Oral appliances: An odds-on in obstructive sleep apnoea management

Breathing affiliated with sleep disorders usually lies between simple snoring without sleepiness, upper airway resistance syndrome, obstructive sleep apnoea (OSA) syndrome, and hypercapnic respiratory failure. Of all these, OSA is very often accompanied with morning symptoms and extension of comorbidities and mortalities with a high prevalence rate. General health implications and an altered quality of living are the major setbacks. Mostly patients with neurologic disorders are affected. There are many surgical and non-surgical approaches concerned with its management. This review article provides a description of oral appliances along with recent treatment modalities, clinical efficacy of alternative treatment modalities of OSA patients.

The Role of Myofunctional Therapy in Treating Sleep-Disordered Breathing: A State-of-the-Art Review

Myofunctional therapy (MFT) may have a role in improving muscle tone and alleviating upper airway collapse in sleep-disordered breathing. The purposes of this state-of-the-art review are to first review systematically the current literature on the effectiveness of MFT in treating sleep-disordered breathing and then to provide an overview of the current understanding of patient selection, side effects, type and duration of exercises, guidance of exercise performance, evaluation of results, and how best to promote adherence. PubMed (Medline), the Cochrane Library, and the EMBASE, Scopus and SciELO databases were checked for relevant studies by three authors, and a total of 23 studies were included. This review focuses only on adults with sleep-disordered breathing. The available evidence shows a positive effect of MFT in reducing sleep apnoea, as measured using polysomnography and clinical variables (including snoring). There is no evidence of the utility of MFT for treating upper airway resistance syndrome, the duration of the effects of MFT, or regarding which MFT protocol is best. Despite these knowledge gaps, the available evidence suggests that MFT is a safe treatment modality.

391 Upper Airway Resistance Syndrome is associated with high Cyclic Alternating Pattern

Introduction Upper Airway Resistance Syndrome (UARS) is suspected in individuals with excessive daytime sleepiness, fatigue, and sleep fragmentation associated with increased respiratory effort. UARS can negatively impact daytime function. Conventional polysomnography parameters do not demonstrate significant abnormalities in UARS patients but increase in RERAs and arousal index. Cyclic alternating pattern (CAP) is a periodic electroencephalogram activity of non-REM sleep that expresses a condition of sleep instability. The objective of the study was to compare CAP components between UARS patients and health individuals. Methods Fifteen subjects with UARS and 15 age- and sex- matched controls had their sleep study blinded analyzed. UARS criteria were the presence of sleepiness (Epworth Sleepiness Scale – ESS - ≥ 10) and/or fatigue (Modified Fatigue Impact Scale ≥ 38) associated with an apnea/hypopnea index (AHI) ≤ 5 and a respiratory disturbance index (RDI) > 5 events/hour of sleep, and/or flow limitation in more than 30% of total sleep time. Control group criteria were AHI < 5 events/hour, RDI ≤ 5 events/hour and < 30% of TST with flow limitation and ESS < 10, without sleep, clinical, neurological, or psychiatric disorder. CAP electroencephalogram of both groups was analyzed. Results We found higher CAP rate (p = 0.05) and CAP index in N1 stage (p < 0.001) and in N3 stage (p < 0.001) in UARS patients compared to control group. Considering only CAP phase A1 analysis, UARS patients presented higher CAP rate (p = 0.05) and CAP index in N1 stage (p < 0.001) as well as CAP index in N3 stage (p < 0.001) compared to control group. Considering only CAP phase A2 analysis, UARS patients also presented higher number of CAP in N1 stage (p = 0.05). There was no significant difference for CAP phase A3 between groups. Conclusion Although UARS is associated with high arousal index, we found increase in CAP phase A1 and A2, which do not include necessarily AASM arousals, suggesting not only sleep fragmentation but also sleep instability. Support (if any) Associação Fundo de Incentivo à Pesquisa (AFIP) and Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP).