CASE REPORT   

Minerva Pneumologica 2020 June;59(2):38-40

DOI: 10.23736/S0026-4954.20.01870-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Treatment of severe obstructive sleep apnea with mandibular advancement appliance after phenotyping the patient

Valentina CONTI ¹ ✉, Silvia RULI ², Mei RULI ², Enrico ROSSI ¹

¹ Division of Pneumology, State Hospital, San Marino, Republic of San Marino; ² Department of Geriatrics Care and Pneumology, State Hospital, San Marino, Republic of San Marino

Treatment with a mandibular advancement device (MAD) is recommended for mild to moderate obstructive sleep apnea (OSA) and for primary snoring because it has better adherence and acceptance than continuous positive airway pressure (CPAP) that is the first-line treatment. In fact CPAP is often poorly tolerated. Approximately 50% or more of all OSA patients who are prescribed CPAP either do not use it at all or on average use it for less than four hours per night and another substantial proportion of people refuse to even try CPAP therapy (1). A correct phenotyping of the patient which takes into consideration anatomical and non-anatomical characteristics could change the therapeutic approach in OSA and could extend the use of second line therapies such MAD and upper airway surgery. Following we present case of a 49-year-old Caucasian with a diagnosis of severe OSA associated to nocturnal respiratory failure. The patient did not tolerate CPAP and after an analysis detailed of the polygraphy started therapy with MAD. MAD is considered a second line therapy in OSA but if it is used in specific cases it can give the same results of CPAP.

KEY WORDS: Sleep apnea, obstructive; Mandibular advancement; Continuous positive airway pressure