title: Clinical co-morbidities in obstructive sleep apnea syndrome treated with mandibular repositioning appliance.
abstract: BACKGROUND
  Intraoral mandibular repositioner appliances (IOMRAs) are designed to enlarge pharyngeal airway space advancing the mandible and increasing genioglossus tone during sleep. Obstructive sleep apnea syndrome (OSAS) treatment with IOMRAs is beneficial, but there is a lack of studies in the literature defining the target population more inclined to respond to this treatment.
  
  
  METHODS
  We contacted by telephone 188 previously treated patients with IOMRA, detecting 20 not improved patients (Study Group). Twenty improved patients of the remaining 168 were randomly paired according to gender, age, apnea, and hypopnea index as Control Group. Both groups answered questionnaires for diagnosis of sleep disorders, depression, anxiety, and the Epworth sleepiness scale. We did a descriptive and inferential statistical analysis. The inferential analysis was divided into two steps: univariate analysis using Fischer exact test and a multiple inferential analysis using a stepwise regression model.
  
  
  RESULTS
  Although the final model included only insomnia, we concluded that the presence of gastric, neurological and rheumatic diseases also tended to be associated with the self-perception of non-improvement. The association between the accumulation of gastric, neurological, and rheumatic diseases and insomnia and improvement demonstrated that an increase in one of these diseases correspond to a two-fold increase in the chance of non-improvement.
  
  
  CONCLUSIONS
  Insomnia was the most important factor compromising the success of OSAS treatment with IOMRAs, and the isolated presence of gastric, neurological and rheumatic diseases, but especially their combination, reduces the perception rate of well-succeeded treatment with IOMRAs.
authors.affiliation: Department of Medicine, Federal University of Sao Paulo, Rua Pedro de Toledo, 980 cj 145, CEP 04039-002 SP, Brazil. macmachado@uol.com.br
authors.forename: Marco Antonio Cardoso
authors.initials: MA
authors.lastname: Machado
authors.forename: Luciane Bizari Coin
authors.initials: LB
authors.lastname: de Carvalho
authors.forename: Maria Ligia
authors.initials: ML
authors.lastname: Juliano
authors.forename: Marcel
authors.initials: M
authors.lastname: Taga
authors.forename: Lucila Bizari Fernandes
authors.initials: LB
authors.lastname: do Prado
authors.forename: Gilmar Fernandes
authors.initials: GF
authors.lastname: do Prado
mesh_terms: D000202:Activator Appliances; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D017286:Polysomnography; D012044:Regression Analysis; D012216:Rheumatic Diseases / Q000150:complications; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000523:psychology / Q000628:therapy*; D013272:Stomach Diseases / Q000150:complications; D016896:Treatment Outcome