Non-ablative laser treatment for snoring and obstructive sleep apnea

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Introduction: By preventing the progression of sleep breathing disorder (SBD) , the risk of developing chronic diseases highly prevalent in society, such as hypertension and type 2 diabetes, is reduced. This study aimed to clinically evaluate the effect of non-ablative treatment with Nd:YAG (1064 nm) and Er:YAG lasers (2940 nm) in sleep breathing disorder (SBD), in a longitudinal, interventional and prospective study. Materials and Methods: After approval from the Research Ethics Committee (CEP FOUSP CAAE: 44068621.8.0000.0075) and clinical trial registration - WHO - Rebec UTN code: U1111-1284-3764, thirty volunteers, in the city of São Paulo, Brazil, with clinical status from snoring to moderate OSA, both sexes, 25 to 65 years old, BMI < 40kg/m2 were blinded and randomized in control and laser groups. Patients received three treatment sessions, 14 days apart. In the control group (12 volunteers), only a guide light was used without delivering laser energy. 18 volunteers of laser group were treated with non-ablative high-intensity irradiation with the association of Nd:YAG and Er:YAG lasers. Entire soft palate, uvula, palatoglossal and palatopharyngeal arches were punctually irradiated with four to five shoots per point and six scans in each line. Parameters were selected to deliver energy efficiently and safely in a five-step sequence wich enable tissue thermal sensitization, gradually. Outcome measures were performed before, after treatment and at three and six months follow up visits, including photographic record, type IV polysomnography and analysis of snoring noise. The main outcome of the study, analysis of the upper airway lumen variation according to the Modified Mallampati Index was performed independently and blinded and as well as the statical analysis. Oxyhemoglobin desaturation index (ODI), snoring time during sleep and peak amplitude of snoring noise were also analysed. Observation of the variability of each outcome allowed analysis of the differences between experimental periods compared to baseline for each variable and the behavior of the laser group compared to the control group. Fisher's corrected chi-square test with a significance level of α = 5% was applied. Results: The main clinical outcome is the expansion of the upper airway lumen, in all study periods analyzed after irradiation [variation between control and laser groups: (0.0 ± 0.0); (-25.0 ± 50.0) with p = 0.00060]. Therefore, improvement in ODI [variation between control and laser groups: (19.6 ± 67.6); (-18.1 ± 88.2) with p = 0.018]; improvement in snoring time (64.8 ± 179.1); (-1.5 ± 85.0) with p = 0.034 and in snoring noise peak amplitude (-8.3 ± 12.3); (-12.4 ± 15.8) with p = 0.029. No major adverse events or side effects were observed. Conclusion: Non-ablative laser treatment is effective in rehabilitation of patients with Sleep Breathing Disorder. In the protocol used in this study, the procedure is performed in outpatiente basis, without medication or anesthesia. Increasing the lumen of the upper airway by decreasing tissue flaccidity, leads to the improvement of oxyhemoglobin desaturation index (ODI), snoring time during sleep and peak amplitude of snoring noise.

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MENDES, V.; AZEVEDO, L.; ZEZELL, D. Non-ablative laser treatment for snoring and obstructive sleep apnea: a controlled randomized double-blind clinical trial. Sleep Medicine, v. 115, p. 367-367, 2024. Supplement 1. DOI: 10.1016/j.sleep.2023.11.990. Disponível em: Acesso em: 21 Jul 2024.
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