CASE STUDY 10

41 year old woman, habitual snorer, waking up 5 or more times a night, excessively tired and sleepy during the day, wakes with a dull headache. BMI of 30.7. Epworth score of 9.

Dynamic Nasopharyngoscopy

Narrow nasal passages, shallow velopharynx and hypopharynx that show moderate collapse with Muller's maneuver. Jaw thrust elevates soft palate and base of tongue.

Oximetry was reported as normal.

ODI of 25.2.

Diagnosis - Moderately Severe Hypopneic Obstructive Sleep Apnea

Treatment - The Silencer, an adjustable dental appliance that advances the mandible during sleep.

Outcomes - No longer snoring or waking up at night. No longer wakes up with a dull headache. Improved alertness and energy during the day. Epworth score has fallen to 4 from 9.

ODI of 1.4. Normal oximetry.

This case illustrates the following points:

• Oximetry with sampling and/or averaging over long intervals will obscure important detail and lead to incorrect diagnoses - the maximum acceptable sampling interval for assessing patients suspected of having OSA or a related condition is 4 seconds,
• Airway dilation on jaw thrust during dynamic nasopharyngoscopy predicts for success with mandibular advancement during sleep with a dental appliance.