Dental Sleep Medicine Insider August 2016 | Page 16

MICHAEL GELB AND EDLIR DUME

PATIENT
TREATMENT
SUCCESS
With the Comfort and Tongue Space of the Micro Sleep Device
®

²

M

atching the patient with the
right oral appliance can be tricky.
Sometimes the first effort doesn’t’
work out and it’s important to stick
with the patient and have other options in your toolkit in order to get
the best compliance and outcomes.
Here are two case studies that may
shed some light on two types of patients that eventually were successfully treated with the MicrO2® Sleep
device.
CASE I – Gag Reflex and Large Tongue
Patient MF , a 73-year-old man, at his
first office visit, April 2015, reported
tiredness late in the day,. He has loss
of memory and needs to nap. He is
overweight. He has reflux and loud
snoring, as well as witnessed apneas. He had a polysomnogram performed on November 24, 2014, which
showed an AHI of 37.8. He was titrated for CPAP on the same day and
was brought up to 10 cm of H2O. Unfortunately, CPAP was unsuccessful.
The patient also was diagnosed with
atrial fibrillation on November 14,
2014, during the PSG. He also has leg
movements. The patient had a high
narrowed palate, enlarged tongue,
and a gag reflex. Because he was a
Medicare patient, we started off with
a Herbst appliance, which he could
not tolerate. We then decided to go
with a 3D printed appliance, which
was a Narval™ CC oral appliance (Fig

1). The Narval appliance was also
unsuccessful, and the patient could
not tolerate it. We then decided to
go to a MicrO2® Sleep Device (Fig 2),
as it is the thinnest appliance on the
market, lingually. MF was able to
tolerate this appliance and, as of December 17, 2015, we gave the patient
an ApneaLink Air home sleep test,
which showed an AHI of 7.2 and RDI
of 7.7 with an ODI of 8.6, a significant
reduction from the original AHI,
37.8. This is an incredible success in
that this patient could not tolerate
almost anything in his mouth; however, he was able to tolerate the MicrO2, which did produce good success in terms of his sleep study. In
terms of his symptoms, as of December 10, 2015, he was less tired during
the day. His memory was still the
same. He required less naps. There
was no snoring and no more witnessed apnea. Addressing the memory issues may involve some nutritional changes for the patient.

Figure 1, Narval CC Oral Appliance

CASE II - Anterior Teeth Pressure
Patient DB presented to us with a
sleep study that he had done in Connecticut Center for Sleep Medicine
at Stanford Hospital. It showed an
AHI of 32, and 6.9% of the time was
below 90% oxygen level. The ODI was
35. For the last two years, the patient
has felt pressure in his head, and this
may be causing him to be tired. He
has constant temple pain, which radiates into the TMJ and into the ear,
along with pressure. The patient is
now using CPAP. He has had four to
five different masks and currently
wears a DreamWear Mask; however,
he does not feel rested on awakening.
We evaluated the patient and found
exquisite tenderness in his right
temporomandibular joint, as well
as the right trapezius, right masseter, and right sternocleidomastoid.
There was compression and loading

Figure 2, Micro2® Sleep Device