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March 4, 1992

Pathophysiology of Upper Airway Closures During Sleep

Author Affiliations

University of Pittsburgh (Pa) Medical Center

JAMA. 1992;267(9):1207. doi:10.1001/jama.1992.03480090054019

To the Editor.  —Drs Kuna and Sant'Ambrogio1 have presented an excellent review of the pathophysiology of OSA but failed to include a discussion of the use of dental appliances in the treatment of OSA. Although nasal continuous positive airway pressure (CPAP) is the treatment of choice for OSA, it is cumbersome, expensive, and socially unacceptable to some patients. Long-term compliance with nasal CPAP has been estimated to be as low as 50%.2 The following case report (I describe myself) is an example of moderate to severe OSA successfully treated with a dental appliance.

Report of a Case.  —I am a 36-year-old physician who, for many years, had experienced excessive daytime sleepiness and had snored loudly. These symptoms had worsened in 1985 after I had stopped smoking and had gained 65 pounds. In 1987, a psychiatrist gave me an antidepressant for depression. I presented to a sleep evaluation