Clinical management of a severe case of positional obstructive sleep apnea syndrome

Obstructive sleep apnea syndrome (OSAS) is a common disorder which involves upper airway collapse during sleep. Positional Obstructive Sleep Apnoea Syndrome is a sub-type of OSAS characterized by obstructive apneas mainly in the supine sleeping position. Mandibular advancement devices (MAD) are recommended as first-line therapy for mild to moderate OSA or as second-line treatment for severe OSA for patients who do not tolerate or respond to CPAP. A case report of severe positional OSAS (AHI/h 34.7) is presented. The clinical case was studied by CBCT head and neck scan and nocturnal polysomnography and treated with a mandibular advancement device, positional therapy, dietary adjustments and instructions for proper sleep hygiene. After the treatment the patient’s AHI decreased to 5.1 and his general health improved. The MAD appliance represents a valid therapeutic alternative in subjects with severe OSAS who do not tolerate CPAP. A combined approach to the pathology can improve the patient’s overall health and quality of life.