著者

奥野 健太郎 野原 幹司 尾花 綾 佐々生 康宏 加藤 紀子 阪井 丘芳

出版者

特定非営利活動法人 日本睡眠歯科学会

雑誌

睡眠口腔医学 (ISSN:21886695)

巻号頁・発行日

vol.2, no.2, pp.115-120, 2016

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Objectives: We present a case of severe obstructive sleep apnea(OSA) in which oral appliance(OA) therapy had no significant efficacy and there was poor compliance of continuous positive airway pressure (CPAP) therapy related to pressure intolerance, but in which combination therapy of OA and CPAP reduced optimal pressure and improved compliance.<br>Methods: The patient was a 69-year-old man with no significant past medical history who was diagnosed as having severe obstructive sleep apnea (AHI: 92.5/h, lowest SpO2: 82%) by polysomnography (PSG). We recommended CPAP therapy due to the severe OSA, but the patient refused this therapy and desired OA therapy. First, OA therapy was applied to this patient. After OA insertion for 2 months, the patient reported reduction of snoring and wore the OA comfortably; the efficacy of OA therapy in OSA was evaluated by PSG.<br>Results: PSG under OA showed an improvement of OSA in AI from 81.3/h to 33.1/h, but residual findings in AHI: 73.2/h. Secondly, we adopted CPAP therapy because of inadequacy of the efficacy of OA therapy. In PSG with CPAP titration, optimal pressure is 17cmH2O. After wearing CPAP for 3 months, the patient reported insomnolence because of discomfort of airflow from CPAP. The data of compliance of CPAP therapy were actual days utilized: 54.8%, compliance per day: 3 h 45 min, and % of days utilized ≥ 4 h/d (%): 23.8%. We considered that a cause of the poor compliance of CPAP therapy was that the optimal pressure was too high. Thirdly, we adopted combination therapy of OA and CPAP for the purpose of reducing the optimal pressure of CPAP. The optimal pressure with CPAP titration PSG wearing OA decreased from 17cmH2O to 11cmH2O. The combination therapy showed improvement of compliance in terms of actual days utilized from 54.8% to 96.8%, in terms of compliance per day from 3 h 45 min to 4 h 8 min, and in terms of % of days utilized ≥ 4 h/d from 23.8% to 54.8%.<br>Conclusions: This report suggests that wearing an OA decreased the optimal pressure of CPAP and improved the compliance of CPAP therapy for severe OSA. It is important that, in the selection of treatment for patients with OSA, we adopt not only OA therapy or CPAP therapy, but also combination therapy of OA and CPAP.