Preditores de diagnóstico e avaliação da eficácia do aparelho intraoral de avanço mandibular no tratamento da apneia obstrutiva do sono grave

Abstract

Obstructive sleep apnea (OSA) is considered a respiratory disorder characterized by repetitive episodes of partial or total collapse of the upper airway during sleep. The oral appliance therapy (OAT) is a therapeutic option for the treatment of OSA. The aim of this study was to analyze possible anthropometric and cephalometric diagnostic predictors in individuals with severe OSA. The effectiveness of the mandibular advancement AIO in the treatment of severe OSA was also evaluated. Thirty-six patients with severe OSA participated in this retrospective study and were treated with an individualized titratable mandibular advancement AIO. The effectiveness of the treatment was evaluated using type I polysomnography (PSG), which were performed before (T0) and after treatment with AIO (T1). Cephalometric analysis indicated the presence of a hyperdivergent face and a mandible with micrognathia and retrognathia. Decreased upper and middle pharyngeal space in men and women; with reduced lower air space only in women. PSG after AIO therapy showed that the mean apnea hypopnea index (AHI) decreased from 41.67 to 12.14 (p<0.001). Minimum saturation increased from 81% to 84% (p=0.004*). The desaturation index reduced from 20.91 e/h to 8.76 e/h (p=0.002*) and the arousal index improved from 32 e/h to 20 e/h (p=0.001*). This work showed that 25% (n=9) of individuals with severe OSA, treated with the mandibular advancement OA, had a final AHI ≤ 5 e/h; 50% (n=18) had a final AHI between 5 - 15 e/h; 8.33% (n=3) had a final AHI > 15 e/h, with a reduction of more than 50% from the baseline value and in 16.66% (n=6) of the participants there was a reduction in the final AHI < 50 % in relation to baseline value.