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Treatment Guideline For Adult Obstructive Sleep Apnea Patients In Perspective Of Sleep Function And Facial Aesthetics Seung Hak Baek. Episode 48. IOC 2020

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Farooq Ahmed

Classification of phenotype in adults An 2020

  1. Obesity type
    1. 50%
    2. Moderate OSA, Obese – BMI 25+, no skeletal discrepancy, no soft tissue abnormality
    3. Treatment: Weight loss, sleep hygiene
  2. Skeletal type
    1. 33%
    2. Moderate OSA, severe skeletal 2, high angle, narrow pharyngeal space
    3. Treatment: Craniofacial modification, MAS or surgery
  3. Complex
    1. 16%
    2. Severe OSA, combining features of 1 and 2
    3. Treatment: Craniofacial modification, MAS or surgery

 

Cause of OSA

  1. Anatomical factors
  2. Poor response of upper airway muscles
  3. Low arousal threshold to airway
  4. Unstable ventilation control

Respiratory physician for 2-4

 

Mandibular advancement splint

  • Enlarge upper airway
  • Prevent from collapse
  • Can produce occlusal changes
  • TMJ should be healthy
  • Patient non-compliance: year 1 25%, year 5 63% Soose 2017

 

CPAP Vs MAS

  • CPAP more effective at reducing AHI scores Cammaroto 2017

Orthognathic surgery

  • Posterior impaction alone does not trigger OSA
  • Posterior impaction and maxillary set back can trigger OSA
  • Maxillary-mandibular counter clockwise rotation increased airway space

 

RME and SARPE Systematic RV Adbulatif 2016

  • RME: Improvement of 60% AHI
  • SARPE: improvement of 77%
  • MARPE (miniscrew assisted expansion) can be used for nasopharyngeal obstruction

 

Seung proposed a segmental MMA for protrusive maxillary cases

  • Extraction of 4s at the time of surgery
  • Advancement of posterior segment
  • Maintain anterior segment in AP position
  • BSSO advancement

 

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