title: Three-piece oral appliance with herbst attachments for persistent vegetative state patient with sleep-disordered breathing.
abstract: OBJECTIVE
  Persistent vegetative state is a form of wakefulness without awareness. This report describes a dental appliance for the treatment of sleep breathing disorders in this condition. The device can be easily inserted and removed by the patient's family or nurse.
  
  
  METHODS
  A 19-year-old woman had been in a persistent vegetative state since having hypoxic-ischemic encephalopathy because of cardiopulmonary arrest. Although she exhibited a sleep-wake cycle and normal respiration, she had sleep apnea and snoring, and produced snoring-like sounds even in an awake state. A three-piece device with Herbst attachments was fabricated to treat the symptoms. Overnight sleep studies were carried out to evaluate the effectiveness of the appliance.
  
  
  RESULTS
  The device could be handled by the patient's family. Snoring was satisfactorily reduced after insertion of the device. Sleep apnea, desaturation, and minimal oxygen saturation were markedly improved.
  
  
  CONCLUSIONS
  If the family of a persistent vegetative state patient wishes to treat sleep-disordered breathing, the appliance may be helpful as an alternative to relieve the symptoms. The device could be applied for sleep apnea patients who experience difficulties using other types of oral appliances.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Graduate School of Medicine, Kyoto University, Japan. kyoshida@kuhp.kyoto-u.ac.jp
authors.forename: Kazuya
authors.initials: K
authors.lastname: Yoshida
authors.forename: Kiwako
authors.initials: K
authors.lastname: Sakamoto
authors.forename: Akira
authors.initials: A
authors.lastname: Takagi
authors.forename: Tadahiko
authors.initials: T
authors.lastname: Iizuka
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D016382:Orthodontic Appliance Design; D017289:Orthodontic Appliances, Functional; D018458:Persistent Vegetative State / Q000150:complications*; D012891:Sleep Apnea Syndromes / Q000628:therapy*; D012913:Snoring / Q000628:therapy