Improvement in daytime sleepiness by the use of an oral appliance in a pateint with upper airway resistance syndrome

Abstract

This case report details the treatment outcome of an oral appliance (OA) used in a patient suffering from excessive daytime sleepiness (EDS) caused by an upper airway resistance syndrome (UARS). The patient demonstrated significant improvement in the multiple sleep latency test (MSLT) and the maintenance of wakefulness test (MWT) after treatment with an OA. The presented case suggests that an OA may be considered as a further treatment option for UARS.

Treatment of upper airway resistance syndrome in adults: Where do we stand?

“…From the 17 articles analyzed, 4 were about CPAP treatment [1,23,24,25] , 1 about drug treatment [26] , 1 about CPAP and surgery [27] , 1 was about rapid palatal expansion [28] , 4 about surgery [22–32] , 5 about oral device treatment [33–37] and 1 about external nasal device [38] . The definition of UARS also varied.…”

“…Other studies only considered objective parameters from sleep study. The polysomnographic parameters considered were AHI less than 5–15 events/hour (10 studies) [24,25,27,28,31,32,34,35,37,38] , RDI<5–10 events/hour (3 studies) [29,30,33] , RDI>5 events/hour (2 studies) [31,35] , Pes more negative than 10 or 20 mmH 2 O (8 studies) [1,23,24,27,29,30,33,35] , total arousal index (TAI)>5–15 events/hour (7 studies) [1,24,25,33,34,35,38] , the presence of excessive daytime sleepiness or fatigue or snoring (9 studies) [22,25,26,29,30,32,33,36,38] and presence of RERA or flow limitation (3 studies). [25,27,28] …”

“…There are some case reports [33–36] and a prospective study [39] published about oral device as UARS treatment. Some authors noticed polysomnographic differences, such as a decrease in the total arousal index (TAI) [33,34,37] , a less negative mean Pes [33,34] , an improvement in sleep efficiency [37] and lower oxygen saturation [37] . A significant increase in the mean sleep latency in the MSLT [34,35] and an absence of sleep during the Maintenance of Wakefulness Test (MWT) was also observed [34] .…”

“…Some authors noticed polysomnographic differences, such as a decrease in the total arousal index (TAI) [33,34,37] , a less negative mean Pes [33,34] , an improvement in sleep efficiency [37] and lower oxygen saturation [37] . A significant increase in the mean sleep latency in the MSLT [34,35] and an absence of sleep during the Maintenance of Wakefulness Test (MWT) was also observed [34] . Oral appliance also decreased subjective daytime sleepiness [33,37] and snoring [33] .…”