Palavras-chave
PMPositioner, aparato bucal, apnea del sueño, trastornos del sueño.
Como Citar
Uso del aparato bucal PMpositioner" en el tratamiento del ronquido y la apnea obstructiva del sueño. (2010). Odontoestomatología, 12(15), 39-45. https://odon.edu.uy/ojs/index.php/ode/article/view/220
Resumo
La elección de un aparato bucal apropiado para lograr los mejores resultados en el tratamiento de la apnea obstructiva del sueño es importante. El objetivo de este estudio fue evaluar el efecto de un aparato bucal específico, el PMPositioner, para el tratamiento del ronquido y la apnea obstructiva del sueño leve, a través de polisomnografía y la Escala de Epworth del sueño, después de seis meses de uso del mencionado aparato. Se incluyeron en el estudio 17 pacientes divididos en dos grupos: un grupo de roncadores integrado por 7 pacientes y otro grupo de 10 pacientes con apnea obstructiva leve. Los resultados fueron significativos para el segundo grupo, revelando una disminución en el índice de apnea-hipoapnea de 7,4 ± 5,0 a 3,0 ± 2,5 (p <0,05), un aumento de la saturación de oxígeno en un rango de 88,0 ± 6,0 a 90,0 ± 2,8 (p <0,05), aumento del sueño REM de 16,0±4,0 a 19±6,0 y una mejora de la somnolencia en la Escala Epworth de 12,5±5,4 a 7,4±2,4. Asimismo, se constató una disminución en los ronquidos y los síntomas subjetivos de acuerdo a lo informado por los pacientes y sus parejas. Se concluyó que el aparato bucal evaluado, PMPositioner, fue efectivo en el tratamiento de los ronquidos y la apnea obstructiva leve, así como en la reducción de la somnolencia y de otros síntomas.
Referências
American Academy of Sleep Medicine. Diagnostic and coding manual. 2nd ed. Westchester, Illinois: American Academy of Sleep Medicine; 2005. International classification of sleep disorders.
2. Ayappa I, Rapoport DM. The upper airway in sleep: physiology of the Pharynx. Sleep Medicine Reviews. 2003;7(1):9-33.
3. Mahfoud Y, Talih F, Streem D, Budur K. Sleep disorders in substance abusers: how common are they? Psychiatry (Edgmont). 2009; 6(9):38-42.
4. Shepard JW Jr, Gefter WB, Guilleminault C, Hoffman EA, Hoffstein V, Hudgel DW, Suratt PM, White DP. Evaluation of the upper airway in patients with obstructive sleep apnea. Sleep. 1991; 14(4):361-71. Review .
5. Chiu KL, Ryan CM, Shiota S, Ruttanaumpawan P, Arzt M, Haight JS, Chan CT, Floras JS, Bradley TD. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med. 2006; 174(12):1378-1383.
6. Tsuda H, Fastlicht S, Almeida FR, Lowe AA. The correlation between craniofacial morphology and sleep-disordered breathing in children in an undergraduate orthodontic clinic. Sleep Breath. 2010; DOI 10.1007/s11325-010-0345-4.
7. Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research- The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999; 22(5): 667-89.
8. Zias N, Bezwada V, Gilman S, Chroneou A Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor? Sleep Breath. 2009; 13: 3-10.
9. Provini F, Vetrugno R, Lugaresi E, Montagna P. Sleep-related breathing disorders and headache. Neurol Sci. 2006; 27 Suppl 2:S149-52.
10. Zamarron C, García Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med. 2008;19(6):390-8.
11. Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007; 11:1-22.
12. Lowe AA. Titratable Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea. J Can Dent Assoc. 1999; 65:571-4.
13. Vanderveken OM, Devolder A, MArklund M et al. Comparison of a Custom-made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea. Am J Respir Crit Care Med. 2008; 178:197–202.
14. Rose E, Staats R, Virchow C et al. A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod. 2002; 24:191-98
15. Coruzzi P, Gualerzi M, Bernkopf E, Brambilla V, Broia V, Lombardi C, Parati G. Autonomic Cardiac Modulation in Obstructive Sleep Apnea: Effect of an Oral Jaw-Positioning Appliance. Chest. 2006;130:1362-68.
16. Otsuka R, Almeida F R, Lowe A A, Linden W, Ryan F. A comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2006;129:222-9.
17. Tan Y K, L’estrange P R, Luo Y M, Smith C, Grant H R, Simonds A K. Mandibular Advancement Splints and Continuous Positive Airway Pression in Pacients with Obstructive Sleep Apnea: a mandibular randomized cross-over trial. Eur J Orthod. 2002; 24: 239-49.
18. Johnston C D, Gleadhill I C, Cinnamond M J, Gabbey J, Burden D J. Mandibular advancement appliance and OSA a randomized clinical trial. Eur J Orthod. 2002; 24:251-62.
19. Giannasi LC, Magini M, Oliveira CS, Oliveira LVF. Treatment of obstructive sleep apnea using an adjustable mandibular repositioning appliance fitted to a total prosthesis in a maxillary edentulous patient. Sleep Breath. 2008; 12(1):91-95.
20. Schimidt-Nowara W, Lowe A A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for treatment of snoring and sleep apnea a review. Sleep. 1995;18(6):501-510.
21. Lowe AA, Sjoholm T, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE. Treatment, airway, and compliance effects of titrattable oral appliance. Sleep. 2000; 23:172-78.
22. Giannasi LC, Magini M, Costa MS, Oliveira CS, Oliveira LVF. Oral appliance treatment for obstructive sleep apnea in partly edentulous patient. Am J Orthod Dentofacial Orthop. 2010; 137:548-51.
23. Kushida CA, Morgenthaler TI, Littner MR et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An update for 2005. Sleep. 2006; 29:240-43.
24. Johns, MW. Daytime sleepiness, snoring, and obstructive sleep apnea. Chest. 1993; 103:30-36.
25. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles: UCLA. Brain Information Service/Brain Research Institute, 1968.
26. Tsuiki S, Lowe AA, Almeida FR, Kawahata N, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir. 2004; 23:263-68.
27. Tsuik S, Lowe AA, Almeida FR, Fleethan JA. Effects of an anteriorly titrated mandibular position on awake airway and obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop. 2004;125:548-55.
28. Marklund M, Sahlin C, Stenlund H, Person M, Franklin KA. Mandibular advancement device in patient with obstructive sleep apnea: long-term effects on apnea and sleep. Chest. 2000;120:162-69.
29. Rose E, Mering L, Frucht S, Virchow C, Jonas IE. Oral Appliances in Patients with Obstructive Sleep Apnoea-Polysomnographic outcome. Eur J Orthod. 2000;22:456-57.
30. Wolk R, Ahamsuzzaman A, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension. 2003; 42:1067-74.
31. Isono S. Contribution of obesity and craniofacial abnormalities to pharyngeal collapsibility in patients with obstructive sleep apnea. Sleep and Biological Rythms. 2003;2:17-21.
32. Ward FW, McNicholas WT. Clinical prediction of the sleep apnea syndrome. Sleep Med Rev. 1997; 1: 19-32.
33. Walker-Engström ML, Ringqvist I, Vestling O, Wilhelmsson B, Tegelberg AA. Prospective Randomized Study Comparing Two Different Degrees of Mandibular Advancement with a Dental Appliance in treatment of Severe Obstructive Sleep Apnea. Sleep and Breath. 2003; 10:119-30.
34. Almeida FR, Bittencourt LR, de Almeida CIR, Tsuik S, Lowe AA, Tufik S. Effects on Mandibular Posture on Obstructive Sleep Apnea Severity and the Temporomandibular Joint in Patients Fitted with an Oral Appliance. Sleep. 2002; 25(5):505-11.
35. Johal A, Gill G, Ferman A, McLaughlin K. The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea. Clin Physiol Funct Imaging. 2007; 27:47–53.
2. Ayappa I, Rapoport DM. The upper airway in sleep: physiology of the Pharynx. Sleep Medicine Reviews. 2003;7(1):9-33.
3. Mahfoud Y, Talih F, Streem D, Budur K. Sleep disorders in substance abusers: how common are they? Psychiatry (Edgmont). 2009; 6(9):38-42.
4. Shepard JW Jr, Gefter WB, Guilleminault C, Hoffman EA, Hoffstein V, Hudgel DW, Suratt PM, White DP. Evaluation of the upper airway in patients with obstructive sleep apnea. Sleep. 1991; 14(4):361-71. Review .
5. Chiu KL, Ryan CM, Shiota S, Ruttanaumpawan P, Arzt M, Haight JS, Chan CT, Floras JS, Bradley TD. Fluid shift by lower body positive pressure increases pharyngeal resistance in healthy subjects. Am J Respir Crit Care Med. 2006; 174(12):1378-1383.
6. Tsuda H, Fastlicht S, Almeida FR, Lowe AA. The correlation between craniofacial morphology and sleep-disordered breathing in children in an undergraduate orthodontic clinic. Sleep Breath. 2010; DOI 10.1007/s11325-010-0345-4.
7. Sleep–Related Breathing Disorders in Adults: Recommendations for Syndrome Definition and Measurement Techniques in Clinical Research- The Report of an American Academy of Sleep Medicine Task Force. Sleep. 1999; 22(5): 667-89.
8. Zias N, Bezwada V, Gilman S, Chroneou A Obstructive sleep apnea and erectile dysfunction: still a neglected risk factor? Sleep Breath. 2009; 13: 3-10.
9. Provini F, Vetrugno R, Lugaresi E, Montagna P. Sleep-related breathing disorders and headache. Neurol Sci. 2006; 27 Suppl 2:S149-52.
10. Zamarron C, García Paz V, Riveiro A. Obstructive sleep apnea syndrome is a systemic disease. Current evidence. Eur J Intern Med. 2008;19(6):390-8.
11. Hoffstein V. Review of oral appliances for treatment of sleep-disordered breathing. Sleep Breath. 2007; 11:1-22.
12. Lowe AA. Titratable Oral Appliances for the Treatment of Snoring and Obstructive Sleep Apnea. J Can Dent Assoc. 1999; 65:571-4.
13. Vanderveken OM, Devolder A, MArklund M et al. Comparison of a Custom-made and a Thermoplastic Oral Appliance for the Treatment of Mild Sleep Apnea. Am J Respir Crit Care Med. 2008; 178:197–202.
14. Rose E, Staats R, Virchow C et al. A comparative study of two mandibular advancement appliances for the treatment of obstructive sleep apnoea. Eur J Orthod. 2002; 24:191-98
15. Coruzzi P, Gualerzi M, Bernkopf E, Brambilla V, Broia V, Lombardi C, Parati G. Autonomic Cardiac Modulation in Obstructive Sleep Apnea: Effect of an Oral Jaw-Positioning Appliance. Chest. 2006;130:1362-68.
16. Otsuka R, Almeida F R, Lowe A A, Linden W, Ryan F. A comparison of responders and nonresponders to oral appliance therapy for the treatment of obstructive sleep apnea. Am J Orthod Dentofacial Orthop. 2006;129:222-9.
17. Tan Y K, L’estrange P R, Luo Y M, Smith C, Grant H R, Simonds A K. Mandibular Advancement Splints and Continuous Positive Airway Pression in Pacients with Obstructive Sleep Apnea: a mandibular randomized cross-over trial. Eur J Orthod. 2002; 24: 239-49.
18. Johnston C D, Gleadhill I C, Cinnamond M J, Gabbey J, Burden D J. Mandibular advancement appliance and OSA a randomized clinical trial. Eur J Orthod. 2002; 24:251-62.
19. Giannasi LC, Magini M, Oliveira CS, Oliveira LVF. Treatment of obstructive sleep apnea using an adjustable mandibular repositioning appliance fitted to a total prosthesis in a maxillary edentulous patient. Sleep Breath. 2008; 12(1):91-95.
20. Schimidt-Nowara W, Lowe A A, Wiegand L, Cartwright R, Perez-Guerra F, Menn S. Oral appliances for treatment of snoring and sleep apnea a review. Sleep. 1995;18(6):501-510.
21. Lowe AA, Sjoholm T, Ryan CF, Fleetham JA, Ferguson KA, Remmers JE. Treatment, airway, and compliance effects of titrattable oral appliance. Sleep. 2000; 23:172-78.
22. Giannasi LC, Magini M, Costa MS, Oliveira CS, Oliveira LVF. Oral appliance treatment for obstructive sleep apnea in partly edentulous patient. Am J Orthod Dentofacial Orthop. 2010; 137:548-51.
23. Kushida CA, Morgenthaler TI, Littner MR et al. Practice parameters for the treatment of snoring and obstructive sleep apnea with oral appliances: An update for 2005. Sleep. 2006; 29:240-43.
24. Johns, MW. Daytime sleepiness, snoring, and obstructive sleep apnea. Chest. 1993; 103:30-36.
25. Rechtschaffen A, Kales A. A Manual of Standardized Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Los Angeles: UCLA. Brain Information Service/Brain Research Institute, 1968.
26. Tsuiki S, Lowe AA, Almeida FR, Kawahata N, Fleetham JA. Effects of mandibular advancement on airway curvature and obstructive sleep apnoea severity. Eur Respir. 2004; 23:263-68.
27. Tsuik S, Lowe AA, Almeida FR, Fleethan JA. Effects of an anteriorly titrated mandibular position on awake airway and obstructive sleep apnea severity. Am J Orthod Dentofacial Orthop. 2004;125:548-55.
28. Marklund M, Sahlin C, Stenlund H, Person M, Franklin KA. Mandibular advancement device in patient with obstructive sleep apnea: long-term effects on apnea and sleep. Chest. 2000;120:162-69.
29. Rose E, Mering L, Frucht S, Virchow C, Jonas IE. Oral Appliances in Patients with Obstructive Sleep Apnoea-Polysomnographic outcome. Eur J Orthod. 2000;22:456-57.
30. Wolk R, Ahamsuzzaman A, Somers VK. Obesity, sleep apnea, and hypertension. Hypertension. 2003; 42:1067-74.
31. Isono S. Contribution of obesity and craniofacial abnormalities to pharyngeal collapsibility in patients with obstructive sleep apnea. Sleep and Biological Rythms. 2003;2:17-21.
32. Ward FW, McNicholas WT. Clinical prediction of the sleep apnea syndrome. Sleep Med Rev. 1997; 1: 19-32.
33. Walker-Engström ML, Ringqvist I, Vestling O, Wilhelmsson B, Tegelberg AA. Prospective Randomized Study Comparing Two Different Degrees of Mandibular Advancement with a Dental Appliance in treatment of Severe Obstructive Sleep Apnea. Sleep and Breath. 2003; 10:119-30.
34. Almeida FR, Bittencourt LR, de Almeida CIR, Tsuik S, Lowe AA, Tufik S. Effects on Mandibular Posture on Obstructive Sleep Apnea Severity and the Temporomandibular Joint in Patients Fitted with an Oral Appliance. Sleep. 2002; 25(5):505-11.
35. Johal A, Gill G, Ferman A, McLaughlin K. The effect of mandibular advancement appliances on awake upper airway and masticatory muscle activity in patients with obstructive sleep apnoea. Clin Physiol Funct Imaging. 2007; 27:47–53.