Dispositivos intraorales utilizados para el tratamiento de la apnea obstructiva del sueño en pacientes edéntulos. Revisión de la literatura y bases de patentes / Intraoral Devices for OSA Treatment in Edentulous Patients. Literature and Patents Datebase Review

Introducción: la apnea obstructiva del sueño (AOS) se considera un problema de salud pública que afecta en gran medida a hombres y mujeres entre 50 y 70 años de edad, donde en ocasiones son, además, pacientes edéntulos, lo cual dificulta su tratamiento. Objetivo: identificar los aparatos intraorales existentes para tratar la AOS leve y moderada en pacientes edéntulos. Metodología: se buscó literatura sobre el tema en bases de datos y de patentes. Resultados: se encontraron cinco artículos y dos patentes. El objetivo terapéutico de todos los dispositivos es aumentar la vía aérea superior entre la bsise de la lengua y la pared posterior de la faringe, mediante el avance mandibular. Dentro de las principales desventajas que presentan estos dispositivos están falta de retención, dificultad para mantener la dimensión vertical, problemas musculares y trastornos en la articulación temporomandibular. Conclusión: existen pocos dispositivos intraorales efectivos en la literatura para el tratamiento de la AOS en pacientes edéntulos. Esto hace necesario diseñar futuras investigaciones en esta área.

Introduction: The Obstructive Sleep Apnea (OSA) is considerad a problem of World Public Health that greatly affects men and women between ¿0 and 70 years oíd, where some of them are edentulous patients which treatment difficulty. Objective: lo identiíy the existing devices for mild and modérate OSA treatment ¿n edentulous patients. Method: A comprehensiva review was conducted in the literatura and patent databases. Results: 5 articles and 2 patents were round. The main therapy objective ¿n all devices is to increase the upper airway space between the tongue base and the posterior pharyngeal wall trough mandibular advancement. Several problems with use of these devices inelude lack retention, difficult for maintain the vertical dimensión, muscular discomfort and Temporomandibular Disorders. Conclusión: There are limited effective ¿ntraoral devices in literatura for OSA treatment in edentulous patients. It is necessary to design futura investigations in this area.

Melatonin prevents hyperglycemia in a model of sleep apnea

Objective Obstructive sleep apnea is a common disorder associated with aging and obesity. Apneas cause repeated arousals, intermittent hypoxia, and oxidative stress. Changes in glucolipidic profile occur in apnea patients, independently of obesity. Animal models of sleep apnea induce hyperglycemia. This study aims to evaluate the effect of the antioxidants melatonin and N-acetylcysteine on glucose, triglyceride, and cholesterol levels in animals exposed to intermittent hypoxia. Materials and methods Two groups of Balb/c mice were exposed to intermittent hypoxia (n = 36) or sham intermittent hypoxia (n = 36) for 35 days. The intermittent hypoxia group underwent a total of 480 cycles of 30 seconds reducing the inspired oxygen fraction from 21% to 7 ± 1% followed by 30 seconds of normoxia, during 8 hours daily. Melatonin or N-acetylcysteine were injected intraperitonially daily from day 21 on. Results At day 35, glucose levels were significantly higher in the intermittent hypoxia group than in the control group. The intermittent hypoxia groups receiving N-acetylcysteine and vehicle showed higher glucose levels than the group receiving melatonin. The lipid profile was not affected by intermittent hypoxia or antioxidant administration. Conclusions The present results suggest that melatonin prevents the well-recognized increase in glucose levels that usually follows exposure to intermittent hypoxia. Further exploration of the role of melatonin in sleep apnea is warranted. Arch Endocrinol Metab. 2015;59(1):66-70 .

Anti-oxidant treatment in obstructive sleep apnoea syndrome.

Purpose. To investigate whether oral intake of N-acetylcysteine (NAC) is a treatment option in patients with obstructive sleep apnoea syndrome (OSAS). Methods. Twenty patients with OSAS were enrolled in the study. After polysomnography (PSG), they were randomly assigned to receive a placebo (n=10) and NAC (n=10). A repeat PSG was done after the treatment period of 30 days. Fasting venous samples were collected for various biochemical analysis. Results. In the patients of NAC group, compared to their baseline values, slow wave sleep as sleep percent time (27.9±2.7 vs 42.3±4.2; p<0.01) and sleep efficiency (90.8±1.3 vs 94.4±1.5; p<0.05) improved considerably. The apnoea-hypopnoea index (61.2±8.5 vs 43.1±8.6; p<0.05), apnoea related arousals (22.2±7.6 vs 11.6±4.7; p<0.05), longest apnoeic episode duration (seconds) (54.9±7.1 vs 37.8±5.6; p<0.01), oxygen desaturation events per hour (51.8±7.7 vs 37±7.8; p<0.01) and epworth sleepiness score (16.6±0.8 vs 9.2±0.9; p<0.001) decreased significantly. The relative snore time (%) (10.2±2.9 vs 4.9±1.9; p<0.01), number of snore episodes (63.8±23.9 vs 28.2±9.9; p<0.05) and duration of longest snore episode (min) (2.5±0.7 vs 0.6±0.1; p<0.05) also decreased significantly. Such responses were not evident in the placebo group. N-acetylcysteine produced significant decrease in lipid peroxidation and increase in total reduced glutathione. Conclusions. Oral NAC administration appears to have a therapeutic potential in the treatment of OSAS. It is proposed that long-term treatment with NAC in patients with OSAS may reduce their dependency on continuous positive airway pressure therapy.