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Título

Myofunctional therapy as an Oral Appliance Therapy adjunct in moderate OSA patient with Sleep Apnea Digital Monitoring home test follow-up.

Introdução

Obstructive Sleep Apnea Syndrome (OSAS) is a highly prevalent condition affecting people with an increasing public health burden. Oral Appliance Therapy (OAT) is recommended in clinical practices in OSAS non-adherent patients or who refused CPAP therapy. In OSAS patients, the hypoglossal nerve structure and genioglossus muscles function are always abnormal. In addition, the tongue does not always move simultaneously with the mandible when an Oral Appliance (OA) is being used. Sometimes, the genetic and environmental influences can interfere in clinical endpoint, as malocclusion and oropharyngeal muscles hypotonia. Thus, some patients with OSAS, malocclusion and stomatognathic dysfunction may benefit from myofunctional therapy (MFT) as an to OAT adjunct for treatment efficacy. Furthermore, the polysomnography (PSG) is a gold standard study for diagnosis and monitoring of OSAS patients; however, the test is expensive, time-consuming and difficult to access. Therefore, other methods have been proposed such as Sleep Apnea Digital Monitoring (SADM), which is a home-styled oximetry diagnosis to detect severe OSA that uses the Oxygen Desaturation Index (ODI).

Objetivo

We show an OSAS patient who refused CPAP therapy, and was treated with OAT and MFT, his monitoring and following-up with SADM before final PSG sleep study.

Métodos

Caucasian 63-year-old man with class III dental occlusion and 24 BMI, with moderate AHI and intense snoring who refused CPAP therapy. Patient with clinical history of diabetes II, hypercholesterolemia, hypertension who was submitted to septal deviation surgery. At first OAT was prescribed and after that, MFT. The OA used induced lip sealing, mandible and tongue protrusion. MFT induced neuromuscular and functional balance for stomatognathic system. Clinical evaluation, Epworth Sleepiness Scale, polysomnography and SADM were evaluated in 12 months of follow-up.

Resultados

An improvement in objective and subjective parameters were shown as: BMI(24.5 to 23.9), SaO2 min(79 to 86%), SaO2 max(93 to 96%), Arousal Index(29,7 to 7.1/h), IDO=10 to 8, ESE (13 to 7) and Snore ( intense to mild).

Conclusões

Patient demonstrated as being compliant with OAT and MFT as an adjunct therapy. An improvement in respiratory parameters and daytime sleepiness were achieved. In this case report the SADM demonstrated to be a good tool for OAT and MFT monitoring and follow-up before final PSG sleep study.

Palavras-chave

sleep apnea syndrome, snoring, oral appliance, myofunctional therapy, oximetry, follow-up.

Área

Relato de Caso

Instituições

FOP - UNICAMP - Sao Paulo - Brasil

Autores

Denise Fernandes Barbosa, Valéria Muralha Sousa, Fausto Berzin