Protesi orale nella terapia delle apnee ostruttive: un'esperienza personale

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Summary Background. The application of a continuous positive airway pressure (CPAP) to opening airway is the treat- ment of choice for the obstructive sleep apnea (OSA) but sometimes it is not well tolerated by the patient. The mandibular advancement device (MAD) is a promising alternative therapy for the treatment of OSA in patients with mild to moderate disease. Aim. Evaluate the effectiveness and adherence of MAD in patients with moderate to severe OSA. Methods. Patients with OSA who did not tolerate the CPAP, with a reduction of the oropharyngeal diameters and who were not candidate for a surgical intervention were treated with a custom-made MAD. Results. From 1 st February to 31 st December 2006, 243 subjects who underwent diagnostic home polygraphy for suspected OSA. Of these, 34.6% presented an AHI 30. Of the 104 patients undergoing CPAP, 15 (14.4%) did not tolerate the treatment, and underwent 7 to surgical pro- cedures and 8 custom-made MAD. MAD and CPAP resulted in similar reduction of Epworth-score and apnea index and in similar improvement of oxygenation. These results remained unchanged during the follow-up at 3, 12 and 36 months. Adherence to treatment with MAD was high in the first 12 months, but significantly reduced at 36 months. Conclusions. MAD can be considered as an alternative therapy to CPAP in patients with moderate to severe sleep apnea syndrome. The adherence to the treatment appears to be linked to a frequent follow-up of the patient.

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