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MONITORING FOR 8 YEARS OF SERIOUS CASE OF CONTROLLED SLEEP APNEA SYNDROME THROUGH LINGUAL TECHNIQUE: CASE REPORT
Obstructive sleep apnea syndrome (OSAS) is a sleep disorder caused by upper airway occlusion. It has a high prevalence, mortality and morbidity, with consequent reduction or absence of respiratory airflow causing nocturnal awakenings and oxyhemoglobin desaturation. Patients with OSAS have a reduced pharyngeal muscle contractile capacity and higher upper airway blockade pressure than those without OSAS. Intermittent hypoxia in the pharynx muscles and central nervous system represents a disease progression factor by altering the structure of the dilator muscles.
The most efficient noninvasive treatment for OSAS control is the use of Continuous Positive Airway Pressure (CPAP) devices. However, the discomfort caused by the ventilatory mechanism causes many patients to opt for the use of oral appliances (OA).
To demonstrate the performance of an oral device, based on the concepts of Lingual Technique, that uses a different mode of action. The mechanism, called 'Lingual Orthosis', is proposed as an alternative method of treatment for resistant CPAP patients.
A patient with severe OSAS - 36.4 ev/h - and resistant to CPAP was submited to a treatment with AIO Lingual Orthosis and was followed up for eight years. At the end of this period a second lingual orthosis was made. This device, one of the components of the lingual arsenal techniques, acts controlling directly and actively with the purpose of containing the retroposition and consequent occlusion of the oropharyngeal canal. To attest the results, three polysomnographic (Icelera, São Paulo, Brasil) examinations were performed, one baseline and the other two with their respective devices installed.
Polysomnographs demonstrate that both devices were effective in controlling OSAS. The first device reduced the initial apneia hipopneia index (AHI) from 36.4 to 3.3 ev/h. The second device, eight years later, also reduced the AHI, scoring it down to 0.6 ev/h.
The results of the polysomnographs demonstrated the effectiveness of the active and direct action proposed by Lingual Technique, represented here by the Lingual Orthosis device. The primary action of restraining the posterior sliding of the tongue was successful, thus ensuring AHI reduction.
obstructive sleep apnea syndrome; polysomnography; sleep.
Relato de Caso
Antonio Rocha, Litiele Evelin Wagner, Lilian Abentroth, Jorge Machado Caran, Marilene Trindade, Dulciane Nunes Paiva