Hostname: page-component-cd9895bd7-p9bg8 Total loading time: 0 Render date: 2024-12-28T15:10:19.017Z Has data issue: false hasContentIssue false
  • English
  • Français

Never say never: circumventing a contraindication to control apnoea-induced epileptic events with a mandibular advancement device

Published online by Cambridge University Press:  05 November 2018

J E Fenton ,
C Fitzgerald ,
P J Dillon  and
D O'Shea
J E Fenton*
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, University of Limerick Medical School, Limerick, Ireland
C Fitzgerald
Affiliation:
Department of Otorhinolaryngology and Head and Neck Surgery, University of Limerick Medical School, Limerick, Ireland
P J Dillon
Affiliation:
Department of Anaesthesia, University of Limerick Medical School, Limerick, Ireland
D O'Shea
Affiliation:
Department of Restorative Dentistry, St Camillus' Hospital, Limerick, Ireland
*
Author for correspondence: Prof J E Fenton, Dept of ORL-HNS, UL GEMS, Dooradoyle, Limerick, Ireland E-mail: johnefenton@eircom.net
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

The benefit of mandibular advancement devices in patients with sleep-disordered breathing and as a potential option for obstructive sleep apnoea syndrome is well recognised. Their use in the setting of epilepsy or other seizure disorders is typically contraindicated.

Case report

A 48-year-old patient with a history of poorly controlled epilepsy and obstructive sleep apnoea syndrome was referred for ENT review for possible tracheostomy. The patient was wheelchair-bound with 24-hour continuous positive airway pressure, but sleep studies demonstrated persistent, severe episodes of apnoea and notable sleep disturbance. Sleep nasendoscopy demonstrated marked improvement on capnography with the laryngeal mask airway in situ, and this was maintained with mandibular advancement using jaw thrust following removal of the laryngeal mask airway. A mandibular advancement device was subsequently trialled; this had no subjective benefit for the patient, but the seizures resolved and control of apnoea was achieved with the combination of a mandibular advancement device and continuous positive airway pressure.

Conclusion

This paper highlights a novel application of mandibular advancement devices, used in combination with continuous positive airway pressure, which resulted in complete resolution of sleep deprivation and apnoea-induced epileptic events.

Keywords

Mandibular AdvancementObstructive Sleep ApneaContinuous Positive Airway PressureEpilepsyObesityTracheostomy
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 11 , November 2018 , pp. 1036 - 1038
Copyright
Copyright © JLO (1984) Limited, 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Prof J E Fenton takes responsibility for the integrity of the content of the paper

References

1Virk, JS, Kotecha, B. Otorhinolaryngological aspects of sleep-related breathing disorders. J Thorac Dis 2016;8:213–23Google Scholar
2Sheller, B. Orthodontic management of patients with seizure disorders. Semin Orthod 2004;10:247–51Google Scholar
3Pancer, J, Al-Faifi, S, Al-Faifi, M, Hoffstein, V. Evaluation of variable mandibular advancement appliance for treatment of snoring and sleep apnea. Chest 1999;116:1511–18Google Scholar
4Marklund, M, Franklin, KA, Stenlund, H, Persson, M. Mandibular morphology and the efficacy of a mandibular advancement device in patients with sleep apnoea. Eur J Oral Sci 1998;106:914–21Google Scholar
5Takaesu, Y, Tsuiki, S, Kobayashi, M, Komada, Y, Nakayama, H, Inoue, Y. Mandibular advancement device as a comparable treatment to nasal continuous positive airway pressure for positional obstructive sleep apnea. J Clin Sleep Med 2016;12:1113–19Google Scholar
6Cistulli, PA, Gotsopoulos, H, Marklund, M, Lowe, AA. Treatment of snoring and obstructive sleep apnea with mandibular repositioning appliances. Sleep Med Rev 2004;8:443–57Google Scholar
7Schmidt-Nowara, W, Lowe, A, Wiegand, L, Cartwright, R, Perez-Guerra, F, Menn, S. Oral appliances for the treatment of snoring and obstructive sleep apnea: a review. Sleep 1995;18:501–10Google Scholar
8Denbar, MA. A case study involving the combination treatment of an oral appliance and auto-titrating CPAP unit. Sleep Breath 2002;6:125–8Google Scholar
9Upadhyay, R, Dubey, A, Kant, S, Singh, BP. Management of severe obstructive sleep apnea using mandibular advancement devices with auto continuous positive airway pressures. Lung India 2015;32:158–61Google Scholar
10Cantore, S, Ballini, A, Farronato, D, Malcangi, G, Dipalma, G, Assandri, F et al. Evaluation of an oral appliance in patients with mild to moderate obstructive sleep apnea syndrome intolerant to continuous positive airway pressure use: preliminary results. Int J Immunopathol Pharmacol 2016;29:267–73Google Scholar
11Johal, A, Hector, MP, Battagel, JM, Kotecha, BT. Impact of sleep nasendoscopy on the outcome of mandibular advancement splint therapy in subjects with sleep-related breathing disorders. J Laryngol Otol 2007;121:668–75Google Scholar
12Hewitt, RJ, Dasgupta, A, Singh, A, Dutta, C, Kotecha, BT. Is sleep nasendoscopy a valuable adjunct to clinical examination in the evaluation of upper airway obstruction? Eur Arch Otorhinolaryngol 2009;266:691–7Google Scholar
13Petit, FX, Pépin, JL, Bettega, G, Sadek, H, Raphaël, B, Lévy, P. Mandibular advancement devices: rate of contraindications in 100 consecutive obstructive sleep apnea patients. Am J Respir Crit Care Med 2002;166:274–8Google Scholar
14Manni, R, Terzaghi, M, Arbasino, C, Sartori, I, Galimberti, CA, Tartara, A. Obstructive sleep apnea in a clinical series of adult epilepsy patients: frequency and features of comorbidity. Epilepsia 2003;44:836–40Google Scholar