Personalized medicine in the evaluation of sleep breathing disorders - The contribution of stomatology

Sleep breathing disorders (SBD), mainly obstructive sleep apnea (OSA), are very common. Therapy is mostly based on positive airway pressure ventilation (PAP), and its success largely depends on patient compliance. However, the idea “one size fits all” centered on PAP is misleading. The discomfort and change of personal image caused by masks, or the air pressure imposed by the equipment, jeopardizes patient9s adherence. Alternatives to PAP emerged and oral devices, although not first-line options, are valid in less severe cases or in patients that couldn’t adapt to PAP. Thus, to better suit therapy to a patient, pulmonology and stomatology should work as a team. We retrospectively assessed patients with SBD evaluated in outpatient day stomatology clinic from 2014 to September 2020. 98 patients, 72% males, were evaluated. Mean age was 55 yo. Snoring was the cause of the referencing in 28% of patients. 72% had OSA - 54% mild(n=38), 38% moderate(n=27) and 8% severe(n=6). All cases of severe OSA were referred to stomatology due to PAP intolerance. 14% of the OSA patients (n=10) were not candidates for mandibular advancement devices (MAD) - 7 due to absence of dental pieces and 3 due to temporomandibular joint instability. Five patients refused the device. Therapy with MAD was instituted in 45 patients, but 2 did not tolerate. Among the adherents to therapy, 65% (n=28) maintained a regular use of MAD. Reevaluation polysomnography with MAD was performed in 19 patients, and OSA correction was observed in 52%. The success rate of MAD therapy was higher in mild OSA. This study showed the importance of a multidisciplinary approach, encouraging the contribution of stomatology in SBD treatment.