Dados do Trabalho

Título

FOLLOW-UP OF A CHALLENGING CASE OF SEVERE OBSTRUCTIVE SLEEP APNEA TREATED WITH MANDIBULAR ADVANCEMENT DEVICE IN THE COVID-19 PANDEMIC.

Introdução

The non-adherence of continuous positive airway pressure (CPAP) for obstructive sleep apnea syndrome (OSAS) patients therapy is typical. A physician must consider a mandibular advancement device (MAD) option for these patients; although CPAP is more effective in AHI improvement, MAD is more acceptable. Polysomnography (PSG) is a mandatory laboratory sleep study for diagnosed and monitored OSAS patients; however, the test is expensive, time-consuming, and challenging to access, mainly in COVID -19 pandemic. A potential problem in Dental Sleep Medicine is some patients do not accept undergoing a second PSG study to monitor MAD follow-up therapy. For these patients, BIOLOGIX, a Nocturnal Digital monitoring (NDM) with high-resolution oximetry with an accurate OXISTAR® sensor, sleep study type IV out-of-center, provides diagnostic performance in OSA severity detection. Although there are few published studies, here we present a challenging case report of OSAS treated with MAD.

Objetivo

The aim of this challenging case report is to present the MAD therapy for severe OSAS and the NDM out-of-center sleep study in followed-up during the COVID-19 pandemic.

Métodos

The case report was a 44-year-old male, caucasian, with a BMI of 40.12 with OSAS of 131.7 ev/hours. The patient was non-adherent to CPAP therapy and submitted for all-night sleep recordings PSG type I to monitor the MAD follow-up. The patient presented excessive daytime sleepiness, non-restorative sleep, respiratory allergy, difficulty nasal breathing, snoring, OSA, and a sedentary lifestyle. The clinical history included prediabetes, hypertension, gastroesophageal reflux disease, nasal polyps, and septum deviation. In clinical examination, he showed macroglossia, Mallampati, and Brodsky classifications of IV and 2, respectively. He presented good mandibular dynamic and neuromuscular stimulus-response. He was treated with MAD, followed up by a multidisciplinary team, and monitored with NDM during the COVID-19 pandemic.

Resultados

The severe OSA was successfully controlled with MAD to15.3 ev./h. The action mode of MAD supported the airway patency during sleep, and the NDM confirmed it with an oxygen desaturation index of 5.2 ev./h.

Conclusões

In this challenging case, we followed up OSAS patient during a COVID-19 pandemic with NDM, maintaining good results with a multidisciplinary team to optimize the outcome.

Palavras -chave

Interdisciplinarity. Orthoses. Obstructive Sleep Apnea. Polysomnography. Oximetry. Follow-Up Studies.