Introduction: Obstructive sleep apnea syndrome - OSA promotes sleep fragmentation and consequent daytime sleepiness. OSAS is polissonographically diagnosed and demand effective treatment. Although nasal CPAP is therapeutically effective, particularly for severe OSA, its compliance rate in mild to moderate OSA patients may not exceed 58-78%(1). Among other physical therapeutic alternatives also employed simultaneously with behavioral measures (weight loss, position training) there is the use of removable intraoral appliances. The authors report herein the a evaluation of daytime sleepiness in 115 patients treated with Mandibular-Lingual Repositioning Device - MLRD worn during sleep and developed by one of the authors (Barbosa,RC).

Methods: Patients were included on the basis of their willingness to be treated with the MLRD. All patients had their clinical diagnosis polissonographically confirmed as OSA. Standard behavioral therapeutic measures were also recomended for all patients. Subjective improvement of daytime feelings of tiredness, fatigue and sleepiness as well as subjective improvement in nighttime sleep quality and snoring were recorded with a questionnaire. Statistical analysis was performed with paired Student's t test. Demographics: 115 patients (94M/21F), BMI range 20.28 to 39.64 (mean=28.23; SD=4.73). All patients were individually fitted with an MLRD.

Results: Epworth Sleepiness Scale questionnaire - ESS scores were obtained immediately before the MLRD was fitted in use and 30 days later. Pre-treatment ESS: ranged from 2 to 23 (mean=13.52; SD=5.57). Post-treatment ESS ranged from 1 to 20 (mean=5.56; SD=2.92). The difference between the pre- and post-treatment ESS mean scores is statistically significant (p<0.001 - t Student Test). More data are presented in Table I.

TABLE I:

Discussion: An improvement in the pre- and post-treatment subjective measures employed herein (ESS) was made evident. The ESS scores reflect the individual's general level of sleepiness from low to high levels. In Johns' original work, the mean ESS for controls was 5.9 +-2.2 and their modal was 6. ESS scores significantly distinguished normal individuals from OSA patients and correlated with mean sleep latencies recorded in the MSLT and with the Respiratory Disturbance Index recorded during overnight PSG. In this report, the mean ESS scores for all 115 patients before and 30 days after the MLRD was in use differed in a statistically significant way. This subjective daytime sleepiness improvement have been generated by the dental appliance-induced employed herein.

Conclusion: Dental appliance-induced subjective improvement is generated by a reduction in the RDI.

Bernstein, A. & Reidy, R. - The effects of mandibular repositioning on obstructive sleep apnea. J Craniomandibular Practice 6:179-181, 1988.

Clark , G.T. & Nakano, M. - Dental appliances for the treatment of obstructive sleep apnea. J. Am. Dent Ass 118:611-619, 1989.

George, P. - A modified functional appliance for treatment of obstructive sleep apnea. J Clin Ortho 21:171-175, 1987.

Guilleminault, C. - Obstructive sleep apnea syndrome. Psych Clin North Am 10: 607-621, 1987.

JOHNS, MW. A New Method for Measuring Daytime Sleepiness: The Epworth Sleepiness Scale. Sleep, 1991; 14: 540-545.