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Patients who refused CPAP have a safe option to treat severe obstructive sleep apnea: pilot study


Obstructive sleep apnea (OSA) is characterized by episodes of complete and/or partial pharyngeal collapse resulting in poor sleep quality. A non-reparative sleep can trigger systemic alterations related to a several co-morbidities including, hypertension, stroke, diabetes II, insulin resistance, depression/anxiety, obesity, neurocognitive deficits and others pathologies. OSA is progressive, life-threatening and multifactor disease, which demands a multiprofessional approach. The most common worldwide treatments are Continuous Positive Airway Pressure (CPAP) and mandibular advancement oral appliance (OAm).


The aim of this study was evaluating the effects OAm on severe OSA, in patients who refused CPAP, comparing polysomnographic and Epworth Sleepiness Scale (ESS) data obtained prior to and during OAm treatment, after 6 month-period.


A prospective study was carried out involving severe OSA patients, who did not accepted CPAP (continuous positive airway pressure) and were referred to treatment with an OAm. Subjects with complaints of snoring, gasping/choking during sleep, fatigue and daily sleepiness were evaluated by a sleep medicine specialist and the diagnosis of severe OSA with a basal polysomnography (PSG).The appliance chosen was PMPositioner®.
After 6 months a new PSG was performed o evaluate the efficacy of OAm therapy. Subjective daytime sleepiness was evaluated by ESS questionnaire prior to treatment and at 6 months follow up.


Seventeen patients met the inclusion criteria and 13 finished the protocol. The following parameters improved significantly OSA severity (44.5±13.5 to 9.0±4.3, p≤0.001), ODI (46.8±11.6 to 12.1±9.1(p<0.05)), REM (18.4± 4.8 to 21.5± 2.9 (p<0.05)) and SaO2nadir (75.7± 9.4 to 87.0±3.6, p<0.001) , as well as ESS (p<0.005). Comorbidities were present in entire group, 9 with hypertension and with hypertension and diabetes II. Ten patients reported that the arterial pressure values reduced for systolic and diastolic parameters and among them, 3 patients reduced the hypertensive drug dose.


The findings of the present study demonstrated that OAm is a safe and viable treatment option to severe OSA, when patients cannot tolerate or refuse CPAP therapy. Further studies should include thermosensitie microsensor to objectively measure the effectiveness of a long-term OAm therapy.


mandibular advancement oral appliance; obstructive sleep apnea; polysomnography; hypertension; Continuous Positive Airway Pressure


Área Clínica


Centro Universitário de Anápolis Uni-Evangélica - Goias - Brasil, ICT-UNESP/SJC - Sao Paulo - Brasil


Lilian Chrystiane Giannasi, Monica Fernandes Gomes, Daniela O Araújo, Luis Vicente Franco Oliveira