Effect of a maxillary appliance in an adult with obstructive sleep apnea: a case report.

Patients who arrive at the dental office with a diagnosis of obstructive sleep apnea (OSA) are often managed with a mandibular advancement device (MAD). However, the use of MADs has been associated with temporomandibular joint (TMJ) issues. The authors describe a case report of a 64-year-old male who was treated with a novel, maxillary oral appliance. The baseline sleep study indicated an apnea-hypopnea index (AHI) of 25.6/hour with 28 episodes of snoring, and 30.9 oxygen desaturation events/hour. The patient wore the maxillary oral appliance for 10-12 hours/day and night. The midpalatal screw mechanism of the appliance was advanced once per week for six months. By the end of this time, the minimum intra-premolar width increased from 27 mm to 30 mm; the minimum intramolar width increased from 35 mm to 37 mm, and the AHI dropped to < 5/hour. During this phase of treatment, the episodes of snoring decreased to 18, and the oxygen desaturation events also decreased to 5.5/hour. After a total of 14 months, the AHI remained at < 5/hour, the episodes of snoring decreased further to 12, and the oxygen desaturation events decreased to 5.2/hour. Therefore, by achieving a > 80% decrease in the AHI, less snoring and an improvement in oxygen saturation after 14 months, the use of a maxillary oral appliance appears to have reached resolution of OSA in an adult male.