IntroductionMandibular advancement device (MAD) may represent a feasible choice in the treatment of obstructive sleep apnea-hypopnea syndrome (OSAHS), in well selected patients.ObjectiveThe aim of this study is to assess the efficacy of MAD in patients with OSAHS, using split night polysomnography (SNP)MethodWe performed an auto controlled clinical trial to assess the efficacy of MAD in 30 patients with snoring and OSAHS. Clinical evaluation was made every 2 weeks to adjust treatment and observe changes in clinical symptoms. Three-months after placement of the MAD, a SNP was performed, using the MAD in the second half of the night, in order to compare the respiratory results.ResultsSNP show significant changes with use of MAD (p<0.05) such as: Decrease in Snore index (from 159.95 to 32.46/h) and in Apnea-hypopnea index (AHI, from 22.45 to 4.63/h), increase in oxygen saturation (SaO2, from 89.98% to 91.39%) and somnolence improvement, using the Epworth Sleepiness Scale (from 14.4 to 4.6 points).ConclusionOur data supports that the use of MAD is an alternative in the management of OSAHS, in well selected patients, used in a multidisciplinary fashion, and evaluated using a SNP.
Background. As described by Mair et al. in 2001, snoreplasty, the application of sclerosant agents in the palate is a promising and cheap alternative to treat snoring. We decided to try this kind of therapy for the management of mild sleep apnea. Study Design. Experimental, longitudinal, prospective, nonrandomized, self-controlled pilot study. Methods. 11 patients were included, all of them with a polysomnographic study showing an Apnea-Hypopnea Index (AHI) from 5 to 20, and with a Müller maneuver showing only retropalatal collapse. Results. We found significant decrease in the number of apneas hypopneas and oxygen desaturation as well as in the snoring index (P < 0.05), although no differences were found in the number of arousals. Conclusion. Sclerosant agents might become a relevant part in the treatment of sleep apnea, in very well-selected patients.
In obstructive sleep apnea (OSA) surgical treatment is discussed controversially. Minimal invasive treatments are favored by the patients. Having shown the efficacy of Pillar Palatal Implant Systems (made of polyethylentherephthalate) in the treatment of primary snoring, the aim of our study was to assess their effectiveness in the treatment of mild to moderate OSA.Methods: Overweight patients (n ϭ 10; BMI 26.5 Ϯ 2.2 kg/m 2 ; age, 49 Ϯ 8.6 years) with mild to moderate OSA were included in our prospective study. Objective (polysomnography) and subjective (daytime sleepiness, snoring, pain, taste, and speech) data were assessed pre-and postoperatively. Three implants were inserted into the soft palate under local anesthesia. The postoperative exam was performed after 3 months.Results: There were no complications during surgery. Snoring was reduced in the Visual Analogue Scale from 8.5 Ϯ 1.8 to 3.8 Ϯ 2.3 (P Ͻ 0.01), the Apnea-Hypopnea-Index went down from 18.4/h Ϯ 4.4 to 11.1/h Ϯ 13.0 (P Ͼ 0.05). Speech, swallowing, and taste remained unchanged.
Conclusion:The new Pillar Palatal Implant System is a safe and secure method to reduce snoring. Short time results show no significant changes in the Apnea-Hypopnea-Index. Detailed analysis of long-term results remains to be carried out.Significance: The Pillar Palatal Implant System is a simple procedure with impact on snoring. We hope that long-term results might show a decrease in the Apnea-Hypopnea-Index.
Introducción: El síndrome de apnea obstructiva del sueño (SAOS) ha aumentado su incidencia en los últimos años, con repercusiones importantes en la salud, su tratamiento debe ser elaborado por un equipo multidisciplinario según las necesidades de cada paciente. Los dispositivos de avance mandibular pueden ser una herramienta útil y no invasiva. Objetivo: Evaluar el efecto que tienen los dispositivos de avance mandibular (DAM) en pacientes con SAOS de intensidad severo, en quienes presentan como único sitio de obstrucción la base de lengua y son candidatos para utilizar el dispositivo. Diseño: Estudio cuasi-experimental no controlado de antes y después. Materiales y Métodos: Se incluyeron 30 pacientes con diagnóstico de SAOS de intensidad severo, con único sitio de obstrucción en la base de lengua, que fueran candidatos al uso dedispositivos de avance mandibular, también se realizó polisomnografía de nochedividida de control, comparándose índice de apnea hipopnea (IAH) e índice de ronquido (IR) antes y después del tratamiento. Resultados: En el estudio polisomnográfico de noche dividida de control, se encontró diferencia significativa p<0,001 al comparar el índice de apnea hipopnea e índice de ronquido antes y después de usar el dispositivos de avance mandibular. Discusión: Los dispositivos de avance mandibular pueden ser una herramienta considerada en el manejo del SAOS con cualquier grado de intensidad, siempre y cuando el sitio de obstrucción sea evaluado adecuadamente mediante un grupo multidisciplinario, donde se individualice a cada paciente.
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