R ic a r d o C a s t r o B a r b o s a , F la v ia A lo e , S t e lla T a v a r e s , A d e m ir B a p t is t a S ilv a
M a n d ib u la r- L in g u a l R e p o s itio n in g D e v ic e - M L R D :
p re lim in a ry
re s u lts o f 8 p a tie n ts w ith O b s tru c tiv e S le e p
A p n e a S y n d ro m e - O S A S
C o l l e g e o f D e n t i s t r y o f t h e U n i v e r s i d a d e d e S a o P a u l o ( U S P ) , C e n t e r f o r S l e e p S t u d i e s o f t h e H o s p i t a l d a s C l i n i c a s o f t h e U S P M e d i c a l S c h o o l , a n d t h e C e n t e r f o r S l e e p D i s o r d e r s a t t h e H o s p i t a l I s r a e l i t a A l b e r t E i n s t e i n , a n d t h e B a p t i s t a S i l v a C l i n i c a - S a o P a u l o , B r a z i l
D e n ta l d e v ic e s h a v e b e e n e m p lo y e d in th e tre a tm e n t o f s n o rin g a n d o b s tru c tiv e s le e p a p n e a s y n d ro m e (O S A S ) o f m ild to m o d e ra te d e g re e s . T h e a u th o rs d is c lo s e th e p re lim in a ry re s u lts in 8 p a tie n ts w ith c lin ic a lly d ia g n o s e d o b s tru c tiv e s le e p a p n e a p o lis o m n o g ra p h ic a lly c o n firm e d a n d tre a te d w ith a d e n ta l d e v ic e (M a n d ib u la r-L in g u a l R e p o s itio n in g D e v ic e - M L R D ) d e v e lo p e d b y o n e o f th e a u th o rs (R C B ). C e p h a lo m e trie s w a s p e rfo rm e d b e fo re u s a g e o f M L R D , E p w o rth S le e p in e s s S c a le (E S S ) te s ts w e re c o n d u c te d b e fo re a n d a fte r th e M L R D a n d a q u e s tio n n a ire th a t s u b je c tiv e ly q u a lifie d th e O v e ra ll S u b je c tiv e Im p ro v e m e n t o f th e p a tie n t (O S I) w a s fille d o u t. T h e te s ts w e re re p e a te d 4 w e e k s a fte r th e a p p lic a tio n o f th e M L R D . T h e a v e ra g e s u b je c tiv e o v e ra ll im p ro v e m e n t w a s 7 3 .7 5 % a n d th e E p w o rth S le e p in e s s S c a le w a s 1 3 .8 8 (p re - M L R D ) a n d 6 .6 3 (p o s t - M L R D ) re p re s e n tin g a s ig n ific a n t s ta tis tic a l v a ria tio n (p = O .0 5 ). T h e a u th o rs d is c u s s p ro b a b le fa c to rs in v o lv e d in th e im p ro v e m e n t o f th e s u b je c tiv e m e a s u re m e n ts o f e x c e s s iv e s le e p in e s s .
U N IT E R M S : O b s tru c tiv e S le e p A p n e a . S n o rin g . D e n ta l d e v ic e .
IN T R O D U C T IO N
O
b s tr u c tiv ein c a p a c ita tin gS le e p c o n d itio nA p n e a S y n d r o m ew ith a ( O S A S )h ig h r a teis a no f m o r b id ity a n d m o r ta lity . V a r io u s p r e v a le n c es tu d ie s e s tim a te th a t 1 to 8 .5 % o f th e m a le a d u lt p o p u la tio n
b e tw e e n 4 5 a n d 6 5 y e a r s o ld s h o w s ig n s o f c lin ic a lly
r e le v a n t o b s tr u c t! v e s le e p a p n e a s y n d r o m e . T h e
c o m b in a tio n o f c r a n io - m a n d ib u la r - f a c ia l a lte r a tio n s
( d is p r o p o r tio n a l a n a to m y ) w ith a s tr u c tu r a l a lig n m e n t o f
A d d r e s s f o r c o r r e s p o n d e n c e : R ic a r d o C a s t r o B a r b o s a R u a D iv in o S a lv a d o r
S a o P a u lo , S P - B r a s il - C E P 0 4 0 7 8 - 0 1 0
th e u p p e r a ir w a y s ( V A ) a s s o c ia te d p r im a r ily w ith o b e s ity
a n d n e u r o - m u s c u la r f u n c tio n a l f a c to r s a r e e le m e n ts th a t
a r e e tio lo g ic a lly r e s p o n s ib le f o r th e c o lla p s e o f th e u p p e r
a ir w a y in th e o b s tr u c tiv e s le e p a p n e a s y n d r o m e .
T h e n a s a l " C P A P " ( c o n tin u o u s p o s itiv e a ir w a y
p r e s s u r e ) is th e f ir s t c h o ic e o f th e r a p y f o r th e tr e a tm e n t o f
o b s tr u c tiv e s le e p a p n e a s y n d r o m e p r im a r ily f o r m o d e r a te
a n d s e v e r e c a s e s . H o w e v e r te r m a d h e r e n c e to n C P A P is
o f 5 8 % in p a tie n ts w ith s lig h t to m o d e r a te O S A S , a n d
8 9 % in s e v e r e c a s e s o f o b s tr u c tiv e s le e p a p n e a s y n d r o m e .
O th e r th e r a p e u tic a l te r n a ti v e s g e n e r a lly u s e d
s im u lta n e o u s ly , in c lu d e : b e h a v io r a l c h a n g e s ( w e ig h t lo s s ,
a b s tin e n c e f r o m a lc o h o l, la te r a l d e c u b itu s ) , m e c h a n ic a l
d e v ic e s ( d e n ta l d e v ic e ) , m e d ic a tio n ( a n ti- d e p r e s s a n ts ,
m e d r o x i p r o g e s te r o n e , th e o p h i ly n e ) , s u r g e r y
( u v u lo p a la to p h a r in g o p la s ty , m a n d ib u la r p r o tr u s io n ,
tr a c h e o s to m y , e tc .) in o b s tr u c tiv e d if f e r e n t c o m b in a tio n s .
889
I n r e c e n t y e a r s th e u s e o f d e n ta l d e v ic e in th e tr e a tm e n t o f o b s tr u c tiv e s le e p a p n e a s y n d r o m e a n d p r im a r y s n o r in g h a v e r e c e iv e d g r o w in g a tte n tlo n p r im a r ily d u e to its a c c e p ta n c e , lo w m o r b id ity o f tr e a tm e n t a n d r e la tiv e e f f ic ie n c y in tr e a tm e n t o f m ild to m o d e r a te c a s e s ( 2 ,4 ,5 ,6 ,7 ,8 ,1 2 ,2 3 ,2 4 ,3 6 ,3 8 ) . T h e f ir s t r e p o r te d u s e o f d e n ta l d e v ic e f o r e x p a n s io n o f th e u p p e r a ir w a y s w a s p e r f o r m e d o n R o b in ( 3 4 ) in 1 9 0 2 a n d s u b s e q u e n tly in 1 9 2 1 a n d 1 9 2 3 o n c h ild r e n w ith c r a n ia l- f a c ia l d is m o r p h ia . I n 1 9 3 4 R o b in ( 3 4 ) d e s c r ib e d a n o th e r ty p e o f o n e - p ie c e d e v ic e th a t p u s h e d th e m a n d ib le a n d to n g u e f o r w a r d s o a s to in c r e a s e th e s iz e o f th e u p p e r a ir w a y s .
T h e r e a r e 2 d if f ic u ltie s c o n c e r n in g th e u s e o f " n C P A P " in o u r c o u n tr y : its h ig h c o s t a n d p r o b le m s w ith to le r a n c e , m a k in g th e u s e o f d e n ta l d e v ic e v ia b le p r im a r ily b e c a u s e o f its lo w c o s t, n o n - in v a s iv e n e s s , r e v e r s ib ility a n d w id e a c c e p ta n c e . I n th is a r tic le w e w ill r e p o r t th e p r e lim in a r y r e s u lts o f s u b je c tiv e p r o c e d u r e s o f 8 p a tie n ts tr e a te d w ith th e M a n d ib u la r - L in g u a l R e p o s itio n in g D e v ic e - M L R D , d e v e lo p e d b y o n e o f th e a u th o r s ( R C B ) . T h e M L R D is a in tr a o r a l r ig id u n ib o d y ty p e D e v ic e , r e m o v a b le , u s e d d u r in g s le e p w ith th e p u r p o s e o f m a n d ib u la r r e p o s itio n in g ( f ig u r e 4 ) .
M E T H O D S
E ig h t p a tie n ts c lin ic a lly a n d p o lis o m n o g r a p h ic a lly d ia g n o s e d a s h a v in g m ild o b s tr u c tiv e s le e p a p n e a s y n d r o m e w e r e s tu d ie d . S ix w e r e m a le , a g e s b e tw e e n 4 5 a n d 5 5 y e a r s o ld ( a v e r a g e 5 1 .2 5 ) a n d a n a v e r a g e b o d y m a s s o f 2 7 .6 4 k g /m2
•
A ll o f th e p a tie n ts u n d e r w e n t a p o ly s o m n o g r a p h ic s tu d y f o r d e f in itiv e d ia g n o s e s . R a d io lo g ic a l te s ts w e r e a ls o p e r f o r m e d c o n s is tin g o f c e p h a lo m e tr ic te le r a d io g r a p h y ta k e n in th r e e p o s itio n s , c e n tr a l o c c lu s io n , e n d to e n d o f th e in c is o r a n d m a x im u m m a n d ib u la r e x te n s io n . R e c o m m e n d a tio n s f o r w e ig h t lo s s , a b s tin e n c e f r o m a lc o h o l, u s e p f s e d a tiv e s a n d im p r o v e m e n t in p o s tu r e w e r e m a d e to a ll o f th e p a tie n ts a s s o c ia te d w ith th e u s e o f th e M a n d ib u la r - L in g u a l R e p o s itio n in g D e v ic e . T h e M a n d ib u la r - L in g u a l R e p o s itio n in g D e v ic e w a s in d iv id u a lly a d ju s te d f o r e a c h p a tie n t. T h e e v a lu a tio n o f th e s u b je c tiv e p a r a m e te r s w e r e m a d e b y :
1 . T h e E p w o r th S le e p in e s s S c a le ( E S S ) ( 1 7 ) w a s a p p lie d b e f o r e a n d a f te r th e p la c e m e n t o f th e M a n d ib u la r -L in g u a l R e p o s itio n in g D e v ic e . T h e E p w o r th S le e p in e s s S c a le c o n s is ts o f e ig h t q u e s tio n s a n s w e r e d b y th e p a tie n t w ith r e g a r d s to d a ily a c tiv itie s m e a s u r e d o n a s c a le o f z e r o to th r e e a n d h a v in g p r o p o r tio n a te v a lu e s o f s ta r tin g f r o m a m in im u m o f z e r o to a m a x im u m o f tw e n ty f o u r p o in ts ( a p p e n d ix 1 ) .
2 . Q u e s tio n n a ir e f o r m e a s u r in g O v e r a ll S u b je c tiv e I m p r o v e m e n t ( O S I ) p o s t- M a n d ib u la r - L in g u a l R e p o s itio n in g D e v ic e . T h is q u e s tio n n a ir e c o n s is te d o f tw o q u e s tio n s a n d w a s a n s w e r e d in th e f o r m o f p e r c e n ta g e s . T h e r e s u lts f o r e a c h p a tie n t w e r e a p e r c e n ta g e a v e r a g e o f b o th q u e s tio n s w h ic h w e r e th e f o llo w in g :
A ) H o w m u c h d id y o u r p h y s ic a l a n d m e n ta l d is p o s itio n im p r o v e u p o n a w a k e n in g ?
B ) H o w m u c h d id y o u r p h y s ic a l a n d m e n ta l d is p o s itio n im p r o v e th r o u g h o u t th e d a y ?
T h e te s ts w e r e r e p e a te d 4 w e e k s a f te r th e f in a l a d ju s tm e n ts w e r e m a d e to th e M a n d ib u la r - L in g u a l R e p o s itio n in g D e v ic e a n d th e r e s u lts th e n s u b m itte d to s ta tis tic a l a n a ly s is ( S tu d e n t's " t" te s t) .
Table I
Patients general data
P a tie n t S e x R D I p r e S a t O2 E S S p r e E S S p o s t 8 M I O S I W e ig h t v a r .
1 F 4 6 .7 9 0 .0 7 .0 4 .0 2 6 .5 3 7 0 .0 0 % + 1
2 M 3 0 .1 9 6 .0 2 3 .0 1 1 .0 2 9 .4 7 7 0 .0 0 % + 0
3 M 4 5 .2 7 1 .0 2 0 .0 1 2 .0 2 7 .6 0 8 0 .0 0 % + 0
4 M 5 5 .0 9 2 .0 1 2 .0 4 .0 2 7 .0 9 7 0 .0 0 % + 0
5 M 5 8 .0 8 2 .0 7 .0 4 .0 2 7 .1 1 8 0 .0 0 % - 2
6 M 2 3 .1 7 5 .0 1 7 .0 1 0 .0 2 6 .1 0 9 0 .0 0 % - 3
7 F 1 1 .0 8 3 .0 1 8 .0 5 .0 2 6 .0 3 9 5 .0 0 % + 0
8 M 5 5 .5 8 0 .0 7 .0 3 .0 3 1 .0 0 7 5 .0 0 % + 0
A v e r a g e 4 0 .5 8 8 3 .5 3 1 3 .8 8 6 .6 3 2 7 .6 4 7 6 .2 5 % - 1
D .P . 1 7 .2 5 8 .5 7 8 .4 7 3 .7 0 1 .7 5 1 1 .5 7 % + 1
L e g e n d - E S S : E p w o r th S le e p in e s s S c a le p r e a n d p o s t M L R D ; B M I: B o d y m a s s in d ic a tiv e ( w e ig h tlh e ig h t2 ) ; O S I: O v e r a ll s u b je c tiv e
im p r o v e m e n t; S a t 0 2 : m in im u m o x ig e n s a tu r a tio n ; R D I: r e s p ir a to r y d is tu r b e s in d ic a tiv e ( e v e n ts /h o u r )
B A R B O S A , R .C .; A L O E , F .; T A V A R E S , S . & S IL V A , A .B . - M a n d ib u la r - L in g u a l R e p o s itio n in g D e v ic e - M L R D : p r e lim in a r y r e s u lts o f 8 p a tie n ts w ith O b s tr u c tiv e S le e p A p n e a S y n d r o m e - O S A S
M ilim m ite rs
Table
2
Cephalometric readings
D IS C U S S IO N
T h e te le ra d io g ra p h y te s ts s h o w e d a n a v e ra g e
d e v ia tio n o f th e p o s te rio r a e ria l s p a c e (P A S ) o f -3 .3 5 m m ;
o f th e d is ta n c e b e tw e e n th e h y o id b o n e a n d th e m a n d ib u la r
p la n e (M P H ) o f 1 1 .9 6 m m , a n d o f th e a v e ra g e le n g th o f
th e s o ft p a la te (P N S -P ) o f 7 .1 6 m m . T h e s e re s u lts a re
p re s e n te d in d e ta il in T a b le II.
T h e E S S s c o re s o b ta in e d p re - a n d p o s t- tre a tm e n t (1 3 .8 8
a n d 6 .6 3 ) re s p e c tiv e ly s h o w e d a s ta tis tic a lly s ig n ific a n t
d iffe re n c e (p = 0 .0 5 ) a n d th a t is s h o w n in fig u re 1 .
T h e O v e ra ll S u b je c tiv e Im p ro v e m e n t (O S I) 7 6 .2 5 %
im p ro v e m e n t. A ll p a tie n ts s h o w e d in c re a s e d s a liv a tio n
im m e d ia te ly a fte r th e a p p lic a tio n o f th e M a n d ib u la
r-L in g u a l R e p o s itio n in g . D e v ic e , b e c o m in g n o rm a l
a p p ro x im a te ly a fte r 3 0 d a y s o f u s e . T h e re w e re n o s ig n s
o f te m p o ro m a n d ib u la r jo in t d is c o m fo rt re la te d to th e
d e v ic e .
P N S -P
4 3 .2
4 1 .8
4 3 .3
4 1 .1
4 9 .3
5 8 .1
3 6 .3
4 0 .2
4 4 .2
6 .7
3 7 .0
P A S
5 .2
1 2 .0
1 .6
7 .2
1 2 .7
9 .5
8 .0
5 .0
7 .7
3 .7
1 1 .0
MPH
2 8 .6
1 4 .5
2 2 .5
2 3 .4
2 2 .3
3 9 .1
2 4 .7
4 0 .8
2 7 .0
8 .9
1 5 .0
N o rm a l
R e a d in g s
L e g e n d - M P H : d is ta n c e b e tw e e n th e h y o id b o n e a n d th e
m a n d ib u la r p la n e ; P A S : p o s te rio r a irw a y ; P N S -P : d is ta n c e b e tw e e n th e p o s te rio r n a s a l s p in e a n d th e s o ft p a la te c a u d a l e n d .
P a tie n t
1 2 3 4 5 6 7 8
A v e ra g e
D .P .
R E S U L T S
T h e re s u lts a re p re s e n te d in T a b le 1 .
T h e p o lis o m n o g ra p h ic te s ts in d ic a te d a n a v e ra g e o f
4 0 .5 8 a p n e a - h y p o p n e a (IA H ) e v e n ts p e r h o u r; 2 9 .3 3
a p n e a e v e n ts p e r h o u r a n d a n a v e ra g e m in im u m o x y g e n
s a tu ra tio n o f 8 2 .4 3 % .
1 4 ,0 0
1 2 ,0 0
1 0 ,0 0
8 ,0 0
6 ,0 0
4 ,0 0
2 ,0 0
0 ,0 0
E S S p '"
E S S p o ll
FIGURE 1 -G ra p h re p re s e n tin g th e v a ria tio n in e x c e s s iv e d a y tim e s le e p in e s s a s m e a s u re d b y th e E p w o rth S le e p in e s s S c a le . V a lu e s o b ta in e d b e fo re a n d a fte r tre a tm e n t w ith th e M a n d ib u la r-L in g u a l R e p o s itio n in g D e v ic e
T h e p re lim in a ry re s u lts o f th is s tu d y s h o w e d a
s ta tis tic a lly s ig n ific a n t im p ro v e m e n t in d a y tim e s le e p in e s s
a s m e a s u re d b y E S S . T h e re w a s a ls o a n o v e ra ll s u b je c tiv e
im p ro v e m e n t a fte r th e in itia l u s e o f th e M a n d ib u la
r-L in g u a l R e p o s itio n in g D e v ic e .
T h e E p w o rth s le e p in e s s s c a le is re c o g n iz e d a s v a lid
fo r th e q u a n tific a tio n o f th e g e n e ra l le v e l o f e x c e s s iv e
d a y tim e s le e p in e s s (1 7 ). It d iffe re n tia te s n o rm a l in d iv id u a ls
fro m th o s e w ith s le e p d is o rd e rs o f v a rio u s p a th o lo g ic a l
a fflic tio n s . T h e v a lu e s o b ta in e d p o s itiv e ly c o rre la te d w ith
th e m u ltip le s le e p la te n c ie s te s t (3 3 ), in d e p e n d e n t o f
p a th o lo g y (1 7 ). V a lu e s a b o v e 5 .9 1 0 2 .2 a re in d ic a to rs o f
e x c e s s iv e s le e p in e s s (1 7 ). P a tie n ts w ith o b s tru c tiv e s le e p
a p n e a s y n d ro m e re c o rd e d v a lu e s th a t s ta tis tic a lly c o rre la te d
w ith in c id e n c e o f a p n e a -h ip o p n e a a n d w ith a m in im u m
s a tu ra tio n o f o x y g e n o b ta in e d in th e p o lis o m n o g ra p h y (1 7 ).
T h e in itia l w e ig h t re c o rd e d w a s o b ta in e d d u rin g th e
p o lis o m n o g ra p h ic d ia g n o s is a n d a fte r in s e rtio n , a d ju s tm e n t
a n d c o n tro l o f th e M a n d ib u la r-L in g u a l R e p o s itio n in g
D e v ic e . A s lig h t w e ig h t v a ria tio n w a s o b s e rv e d in o n ly
tw o o f th e p a tie n ts ; p a tie n t n o . 1 g a in e d 1 k g a n d p a tie n t
n o . 2 lo s t 3 k g d u rin g th e e v a lu a tio n p e rio d .
P a tie n ts w ith o b s tru c tiv e s le e p a p n e a s y n d ro m e
d is p la y a n a to m ic n a rro w in g o f th e u p p e r a irw a y s . u s u a lly
th e n a rro w in g is s p e c ific a lly lo c a te d in th e
p a la to p h a ry n g e a l s e g m e n t. O b e s ity , in a d d itio n to s o ft
tis s u e s , is th e p rin c ip a l c a u s e o f th e n a rro w in g o f th e u p p e r
a irw a y s . C ra n io fa c ia l d is m o rp h ia s c o n trib u te to a le s s e r
e x te n t. L o w e e t a l. re v e a le d in a s tu d y u s in g c o m p u te riz e d
S a o P a u lo M e d ic a l J o u rn a U R P M 1 1 3 (3 ): 8 8 8 -8 9 4 , 1 9 9 5 B A R B O S A , R .C .; A L O E , F .; T A V A R E S , S . & S IL V A , A .B . - M a n d ib u la r-L in g u a l R e p o s itio n in g
891
FIGURE 2 -
S c h e m a tic D ia g ra m s h o w in g th e p o s itio n o f th e h y o idb o n e in a p a tie n t d ia g n o s e d a s h a v in g o b s tru c tiv e s le e p a p n e a
s y n d ro m e .
MP-H
is th e p e rp e n d ic u la r d is ta n c e fro m th e m a n d ib u la r p la n e to th e h y o id b o n e . T h e m a n d ib u la r p la n e is th e d is ta n c e b e tw e e n th egonion
p o in t o f th e m a n d ib le a n g le to th ep o in t o f
gnathion
in th e m e n to n . In p a tie n ts w ith o b s tru c tiv e s le e p a p n e a s y n d ro m e , th is d is ta n c e is a lw a y s in c re a s e d in c o m p a ris o nw ith n o rm a l in d iv id u a ls . T h e h y o id b o n e is fo u n d b e lo w a n d p o s te rio r in p a tie n ts w ith o b s tru c tiv e s le e p a p n e a s y n d ro m e .
three dimensional
CT, an increase of 27.6% the volume
of the upper airways, specifically
in the oropharynx
region
with the application
of dental devices. It is important
to
note that the increased
size to the upper airway decreased
their collapsibility
during inhaling (negative pressure).
Patients
having obstructive
sleep apnea syndrome,
the hyoid bone is located below the mandibular plane. The
FIGURE 4 -
P h o to g ra p h o f th e M a n d ib u la r-L in g u a l R e p o s itio n in gD e v ic e a p p lie d to th e m o u th .
FIGURE 3 -
S c h e m a tic D ia g ra m o f th e h y o id b o n e in a n in d iv id u a ld ia g n o s e d w ith o b s tru c tiv e s le e p a p n e a s y n d ro m e . M P -H is th e
p e rp e n d ic u la r d is ta n c e fro m th e m a n d ib u la r p la n e to th e h y o id b o n e . T h e m a n d ib u la r p la n e is th e d is ta n c e b e tw e e n th e g o n io n
p o in t o f th e m a n d ib u la r a n g le to th e p o in t o f g n a th io n in th e m e n to n . In n o rm a l in d iv id u a ls , th e M P -H d is ta n c e is le s s th a n in p a tie n ts
w ith O S A S .
forward dislocation and positioning of the mandible caused
by the use of the Mandibular-Lingual
Repositioning
Device
allows the geniohyoid
muscle
to function
more
efficiently
in the dilation of the upper airway. When the
hyoid bone is situated below as in the case of obstructive
sleep apnea syndrome,
the contraction
of the geniohyoid
muscle
generates
a force vector
that for the most part
contributes to the opening of the mandible (figure 2). When
the hyoid
bone
is situated
higher
in relation
to the
mandibular plane, the geniohyoid
exerts a forward tension
on the hyoid bone, thereby
dilating
the upper
airways
(figure 3). The mandibular
positioning
achieved
by the
Mandibular-Lingual
Repositioning
Device in patients with
obstructive
sleep apnea syndrome,
with an increase of the
MP-H dimension,
allows the geniohyod
muscle to exert a
forward tension vector on the hyoid bone, consequently
dilating the upper airway passages
without
opening
the
mouth.
The position
of the mandible
has a profound
influence
on the muscular
activity of the tongue,
as was
demonstrated
in animal experiments.
Rotation of the lower
mandibular
increases
tonic basal genioglossal
muscular
activity.
The inferior
rotation
of the mandible
and the
proprioceptive
stimulation
of the tongue
caused
by the
Mandibular-Lingual
Repositioning
Device
can most
B A R B O S A , R .C .; A L O E , F .; T A V A R E S , S . & S IL V A , A .B . - M a n d ib u la r-L in g u a l R e p o s itio n in g D e v ic e - M L R D : p re lim in a ry re s u lts o f 8 p a tie n ts w ith O b s tru c tiv e S le e p A p n e a S y n d ro m e - O S ~ S
probably
cause
increased
activity
in the
tonic
basal
genioglossal
m uscular
activity and consequently
lessen the
collapse
of anterior
w all of the oropharynx.
C O N C L U S I O N S
1) The subjecti ve m easurem ent
of daytim e sleepiness
C ESS) show ed
a statistically
significant
im provem ent
w ith
the use of the M andibular-Lingual
R epositioning
D evice
in this group
of patients
w ith
obstructive
sleep
apnea
syndrom e.
2) O bjective
polysom nographic
data
should
be
studied
to confirm
the effectiveness
of the M
andibular-Lingual
R epositioning
D evice
therapy.
EpWORTH SLEEPINESS
SCALE
N a m e A g e _
W e i g h t D a t e S e x ( ) F ( ) M
D i a g n o s i s
O c c u p a t i o n A H I _
M e d i c a t i o n _
W h a t i s t h e p r o b a b i l i t y o f y o u r " n a p p i n g " o r f a l l i n g a s l e e p i n t h e f o l l o w i n g s i t u a t i o n s , ( n o t t o b e c o n f u s e d w i t h
s i m p l y f e e l i n g t i r e d ) ? T h i s i s i n r e f e r e n c e t o y o u r c u r r e n t r o u t i n e l i f e s t y l e . E v e n i f y o u h a v e n 't n e c e s s a r i l y
e x p e r i e n c e d o n e o f t h e s e s i t u a t i o n s t r y t o a n s w e r h o w t h e s i t u a t i o n m i g h t a f f e c t y o u .
o
= n o p o s s i b i l i t y o f n a p p i n g 2 = m o d e r a t e p o s s i b i l i t y o f n a p p i n gS i t u a t i o n
1 = l o w p o s s i b i l i t y o f n a p p i n g
3 = g o o d p o s s i b i l i t y o f n a p p i n g
P o s s i b i l i t y o f N a p p i n g
S i t t i n g a n d r e a d i n g
W a t c h i n g T V
S i t t i n g i n a p u b l i c p l a c e
A s a p a s s e n g e r o n a t r a i n , b u s o r c a r , h a v i n g b e e n
t r a v e l i n g f o r m o r e t h a n a n h o u r
W h e n c i r c u m s t a n c e s p e r m i t ; l a y i n g d o w n t o r e s t d u r i n g t h e a f t e r n o o n
S i t t i n g a n d t a l k i n g w i t h s o m e o n e
S i t t i n g c a l m l y a f t e r a l u n c h w i t h n o a l c o h o l i c c o n s u m p t i o n
I n h e a v y t r a f f i c f o r a f e w m i n u t e s ; i f y o u h a v e a c a r
T O T A L
s a o P a u l o M e d i c a l J o u r n a l / R P M 1 1 3 ( 3 ) : 8 8 8 - 8 9 4 , 1 9 9 5 B A R B O S A , R . C . ; A L O E , F . ; T A V A R E S , s .& S I L V A , A . B . - M a n d i b u l a r - L i n g u a l R e p o s i t i o n i n g
893
. RESUMO
Introdu~ao: O s aparelhos bueais tem sido usados principalm ente para 0 tratam ento de roneos prim arios e sfndrom e da apneia obstrutiva do so no (SAO S) leve-m oderada. O s autores relatam resultados c1fnieos prelim inares em 8 pacientes com sfndrom e da apneia obstrutiva do sono diagnostieada elfniea e polissonografieam ente. Foram tratados com 0 Aparelho R eposieionador M andfbulo-Lingual (AR M L), desenvolvido por um dos autores (R C B). M aterial e M etodos: Foram realizados: eefalom etria pre-AR M L; eseala de sonolencia de Epw orth (ESE) pre e p6s-AR M L e questionario que quantifiea um a m elhora global subjetiva (M G S) do paciente. C ontroles foram obtidos 4 sem anas p6s-AR M L. R esultados: Am elhora global subjetiva foi de 73,75% em m edia e a eseala de sonoleneia de Epw oeth variou de 13,88 (pre-AR M L) para 6,63 (p6sAR M L) apresentando signifieancia estatfstiea (p=O ,05). O s autores diseutem os provaveis fatores envolvidos na m elhora da m edida subjetiva de sonoleneia exeessiva diu rna.
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