A Study on the Usefulness of Endoscopy to Oral Appliance Therapy in Obstructive Sleep Apnea
Motohiro Gotoh DDS, PhD, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Masahiro Nakajima PhD, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Yuichi Ohnishi DDS, PhD, Second Dept. of Oral and Maxillofacial Surgery, Osaka Dental University, Osaka, Japan
Hirohito Kubo DDS, PhD, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Hideya Haeniwa DDS, PhD, Second Department of Oral and Maxillofacial Surgery, Osaka Dental University, OSAKA, Japan
Katsuko Horii DDS, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Hitoshi Yoshimoto DDS, PhD, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Yuichi Shoju DDS, PhD, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Kenji Kakudo DDS, PhD, Second Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Yoshihide Ugaki Ph.D, 2nd Department of Oral and Maxillofacial Surgery, OSAKA DENTAL UNIVERSITY, OSAKA, Japan
Background : In treatmant for obstructive sleep apnea (OSA),Oral appliance (OA) therapy is indicated in patients of mild-moderate OSA and unable to tolerate continuous positive airway pressure (CPAP). The mandibular position is usually set by 60 to 70 percent of the maximum protrusion and setting the appropriate titration of OA is important because it is one of the factor to make the treatment effective or ineffective. However, there is no clear criteria for the setting, therefore we often face difficulties to decide the necessity of titration of OA regarding the cases with poor effectiveness in the treatment and to explain the treatment to patients. We used nasoendoscope on the cases which were clinically ineffective to OA treatment and assessed the results.
Methods : We conducted titration of OA on 15 cases in Osaka Dental University Hospital between 2012 and 2013, in which patients were administered OA treatment, diagnosed with OSA using polysomnography, and conducted titration of OA under ordinary method, but they were required to be observed on nasoendoscope due to persistent snoring and excessive daytime sleepiness. Regarding those cases, we conducted further titration of OA by reference to the findings. In a horizontal position during nasal respiration,a nasoendoscope was inserted in each patients.We evaluated changes in the airway of the velopharynx with mandibular advancement.
Results : Their mean age was 51.0 (±6.7)years, the mean body mass index (BMI)was 24.4(±3.0) and the mean apnea hypopnea index (AHI) was 21.5(±8.9). After the titration, clinical improvement was shown in 6 cases (6 males) whereas no clinical improvement was shown in 9 cases (5 males, 4 females).
Conclusion : It was concluded that nasoendoscope was effective to assess the cases which failed with the OA therapy clinically and to explain the therapy to patients.
