Tratamento da síndrome da apnéia e hipopnéia obstrutiva do sono com aparelhos intrabucais

Abstract

Obst ructive sleep apnea and hipoapnea syndrome (OSAHS) is a disorder that affects about 4% of the adult population, and besides the social problems associated to snoring and extreme day time sleepiness, it is preoccupying since it may cause pulmonary hypertension and cardiac failure. Review and discussion -Through a literature review, we discuss the use of oral appliances to treat this condition, in regards of therapy effectiveness and limitations, main clinical symptoms, major occlusal side effects, rate of improvement and patient satisfaction. Conclusions -We concluded that the use of oral appliances should be a first choice treatment for mild to moderate OSAHS, being dental, joint and muscular discomforts, hypersalivation and xerostomia, the most frequent clinical symptoms, with light occlusal side effects that normally do not bother the patients, with a good degree of improvement and high satisfaction index.

Aparelhos orais de protrusão mandibular ? IAH, eficiência do sono, sono REM e oxigenação de usuários

“…Individuals that have ten or more obstructive events per hour of sleep showed greater risk of 6.3 accidents that individuals with normal sleep, what shows a strong association between sleep apnea and the risk for motor vehicle accidents (95%) 5,6 . Mortality associated with sleep apnea significantly increases when episodes are more than 20 per sleep hour 7 .…”

“…Radiographically, we can observe some anatomical features relevant to diagnosis in patients with OSAHS, such as narrow mandibular arch, maxillary and mandibular retrognathia, increased height of lower facial third, lower and anterior position of the hyoid bone; reduced pharyngeal area; increased craniocervical angle, distance decreased between the tongue base and posterior pharyngeal wall; hypertrophied tonsils and adenoids, maxillary and mandibular dentition over erupting and elongated tongue 7 .…”

“…Among the treatment options for OSAHS already established in the literature, we have the main therapeutic measures of sleep hygiene, uvulopalatopharyngoplasty surgery, surgery of mandibular and maxillary advancement, the use of CPAP devices and the use of oral appliances protrusion (AOPM) 2,[15][16][17][18][19] . The mandibular protrusion appliances have been consolidated as an alternative treatment to CPAP, with no consensus yet on its indication, but its statement is mainly in cases of low and medium gravity 7,20 . In patients with OSAHS, reduced the apnea-hypopnea index to less than 10 in 54% of those surveyed, reducing snoring in 45% 18 .…”

“…In 30 months, 56-68% of patients continue to use oral appliance. There are still doubts about the effectiveness of oral appliances, but its use in the treatment of apnea of medium severity has received great attention and acceptability 7,18,21 .…”

“…One example is that comparisons between the CPAP and AOPM revealed that, although the intraoral appliance demonstrated to be less effective in reducing the rate of respiratory disorders, they are, on average, more frequently used, being preferred by more patients and more readily accepted the CPAP, whether for comfort, whether at cost 7,21 .…”