Toshihiko Mikami1,2, Tadaharu Kobayashi3, Daichi Hasebe3, Yasuyoshi Ohshima4, Tetsuya Takahashi5, Takayoshi Shimohata6. 1. Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan. t-mikami@dent.niigata-u.ac.jp. 2. Department of Dentistry and Oral Surgery, Niigata Medical Center, Niigata, Japan. t-mikami@dent.niigata-u.ac.jp. 3. Division of Reconstructive Surgery for Oral and Maxillofacial Region, Faculty of Dentistry & Graduate School of Medical and Dental Sciences, Niigata University, 2-5274 Gakkocho-Dori, Chuo-ku, Niigata, 951-8514, Japan. 4. Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. 5. Department of Neurology, National Hospital Organization Nishiniigata Chuo Hospital, Niigata, Japan. 6. Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan.
Abstract
PURPOSE: A recent study demonstrated that continuous positive airway pressure (CPAP) may exacerbate obstructive sleep apnea (OSA) in patients with multiple system atrophy (MSA) and a floppy epiglottis (FE) as the CPAP promotes downward displacement of the epiglottis into the laryngeal inlet. In this case series, we examined the effectiveness of an oral appliance (OA) for treating OSA in three patients with MSA and an FE. METHODS: Patients with MSA were demonstrated to have an FE on fiberoptic laryngoscopy under sedation using intravenous propofol. The therapeutic intervention was fitting an OA. Polysomnography (PSG) was performed subsequently with the OA in place. RESULTS: In three patients with MSA, some parameters used to assess the severity of OSA improved with an OA. Both apnea-hypopnea index (AHI) and arousal index (ArI) decreased while wearing the OA in two cases while in the third case, apnea index (AI) and cumulative time at peripheral oxygen saturation (SpO2) below 90% (CT90) decreased, but AHI and ArI increased. The only side effects were transient TMJ discomfort, masseter muscle pain, and tooth discomfort. CONCLUSION: OA therapy using a two-piece type mandibular advancement device (MAD) may be a useful treatment intervention for patients with OSA who have MSA and FE.
PURPOSE: A recent study demonstrated that continuous positive airway pressure (CPAP) may exacerbate obstructive sleep apnea (OSA) in patients with multiple system atrophy (MSA) and a floppy epiglottis (FE) as the CPAP promotes downward displacement of the epiglottis into the laryngeal inlet. In this case series, we examined the effectiveness of an oral appliance (OA) for treating OSA in three patients with MSA and an FE. METHODS: Patients with MSA were demonstrated to have an FE on fiberoptic laryngoscopy under sedation using intravenous propofol. The therapeutic intervention was fitting an OA. Polysomnography (PSG) was performed subsequently with the OA in place. RESULTS: In three patients with MSA, some parameters used to assess the severity of OSA improved with an OA. Both apnea-hypopnea index (AHI) and arousal index (ArI) decreased while wearing the OA in two cases while in the third case, apnea index (AI) and cumulative time at peripheral oxygen saturation (SpO2) below 90% (CT90) decreased, but AHI and ArI increased. The only side effects were transient TMJ discomfort, masseter muscle pain, and tooth discomfort. CONCLUSION: OA therapy using a two-piece type mandibular advancement device (MAD) may be a useful treatment intervention for patients with OSA who have MSA and FE.
Authors: S Gilman; P A Low; N Quinn; A Albanese; Y Ben-Shlomo; C J Fowler; H Kaufmann; T Klockgether; A E Lang; P L Lantos; I Litvan; C J Mathias; E Oliver; D Robertson; I Schatz; G K Wenning Journal: J Neurol Sci Date: 1999-02-01 Impact factor: 3.181
Authors: Phillip A Low; Stephen G Reich; Joseph Jankovic; Clifford W Shults; Matthew B Stern; Peter Novak; Caroline M Tanner; Sid Gilman; Frederick J Marshall; Frederick Wooten; Brad Racette; Thomas Chelimsky; Wolfgang Singer; David M Sletten; Paola Sandroni; Jay Mandrekar Journal: Lancet Neurol Date: 2015-05-27 Impact factor: 44.182