Barbosa,RC1; Aloe F2;Tavares3,S;Silva,AB4
1. School of Dentistry of Universidade de São Paulo - Brazil.
2. School of Medicine of Universidade de São Paulo - Brazil.
3.Hospital Israelita Albert Einstein - São paulo-Brazil.
4. School of Medicine of Universidade Federal de São Paulo - Brazil.

Introduction:
Clinically effective treatment of mild to moderate cases of obstructive sleep apnea (OSA) can be a challenge to the health care professional. Although nasal CPAP is therapeutically effective, especially for severe OSA, its compliance rate in mild to moderate OSA patients may not exceed 58-78%. Adittionally, CPAP machines availability outside North America, Europe and Japan as well as final costs are major limitations for the for some patients. 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 objective polissonographic and subjective clinical data of a removable mandibular repositioning appliance - RMRA worn during sleep and developed by one of the authors (Barbosa RC) that is being tested for therapeutic clinical efficacy in OSA patients.

Methods:
Patients were included on the basis of their willingness to be treated with the RMRA. 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: 15 patients (11M/4F), age range 35 to 76 (mean=52.6; SD=12.66), BMI range 20.28 to 31.51 ( mean=26.66; SD=3.14). All patients were individually fitted with an RMRA.

Results:
The results are shown in table.

 

Patient	RDI pre	RDI post	ESS pre	ESS post	Sat O2min pre	Sat O2min post	BMI
1	58.10	7.53	7	6	90.00%	87.00%	27.04
2	67.20	22.03	15	9	90.00%	96.00%	27.46
3	82.50	25.60	22	20	98.00%	56.00%	31.22
4	24.40	18.83	12	5	90.00%	79.00%	20.28
5	25.10	5.80	10	4	98.00%	93.00%	29.45
6	28.80	6.54	9	3	80.00%	93.00%	29.41
7	22.40	8.83	8	3	90.00%	80.00%	26.77
8	41.26	2.50	15	4	93.00%	95.00%	27.17
9	50.00	10.30	10	2	61.00%	92.00%	24.39
10	77.14	9.22	10	3	69.00%	89.00%	27.01
11	63.00	5.17	6	4	59.00%	84.00%	31.51
12	40.80	3.80	15	2	73.00%	84.00%	20.58
13	55.50	28.80	21	7	80.00%	85.00%	25.54
14	55.00	1.00	12	4	90.00%	92.00%	24.91
15	57.20	4.10	19	6	75.00%	91.00%	27.25
AVG	49.89	10.67	12.73	5.47	82.40%	86.40%	26.66
S.D.	18.40	8.50	4.81	4.30	12.19%	9.58%	3.14

Legend:
RDI - Respiratory Disturbance index
ESS - Epworth Slepiness Scale
Sat O2 min - minimun O2 saturation
BMI - Body mass Index

Discussion:
An improvement in the pre- and post-treatment objective and subjective measures employed herein (PSG, ESS and questionnaire) 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 15 patients before and 30 days after the RMRA was in use differed in a statistically significant way. Additionally, the reduction in the RDI determined polyssonographically with the appliance in use was also statistically significant confirming thus the ESS subjective data This subjective daytime sleepiness and objective polissonographic improvement have been generated by the dental appliance-induced employed herein.

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

Keywords: Obstructive Sleep Apnea, Oral Appliances.