1. CASE PRESENTATION

2.  THOMAS M. GOTSIS DDS FAGD  MIDWEST DENTAL SLEEP MEDICINE INSTITUTE @ SSM DEPAUL HEALTH CENTER  BOARD OF DIRECTORS MISSOURI SLEEP SOCIETY

3.  "I have no relevant financial relationships to disclose”.

4. Successful therapies of sleep disordered breathing decrease the collapsibility of the pharyngeal airway. American Academy of Sleep Medicine

7. The most common type of treatment is CPAP (continuous positive air pressure) Although highly effective, patients are frequently non-compliant with CPAP Other treatments include oral appliances, surgery and weight loss 7

9.  The TAP I & II & III  Developed by Dr. Keith Thornton  FDA approved for OSA  Pro’s  Fine protrusive adjustability (.25mm)  Variety of acrylics, comfortable  Some lateral mobility (TAP II)  Con’s  Advancement mechanism may slightly intrude on tongue space The TAP I The TAP III

20. ADVANTAGESDISADVANTAGES LAVIGNE, GJ, CISTULLI, PA, SMITH MT, "Sleep Medicine for Dentists", Quintessence Publishing Co., 2009, p. 62. Non-Invasive Non-Invasive Free of radiation Free of radiation Reproducible Reproducible Dynamic imaging modality Dynamic imaging modality No weight limitation No weight limitation Performed with patient in sitting position Performed with patient in sitting position Performed through patient’s mouth (modification of the upper airway anatomy) Performed through patient’s mouth (modification of the upper airway anatomy) Does not provide direct information on airway structures or geometry Does not provide direct information on airway structures or geometry

21. Pick-ups Microphone

22. Oropharyngeal Junction, OPJ Oropharynx Epiglottis Oral Cavity Hypopharynx 2-D Pharyngometer readings

23. Mandible is Advanced - Dilation

29.  Patient had hx of chest pains.  ESS=14  Snoring was keeping spouse from sleeping.  Did not feel refreshed upon wakening.  Excessive daytime sleepiness.

30. AHI=30 events/hr

31. Pt is CPAP-intolerant and is referred for OAT.

32.  Follow-up PSG:  Occasional breakthrough snoring.  AHI=.2 events/hr  At 6 month recare the patient wearing MAD nightly. So compliance=100%