Sleep Disorders |

Mandibular Advancement Device (MAD) in Patients With Obstructive Sleep Apnea Syndrome (OSAS), Who Don't Tolerate the Continuous Positive Airways Pressure (CPAP) FREE TO VIEW

Maria Pavón, MD; Estefania Luque, MD; Jose María Benitez, MD; Jesús Sánchez, MD; Andrés Vega Arias, MD; Teodoro Montemayor, MD
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Virgen Macarena Hospital, Seville, Spain

Chest. 2014;145(3_MeetingAbstracts):593A. doi:10.1378/chest.1801677
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SESSION TYPE: Poster Presentations

PRESENTED ON: Saturday, March 22, 2014 at 01:15 PM - 02:15 PM

PURPOSE: The most suitable treatment for OSAS is the CPAP. However there are patients who don't tolerate it. A therapeutic not surgical alternative is MAD . It consists of a plastic rod which being introduced in dental arcades produces the advance of the jaw and indirectly the advance of the tongue, hyoid and suprahyoidea musculature. All this implies a space and permeability increase of the top airway. Our objective is to evaluate the efficiency of the MAD, Herbst type, as a treatment for OSAS. This evaluation will be carried out by means of clinic and functional variables.

METHODS: Patients diagnosed with OSAS by means of respiratory polygraphy, with indication of treatment with CPAP, who don't tolerate it after two revisions. There are sent to Maxillofacial Surgery to follow the protocol of MAD. The patients who completed the treatment have an appointment to: 1) Determine the body mass index (BMI) and the Epworth somnolence test and compare them with the initial values 2) Carry out a polygraphy with MAD which will be compared with the previous polygraphy for the analysis of the following variables: Apnea-hypopnea index for hour (AHI), Desaturation index for hour (DI), Snores index for hour (SI).

RESULTS: 25 patients fulfill the requirement for MAD. 17 men and 3 women completed the treatment with average age of 52 +/-12 (from 27 to 70 years old). 12 of them had a serious OSAS, 6 a moderate OSAS and 2 of them had a resistance increased of the top airway syndrome. See the following table. 2 patients started the treatment with MAD in 2006; other 2 in 2007; 4 in 2008; 5 in 2009 and 7 in 2010. The BMI average before the treatment was 30.20 and after it 29.53; without statistically significant differences. All the variables decreases significantly. AHI decrease from 37.21 to 20.42; DI from 31.9 to 19.8 and Epworth from 12.90 to 9.45. The snores index decrease from 62.35 to 38.5, which is not statistically significant. The correlations among the variables are significant for 1)Epworth and AHI 2)AHI and DI 3)Snores and AHI differences.

CONCLUSIONS: The use of MAD could be a suitable option for the treatment of OSAS in patients who don't tolerate CPAP.

CLINICAL IMPLICATIONS: The use of MAD like other treatment for OSAS in patients who don't tolerate CPAP.

DISCLOSURE: The following authors have nothing to disclose: Maria Pavón, Estefania Luque, Jose María Benitez, Jesús Sánchez, Andrés Vega Arias, Teodoro Montemayor

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