Effect of maxillary appliance in an adult with obstructive sleep apnea: a case report.

Keywords:  Obstructive sleep apnea, OSA, apnea-hypopnea index, AHI, snoring, oral appliance, maxillary oral appliance, temporomandibular joint disorder, TMD, TMJ, sleep study, and CPAP.

In this case report, a 64-year-old male with obstructive sleep apnea (OSA) was treated with a maxillary oral appliance. A baseline sleep study was conducted and an apnea-hypopnea index (AHI) of 25.6 per hour with 28 episodes of snoring and 30.9 oxygen desaturation events per hour was recorded. After wearing the maxillary oral appliance for 10-12 hours per day and night for six months, with the midpalatal screw being advanced once per week, the patients AHI dropped to 5/hour. Also improving were his episodes of snoring (decreasing to 18) and his oxygen desaturation events (decreasing to 5.5 per hour). Overall, the patient achieved an 80% decrease in AHI, improved oxygen saturation, and experienced less snoring episodes. Dr. Stan Farrell of Scottsdale, Arizona has extensive training in treating sleep apnea and other sleep disorders. AZ TMJ offers one of the leading alternatives for the CPAP, which is an oral appliance that can be used in conjunction with a CPAP or as a stand-alone oral appliance depending on the severity of the individual’s OSA. If you think you might be suffering from obstructive sleep apnea and have experienced compliance issues with the CPAP, call Dr. Farrell at 480-945-3629 to set your consultation and visit AZ TMJ at www.headpaininstitute.com.

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Abstract: Patients who arrive at the dental office with a diagnoseis of obstructive sleep apnea (OSA) are often managed with a mandibular advancement device (MAD). However, the use of MAD’s has been associated with temporomandibular joint (TMJ) issues. The authors describe a case report of a 64-year-old male who was treated with a novel, maxillary oral appliance. The baseline sleep study indicated an apnea-hypopnea index (AHI) of 25.6/hour with 28 episodes of snoring, and 30.9 oxygen desaturation event/hour. The patient wore the maxillary oral appliance for 10-12 hours/day and night. The midpalatal screw mechanism of the appliance was advanced once per week for six months. By the end of this time, the minimum intra-premolar width increased from 27mm to 30mm; the minimum intramolar width increased from 35mm to 37mm, and the AHI dropped to > 5/hour. During this phase of treatment, the episodes of snoring decreased to 18, and the oxygen desaturation events also decreased to 5.5/hour. After a total of 14 months, the AHI remained at > 5/hour, the episodes of snoring decreased further to 12, and the oxygen desaturation events decreased to 5.2/hour. Therefore, by achieving a > 8-% decrease in the AHI, less snoring and an improvement in oxygen saturation after 14 months, the use of a maxillary oral appliance appears to have reached resolution of OSA in an adult male.