CASE STUDY 6
47 year old man investigated at UBC at age 43 and found to have Severe OSA (AHI of 75.5). PSG performed on "Smart CPAP" showed incomplete response with AHI of 30.1. A third PSG with CPAP titration showed elimination of obstructive events at a pressure of 7. He declined CPAP and had a UPPP with minor improvement in symptoms. PSG was not performed to determine if AHI was improved. He was then fitted with a dental appliance that he wore nightly for 3 years. He presented for evaluation because of continued excessive fatigue and sleepiness. He continued to snore, even while wearing the dental appliance. BMI of 27.5. Epworth score of 11.
Post - UPPP with excessive lateral collapse, inadequate splinting of the upper airway by the dental appliance.
With Muller's maneuver
With jaw thrust
With dental appliance in place
Muller's maneuver with dental appliance in place
Oximetry While Wearing the Dental Appliance
Diagnosis - Severe OSA despite use of dental appliance. ODI of 52.
Treatment - Auto - CPAP with base pressure of 6.
Oximetry on Auto - CPAP
Treatment Outcomes - The patient is using the CPAP daily for an average of 6.7 hours each time. He reports increased energy and alertness. ODI of 7.5 on Auto - CPAP of 6, pressure went as high as 8. Epworth score of 5.
This case illustrates the following:
In a UPPP, the tonsils are excised and the palatopharyngeus and palatoglossus are sewed together. This can compromise the beneficial effects of mandibular advancement by:
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