Predictors of success for mandibular repositioning appliance in obstructive sleep apnea syndrome

The characteristics of non-obese patients with mild to moderate Obstructive Sleep Apnea Syndrome (OSAS) who will present with a good response to Mandibular Repositioning Appliance (MRA) treatment have not yet been well established in the literature. The aim of this study is to assess whether polysomnographic (PSG), demographic, anthropometric, cephalometric, and otorhinolaryngological parameters predict MRA success in the treatment of OSAS. Forty (40) males with mild and moderate OSAS were assessed pretreatment and 2-months post-treatment after wearing an MRA. Demographic, anthropometric, otorhinolaryngological (ENT), cephalometric, and polysomnographic parameters, including continuous positive airway pressure (CPAP) titrated pressure, dental models, Epworth Sleepiness Scale, quality of life (Short Form SF-36), and mood state (Profile of Mood States - POMS), were assessed. The responders exhibited fewer oropharyngeal alterations, increased upper pharyngeal space, reduced lower airway space, and increased mandibular intercanine width, and they had milder disease. Nevertheless, no predictive factors of MRA success could be found. MRA was more successful among men with a more pervious airway, a larger interdental width and milder OSAS. However, a combined [1] functional and structural assessment is needed to successfully predict the [2] effectiveness of MRA treatment of OSA.Univ Fed Uberlandia, Sch Odontol, Dept Oclusao Protese Fixa & Mat Odontol, Uberlandia, MG, BrazilUniv Fed Sao Paulo Unifesp, Sch Med, Dept Psicobiol, Sao Paulo, SP, BrazilUniv British Columbia, Dept Oral Hlth, Vancouver, BC, CanadaUniv Fed Uberlandia, Sch Med, Dept Pneumol, Uberlandia, MG, BrazilUniversidade Federal de São Paulo – Unifesp, School of Medicine, Department of Psicobiologia, São Paulo, SP, BrazilWeb of Scienc

Assessment of interobserver concordance in polysomnography scoring of sleep bruxism

Introduction: Objective evaluation of sleep bruxism (SB) using whole-night polysomnography (PSG) is relevant for diagnostic confirmation. Nevertheless, the PSG electromyogram (EMG) scoring may give rise to controversy, particularly when audiovisual monitoring is not performed. Therefore, the present study assessed the concordance between two independent scorers to visual SB on a PSG performed without audiovisual monitoring. Methods: Fifty-six PSG tests were scored from individuals with clinical history and polysomnography criteria of SB. In addition to the protocol of conventional whole-night PSG, electrodes were also placed bilaterally on the masseter and temporal muscles. Visual EMG scoring without audio video monitoring was scored by two independent scorers (Dentist 1 and Dentist 2) according the recommendations formulated in the AASM manual (2007). Kendall Tau correlation was used to assess interobserver concordance relative to variables “total duration of events (seconds), “shortest events”, “longest events” and index in each phasic, tonic or mixed event. Results: The correlation was positive and significant relative to all the investigated variables, being T>0.54. Conclusion: It was found a good inter-examiner concordance rate in SB scoring in absence of audio video monitoring