Dados do Trabalho

Título

Effective treatment with mandibular advancement devices in comorbid insomnia and sleep apnea: a two step study on clinical, polysomnographic and cardiovascular risk

Introdução

One of the options for COMISA treatment is CPAP, which can fail. It is known that the mandibular advancement oral appliance (OAm) has efficacy and adherence in the treatment of OSA, however it has never been tested in COMISA patients.

Objetivo

To test whether OAm may be successful for treating COMISA patients both regarding respiratory parameters and insomnia and related cardiovascular risk.

Métodos

Two independently cohorts were addressed for testing: 1) whether OAm may improve OSA and insomnia in patients with COMISA; 2) whether OAm may improve cardiovascular risk in patients with COMISA. Cohort 1: patients with isolated Obstructive Sleep Apnea (OSA) (n=35; 51,4% males) and COMISA as defined by OSA+ Sleep Latency>30min (n=31; 58,1% males) derived from 3 different centers (Portugal, Spain and Brazil) were treated with OAm; Cohort 2: patients with COMISA, as defined by OSA + Sleep Latency>30min (n=12), were treated with titratable PMPositioner (OAm) and evaluated after 3 months of using OAm. Sleep variables were evaluated by PSG and Heart rate variability (HRV) as a surrogate of cardiac autonomic function was accessed and analyzed by rythmography, which stands on the HRV wave structure as a fingerprint of autonomic regulatory mechanism.

Resultados

Cohort 1: OSA and COMISA groups didn't differ neither regarding age (50,8±12,1 vs 54,8±8,1; p=0,12) and pre-treatment Apnea Hypopnea Index - AHI (26,9 ev/h±14,4 vs 25,2 ev/h±10,6; p=0,6). Post-treatment AHI remained slightly higher and above the normal threshold in COMISA group (6,4 ev/h±6,9) while achieving normal levels (<5/h) in OSA group (3,7 ev/h±3,2); p=0,04. Sleep latency significantly improved from 63,6±46 min to 22,8±20,8 min; p=0,001 in COMISA group without changes in OSA group; Cohort 2: COMISA patients (6 males), mean age= 49.7.The AHI was reduced from 22.7± 12.7 to 4.0± 3.5(p<0.0002) and sleep latency reduced from 63.1±49.4 to 21.8 ±21.4 (p<0.2), reaching a normal level. The time-domain and frequency–domain parameters were significant for RR interval (from 80730 to 93662) and both Fast Fourrier Transform (FFT) in parasympathetic area and Wavelet analysis spectral method (WVT) for sympathetic area, respectively.

Conclusões

OAm can be an effective tool for managing COMISA patients, with significant positive impact on respiratory and insomnia related therapeutic outcomes as well on the reduction of cardiovascular risk, as showed by the positive impact on the autonomic balance

Palavras -chave

comisa; sleep apnea; insomnia; oral appliance; autonomic balance.