EPRAM/MARPE and Obstructive Sleep Apnea
38-year-old female patient. Chronic mouth breathing, unable to breathe through the nose.
Followed by a pulmonologist for known obstructive sleep apnea.
Apnea-hypopnea index is 111/h in supine position (lying on her back) and 42/h when lying on her side.
She has worn a mandibular anvance brace which has been effective, but which she found cumbersome. She uses a CPAP calibrated to a pressure of 5-6 cm of water, which reduces the apnea index to 1/h.
She consulted an oral surgeon, as she was looking for a definitive solution and wanted, one day, to no longer need to use a CPAP. The surgeon referred her to orthodontics for a major orthosurgical treatment of maxillary expansion followed by bimaxillary advancement surgery.
The expansion phase was performed with a bicortical bone anchorage appliance (MSE). This device enabled maxillary disjunction to be achieved without the need for surgical assistance.
Interestingly, this lady asked for a new polysomnography.
It shows that the supine index is now 69/h and the side-lying index is 24.5/h.
PS: this case is the same as the one published on April 13, except that in April, I didn’t have the information about the 2nd polysomnography.