title: Treatment of obstructive sleep apnea syndrome in patients from a teaching hospital in Brazil: is it possible?
abstract: OBJECTIVE
  The aim of this study was to evaluate the efficacy of a cost-effective intra-oral appliance for obstructive sleep apnea syndrome built into a large teaching hospital.
  
  
  METHODS
  Out of 20 evaluated and treated patients, 14 concluded the study: eight men and six women, with a mean age of 42-46 (mean + SD) years and mean body mass index of 27.66. Inclusion criteria were mild or moderate apnea-hypopnea index (AHI) according to a polysomnographic study. All patients were treated with the monobloco intra-oral appliance. They were then submitted to a follow-up polysomnographic study after 60 days using the appliance. An orofacial clinical evaluation was carried out with the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) questionnaire and with clinical evaluation questionnaire devised by the Orofacial Pain Team before and 60 days after fitting the intra-oral appliance.
  
  
  RESULTS
  The AHI showed a statistically meaningful (p = 0.002) reduction from 15.53 to 7.82 events per hour, a non-statistically significant oxygen saturation increase from 83.36 to 84.86 (p = 0.09), and Epworth's sleepiness scale reduction from 9.14 to 6.36 (p = 0.001). Three patients did not show any improvement. The most common side effect during the use of the appliance/device was pain and facial discomfort (28.57%), without myofascial or temporomandibular joint pain as evaluated by the RDC/TMD questionnaire.
  
  
  CONCLUSIONS
  The intra-oral device produced a significant reduction of the apnea-hypopnea index during the study period with the use of the monobloco intra-oral appliance. Patients did not show prior myofascial pain or 60 days after use of the intra-oral appliance.
authors.affiliation: Central Institute, Hospital das Clínicas, University of Sao Paulo, Brazil.
authors.forename: Ana Laura Polizel
authors.initials: AL
authors.lastname: Ranieri
authors.forename: Sumatra Melo Costa Pereira
authors.initials: SM
authors.lastname: Jales
authors.forename: Gilberto Guanaes Simões
authors.initials: GG
authors.lastname: Formigoni
authors.forename: Flávio Sadurny
authors.initials: FS
authors.lastname: de Alóe
authors.forename: Stella Márcia Azevedo
authors.initials: SM
authors.lastname: Tavares
authors.forename: José Tadeu Tesseroli
authors.initials: JT
authors.lastname: Siqueira