Sleep Disorders |

Oral Appliances (MAD) Effectiveness in SAHS Treatment According Facial Growth and Hyoid Bone Position FREE TO VIEW

Rafael Ecija, MD; Javier Jareño, MD; Alejandro Coca, MMed; Inmaculada Sierra, MD; Marta Dominguez, MD; Carlos Gutierrez Ortega, BS
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Universitary Central Hospital Gomez Ulla, Madrid, Spain

Chest. 2014;145(3_MeetingAbstracts):573A. doi:10.1378/chest.1824527
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SESSION TITLE: Sleep Posters

SESSION TYPE: Poster Presentations

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

PURPOSE: AIMS 1-To study the effect of the growth pattern in the treatment of SAHS by a MAD by the use of polysomnographic recordings. 2-To determine the effect of the growth pattern on the position of the hyoid bone in the SAHS treatment by a MAD.

METHODS: 63 Patients (49 males and 14 females) diagnosed with mild to moderate OSAS by the multidisciplinary sleep unit. Patients age range was 40 to 69 years old. The exclusion criteria were RDI > 30, any sign or symptom of temporomandibular joint disease, any clinical sign of periodontal disease and absence > 8 teeth for each jaw, Polisomnographic recordings: Patients slept two different nights. First one to obtain basal recordings. One month later, once patient had to be habituate to the MAD, had to sleep one night to check the MAD effectiveness. We analyzed respiratory disturbance index, desaturation index and the arousals index. Facial growth analysis: We realized one lateral skull radiographs to make the cephalometric analysis for each patient. We used Jarabak prescription. Patients were classified in Brachycephalic: 21 patients ( low facial height), Dolichofacial: 21 patients (hight facial height), and mesofacial: 21 patients (normal facial height).

RESULTS: Brachycephalic group reduce RDI (p<0,001), oxygen desaturation (p<0,001), arousal index (p<0,001). Mesocephalic group reduce RDI (p<0,001), oxygen desaturation (0,001) and the arousal index (p<0,012). Dolichocephalic patients didn’t reduce RDI (p=0,438) and oxygen desaturation (p=0,426), neither arousal index (p=0,981). Dolicocephalic growth patterns,the hyoid bone did not come forward with the use of a mandibular advancement appliance (p=0,571). On the other hand, in the brachicephalic and mesocephalic group hyoid bone move forward 4,7mm (p=0,002) and 3,7mm (p<0,001).

CONCLUSIONS: Facial growth has a deep impact in the DAM treatment efectiveness treating mild to moderate patients. The vertical growth pattern group didn’t improve basal polisomnographic recordings with DAM treatment. The hyoid bone doesn’t move forward in vertical facial patterns.

CLINICAL IMPLICATIONS: We have to do an exhaustive craniofacial study previously to beguin MAD therapy, cos MAD effectiveness is influenciated by facial growth.

DISCLOSURE: The following authors have nothing to disclose: Rafael Ecija, Javier Jareño, Alejandro Coca, Inmaculada Sierra, Marta Dominguez, Carlos Gutierrez Ortega

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