Effects of the Association of nCPAP and Tongue Positioner Device in OSAS Treatment: A Case Report

Study Objectives: Obstructive sleep apnea syndrome (OSAS) is a common disorder in middle-aged people associated with increased cardiovascular and cerebrovascular morbidity and mortality, excessive daytime somnolence, and impaired daytime cognitive function. Its management includes removal of risk factors (if feasible), nasal continuous positive airway pressure (nCPAP), surgical treatment (usually, reserved for cases in whom nCPAP failed), and, in non-severe cases, the application of oral appliances (mandible-advancement devices [MAD] or tongue positioner devices [TPD]). The beneficial effect of the association of TPD with nCPAP was investigated. Design: TPD associated with nCPAP was compared to other approaches: i.e., MAD, TPD alone, nCPAP alone. Patients: A 55-year-old man with moderate OSAS and a retrusive position of the mandible and the tongue. Interventions: series of polysomnographies and cephalometric evaluation. Measurements and Results: baseline parameters were: AHI (apnea-hypopnea index) 24.1 events/h, with 127 episodes of apnea (mean apnea period: 21.7 s), 90 episodes of hypopnea (mean hypopnea period: 37.2 s) and oxygen saturation (SpO2%) between 84% and 94%. The best improvements were obtained with nCPAP associated with TPD: AHI 2.3 events/h, 7 episodes of apnea (mean apnea period: 13 s), and SpO2% between 91% and 97%.