Apnea obstructiva del sueño: reporte de caso y revisión de literatura
DOI:
https://doi.org/10.15517/3t3th077Palabras clave:
Apnea obstructiva del sueño; Cirugía ortognática; Avance maxilomandibular; Osteotomía Le Fort I; Rotación antihoraria; Osteotomía sagital bilateral mandibular; Reporte de caso.Resumen
La apnea obstructiva del sueño (AOS) es un trastorno del sueño causado por la obstrucción de la vía aérea superior durante el sueño, lo que provoca interrupciones en el flujo de aire. A pesar de su creciente prevalencia, la AOS continúa siendo ampliamente subdiagnosticada. Esta revisión de literatura y reporte de caso tiene como objetivo actualizar a la comunidad odontológica sobre el diagnóstico y manejo de la AOS, así como presentar el caso de una paciente tratada mediante un enfoque multidisciplinario que incluyó intervención quirúrgica. Se presenta el caso de una paciente de 27 años con una queja principal de ronquidos y proyección antiestética del mentón, asociados con somnolencia diurna, cefaleas, ronquido severo, y fatiga. La paciente presentaba un IMC de 32 kg/m², deformidad dentofacial clase II, retrognatia mandibular y AOS moderada (índice de apnea-hipopnea: 22), y fue tratada mediante avance maxilomandibular (MMA) con rotación antihoraria del plano oclusal, genioplastia y modificaciones del estilo de vida. La intervención resultó en una reducción del índice de apnea-hipopnea a 0.5 eventos/hora y en un resultado estético y funcional favorable. El control del peso a largo plazo continúa siendo fundamental para prevenir recurrencias, mientras que el seguimiento anual permite un monitoreo adecuado. Este caso respalda la evidencia existente sobre los beneficios de la corrección quirúrgica en pacientes apropiadamente seleccionados y destaca la importancia del manejo multidisciplinario en el tratamiento de la AOS.
Descargas
Referencias
Fujita S., Conway W., Zorick F., Roth T. Surgical correction of anatomical abnormalities in obstructive sleep apnea syndrome: uvulopalatopharyngoplasty. 1981; 89 (6): 923-34.
Schwartz M., Acosta L., Hung Y.L., Padilla M., Enciso R. Effects of CPAP and mandibular advancement device treatment in obstructive sleep apnea patients: a systematic review and meta-analysis. Vol. 22, Sleep and Breathing. Springer Verlag; 2018. p. 555-68.
William Arnett G., Bergman R.T., Santa Barbara M. Facial keys to orthodontic diagnosis and treatment planning-part H. Vol. 103, American Journal of Orthodontics and Dentofacial Orthopedics Founded in. 1915.
Gottsauner-Wolf S., Laimer J., Bruckmoser E. Posterior Airway Changes Following Orthognathic Surgery in Obstructive Sleep Apnea. Vol. 76, Journal of Oral and Maxillofacial Surgery. W.B. Saunders; 2018. p. 1093.e1-1093.e21.
Sharples L.D., Clutterbuck-James A.L., Glover M.J., Bennett M.S., Chadwick R., Pittman M.A., et al. Meta-analysis of randomised controlled trials of oral mandibular advancement devices and continuous positive airway pressure for obstructive sleep apnoea-hypopnoea. Vol. 27, Sleep Medicine Reviews. W.B. Saunders Ltd; 2016. p. 108-24.
Gottlieb D.J., Punjabi N.M. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA - J Am Med Assoc. 2020 Apr 14; 323 (14): 1389-400.
AlRumaih H.S., Baba N.Z., AlShehri A., AlHelal A., Al-Humaidan A. Obstructive Sleep Apnea Management: An Overview of the Literature. Vol. 27, Journal of Prosthodontics. Blackwell Publishing Inc.; 2018. p. 260-5.
Aarab G., Lobbezoo F., Hamburger H.L., Naeije M. Oral appliance therapy versus nasal continuous positive airway pressure in obstructive sleep apnea: A randomized, placebo-controlled trial. Respiration. 2011 Apr; 81 (5): 411-9.
Choi J.W., Jeong W.S., Kang M.K., Lee J.Y., Chung Y.S. Counterclockwise Rotational Orthognathic Surgery for the Obstructive Sleep Apnea in Class II Dentofacial Deformity: Polysomnography and 3D Computed Tomographic Analysis. Ann Plast Surg. 2021 Jun 1; 86 (6): 640-6.
Holty J.E.C., Guilleminault C. Maxillomandibular advancement for the treatment of obstructive sleep apnea: A systematic review and meta-analysis. Sleep Med Rev [Internet]. 2010; 14 (5): 287-97. Available from: http://dx.doi.org/10.1016/j.smrv.2009.11.003
Cheng A. Genioglossus and Genioplasty Advancement. Vol. 27, Atlas of the Oral and Maxillofacial Surgery Clinics of North America. W.B. Saunders; 2019. p. 23-8.
John C.R., Gandhi S., Sakharia A.R., James T.T. Maxillomandibular advancement is a successful treatment for obstructive sleep apnoea: a systematic review and meta-analysis. Vol. 47, International Journal of Oral and Maxillofacial Surgery. Churchill Livingstone; 2018. p. 1561-71.
Soose R.J. Novel Surgical Approaches for the Treatment of Obstructive Sleep Apnea. Vol. 11, Sleep Medicine Clinics. W.B. Saunders; 2016. p. 189-202.
Caples S.M., Rowley J.A., Prinsell J.R., Pallanch J.F., Elamin M.B., Katz S.G., et al. Surgical Modifications of the Upper Airway for Obstructive Sleep Apnea in Adults: A Systematic Review and Meta-Analysis. Sleep. 2010; 33 (10): 1396-407.
Zhou A., Li H., Wang X., Zhang J., Zhang Y., He J., et al. Preliminary comparison of the efficacy of several surgical treatments based on maxillomandibular advancement procedures in adult patients with obstructive sleep apnoea: a systematic review and network meta-analysis. Eur Arch Oto-Rhino-Laryngology. 2020 Feb 1; 278 (2): 543-55.
Lin H.C., Weaver E.M., Lin H.S., Friedman M. Multilevel Obstructive Sleep Apnea Surgery. Adv Otorhinolaryngol. 2017; 80: 109-15.
Zaghi S., Holty J.E.C., Certal V., Abdullatif J., Guilleminault C., Powell N.B., et al. Maxillomandibular Advancement for Treatment of Obstructive Sleep Apnea A Meta-analysis. JAMA Otolaryngol - Head Neck Surg. 2015; 142 (1): E1-9.
Ronchi P., Novelli G., Colombo L., Valsecchi S., Oldani A., Zucconi M., et al. Effectiveness of maxillo-mandibular advancement in obstructive sleep apnea patients with and without skeletal anomalies. Int J Oral Maxillofac Surg. 2010 Jun; 39 (6): 541-7.
Hupp J.R., Ellis E., Tucker M.R. Contemporary Oral and Maxillofacial Surgery. Sixth. St. Louis: ElSevier; 2014. 532-535 p.
Faria A.C., Xavier S.P., Silva S.N., Trawitzki L.V.V., De Mello-Filho F.V. Cephalometric analysis of modifications of the pharynx due to maxillo-mandibular advancement surgery in patients with obstructive sleep apnea. Int J Oral Maxillofac Surg [Internet]. 2013; 42 (5): 579-84. Available from: http://dx.doi.org/10.1016/j.ijom.2012.10.002
Butterfield K.J., Marks P.L.G., McLean L., Newton J. Linear and Volumetric Airway Changes After Maxillomandibular Advancement for Obstructive Sleep Apnea. J Oral Maxillofac Surg. 2015 Jun 1; 73 (6): 1133-42.
Abad V.C., Guilleminault C. Pharmacological Treatment of Obstructive Sleep Apnea. Vol. 17, Current Pharmaceutical Design. 2011.
Rueda J.R., Mugueta-Aguinaga I., Vilaró J., Rueda-Etxebarria M. Myofunctional therapy (oropharyngeal exercises) for obstructive sleep apnoea. Cochrane Database Syst Rev. 2020; 11 (11).
Camacho M., Certal V., Abdullatif J., Zaghi S., Ruoff C.M., Capasso R., et al. Myofunctional Therapy to Treat Obstructive Sleep Apnea: A Systematic Review and Meta-analysis. Sleep. 2015; 38 (5): 669-675A.
Gupta R.J., Kademani D., Stanley Y.C.L. Upper Airway (Hypoglossal Nerve) Stimulation for Treatment of Obstructive Sleep Apnea. Vol. 27, Atlas of the Oral and Maxillofacial Surgery Clinics of North America. W.B. Saunders; 2019. p. 53-8.
Zhu Y., Long H., Jian F., Lin J., Zhu J., Gao M., et al. The effectiveness of oral appliances for obstructive sleep apnea syndrome: A meta-analysis. Vol. 43, Journal of Dentistry. Elsevier Ltd; 2015. p. 1394-402.
Aarab G., Lobbezoo F., Hamburger H.L., Naeije M. Oral Appliance Therapy versus Nasal Continuous Positive Airway Pressure in Obstructive Sleep Apnea: A Randomized, Placebo-Controlled Trial. Respiration. 2011 Apr; 81 (5): 411-9.
Gagnier J.J., Kienle G., Altman D.G., Moher D., Sox H., Riley D., et al. The CARE guidelines: Consensus-based clinical case report guideline development. J Clin Epidemiol. 2014; 67 (1): 46-51.
Behrents R.G., Shelgikar A.V., Conley R.S., Flores-Mir C., Hans M., Levine M., et al. Obstructive sleep apnea and orthodontics: An American Association of Orthodontists White Paper. Am J Orthod Dentofac Orthop. 2019 Jul 1;156 (1): 13-28.e1.
Gottlieb D.J., Punjabi N.M. Diagnosis and Management of Obstructive Sleep Apnea: A Review. JAMA - J Am Med Assoc. 2020 Apr 14; 323 (14): 1380-400.
Susarla S.M., Thomas R.J., Abramson Z.R., Kaban L.B. Biomechanics of the upper airway: Changing concepts in the pathogenesis of obstructive sleep apnea. Vol. 39, International Journal of Oral and Maxillofacial Surgery. 2010. p. 1149-59.
Awad M., Gouveia C., Zaghi S., Camacho M., Liu S.Y.C. Changing practice: Trends in skeletal surgery for obstructive sleep apnea. Vol. 47, Journal of Cranio-Maxillo-Facial Surgery. Churchill Livingstone; 2019. p. 1185-9.
Shelton K.E., Woodson H., Gay S., Suratt P.M. Pharyngeal fat in obstructive sleep apnea. Am Rev Respir Dis. 1993; 148 (2): 462-6.
Eckert D.J., Malhotra A. Pathophysiology of adult obstructive sleep apnea. Proc Am Thorac Soc. 2008; 5 (2): 144-53.
Schendel S.A., Broujerdi J.A., Jacobson R.L. Three-dimensional upper-airway changes with maxillomandibular advancement for obstructive sleep apnea treatment. Am J Orthod Dentofac Orthop. 2014; 146 (3): 385-93.
Giles T., Lasserson T., Smith B., White J., Wright J., Cates C. Continuous positive airways pressure treatment for obstructive sleep apnoea in adults (Review). Cochrane Database Syst Rev. 2008; (3): 1-113.
Ngiam J., Balasubramaniam R., Darendeliler M.A., Cheng A.T., Waters K., Sullivan C.E. Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea. Vol. 58, Australian Dental Journal. 2013. p. 408-19.
Ng J.H., Yow M. Oral Appliances in the Management of Obstructive Sleep Apnea. Vol. 14, Sleep Medicine Clinics. W.B. Saunders; 2019. p. 109-18.
Furuhashi A., Yamada S., Shiomi T., Sasanabe R., Aoki Y., Yamada Y., et al. Effective three-dimensional evaluation analysis of upper airway form during oral appliance therapy in patients with obstructive sleep apnoea. J Oral Rehabil. 2013 Aug; 40 (8): 582-9.
Phillips C.L., Grunstein R.R., Darendeliler M.A., Mihailidou A.S., Srinivasan V.K., Yee B.J., et al. Health Outcomes of Continuous Positive Airway Pressure versus Oral Appliance Treatment for Obstructive Sleep apnea: A Randomized Controlled Trial. Am J Respir Crit Care Med. 2013; 187 (8): 879-87.
Okuno K., Sato K., Arisaka T., Hosohama K., Gotoh M., Taga H., et al. The effect of oral appliances that advanced the mandible forward and limited mouth opening in patients with obstructive sleep apnea: A systematic review and meta-analysis of randomised controlled trials. Vol. 41, Journal of Oral Rehabilitation. Blackwell Publishing Ltd; 2014. p. 542-54.
Gaisl T., Haile S.R., Thiel S., Osswald M., Kohler M. Efficacy of pharmacotherapy for OSA in adults: A systematic review and network meta-analysis. Sleep Med Rev [Internet]. 2019; 46: 74-86. Available from: https://doi.org/10.1016/j.smrv.2019.04.009
Wray C.M., Thaler E.R. Hypoglossal nerve stimulation for obstructive sleep apnea: A review of the literature. World J Otorhinolaryngol - Head Neck Surg [Internet]. 2016; 2 (4): 230-3. Available from: http://dx.doi.org/10.1016/j.wjorl.2016.11.005
Brevi B.C., Toma L., Pau M., Sesenna E. Counterclockwise rotation of the occlusal plane in the treatment of obstructive sleep apnea syndrome. J Oral Maxillofac Surg [Internet]. 2011; 69 (3): 917-23. Available from: http://dx.doi.org/10.1016/j.joms.2010.06.189
Patel P.K., Novia M.V. The Surgical Tools: The LeFort I, Bilateral Sagittal Split Osteotomy of the Mandible, and the Osseous Genioplasty. Clin Plast Surg. 2007; 34 (3): 447-75.
Yamashsita Y., Iwai T., Honda K., Fujita K., Imai H., Takasu H., et al. Effectiveness of subspinal Le Fort I osteotomy in preventing postoperative nasal deformation. J Plast Reconstr Aesthetic Surg [Internet]. 2020; 73 (7): 1326-30. Available from: https://doi.org/10.1016/j.bjps.2020.02.014
Kongsong W., Waite P.D., Sittitavornwong S., Schibler M., Alshahrani F. The correlation of maxillomandibular advancement and airway volume change in obstructive sleep apnea using cone beam computed tomography. Int J Oral Maxillofac Surg. 2021 Jul 1; 50 (7): 940-7.
Gil A.P.S., Machado-Fernández A., Guijarro-Martínez R., Hernández-Alfaro F., Haas O.L., de Oliveira R.B. Le Fort I osteotomy and soft tissue response: A retrospective cohort study comparing three different techniques. J Cranio-Maxillofacial Surg. 2022; 50 (2): 107-13.
Torres H.M., Valladares-Neto J., Torres É.M., Freitas R.Z., Garcia Silva M.A. Effect of Genioplasty on the Pharyngeal Airway Space Following Maxillomandibular Advancement Surgery. J Oral Maxillofac Surg. 2017; 75 (1): 189.e1-189.e12.
Kuşçu O., Süslü A.E., Özer S., Günaydin R.Ö., Öʇretmenoʇlu O., Önerci M. Sole effect of genioglossus advancement on apnea hypopnea index of patients with obstructive sleep apnea. Acta Otolaryngol. 2015; 135 (8): 835-9.
Descargas
Publicado
Número
Sección
Licencia
Derechos de autor 2026 Mauricio E. Muñoz-Pereira, Valeria Martínez-Archer.
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
ODOVTOS - Int. J. Dent. Sc. endorses CC BY-NC-SA
This license enables reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercial purposes only, and only so long as attribution is given to the creator. If you remix, adapt, or build upon the material, you must license the modified material under identical terms. CC BY-NC-SA includes the following elements:
BY: credit must be given to the creator.
NC: Only noncommercial uses of the work are permitted.
SA: Adaptations must be shared under the same terms.
