Institute, LIM23, Universidade de São Paulo General Hospital - São Paulo-SP-Brazil;
†Sleep-Wake Disorders Center, Universidade de São Paulo General Hospital, São Paulo-SP-Brazil;
¨ Radiology Unit, Universidade de São Paulo General Hospital, São Paulo-SP-Brazil;
§ Sleep-Wake Disorders Center - Hospital Israelita Albert Einstein, São Paulo-SP-Brazil.
Introduction: Obstructive sleep apnea-hypopnea syndrome ranges from increased upper-airway resistance manifested as respiratory-related arousals to recurrent airway collapse with apneas and hypopneas. OSAHS is a potentially life-threatening disorder and it causes daytime sleepiness, diverse cognitive deficits, social disadjustments, motor vehicle accidents and cardiovascular morbity and mortality1. Therefore, even mild degree OSAHS demands an effective treatment. Although nasal CPAP is therapeutically effective, its compliance rate is poor even for more severe OSAHS cases. Hence, removable intraoral appliances have become a treatment alternative for selected OSAHS patients. The objective of this study is to correlated the sleep studies-based MLRD2 treatment effectiveness with NMRI-imaging UAW volumes with and without the fitted MLRD.
Methods: A group of nine patients (descriptive data are shown in table I) were divided in three distinct gropus: group one (n=4): 3>RDI>10; group two (n=3): 10³ RDI³ 26 and group three (n=2): 40³ RDI³ 80. Pos-treatment indexes were obtained at approximately 4 months and included: RDI, Epworth Sleepiness Scale (ESS) subjective daytime sleepiness scores, min.SatO2% and UAW volume (mm3) NMR imaging were obtained with and without the MLRD in place. The UAW volume was calculated Taking into consideration upper limit set at the tip of the hard palate down to the tip of the epiglottis3. Student’s t-test was employed to pre and post-treatment conditions.
Results: The results are shown in table below:
AVG |
AGE |
BMI |
RDI 1 |
RDI 2 |
O2 1 |
O2 2 |
ESS 1 |
ESS 2 |
Vol1 |
Vol2 |
RDI (3-10) |
49.25 |
24.09 |
6.04 |
1.61 |
87.50 |
91.50 |
10.50 |
5.75 |
4837.76 |
7099.66 |
RDI (10-26) |
54.00 |
26.32 |
22.51 |
10.54 |
79.00 |
88.00 |
19.67 |
10.00 |
3783.88 |
4697.57 |
RDI (>26) |
56.00 |
32.96 |
61.15 |
53.91 |
71.50 |
77.50 |
15.00 |
6.50 |
2696.25 |
3122.83 |
Conclusions: Pré- and post-treatment RDI, ESS, min Sat O2% and UAW volumes were statistically different confirming the clinical and polissonographic efficiency. UAW significant volume difference confirmed the anatomic effect of the MLRD in this patient population. MLRD-induced improvement in ESS measured subjective daytime slepiness has been reported before and relates to the reduction of the brief respiratory-related arousals. The degree of minimum oxygen desaturation improvement primarily relates to abnormal respiratory event duration rather than to its rate number. This is suggestive the MLRD is more efficient in reducing the number of arousals, and in reducing the number than the duration of abnormal respiratory events.
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