Our purpose was to compare the effectiveness and side effects of a novel, single-piece mandibular advancement device (OSA-Monobloc) for sleep apnea therapy with those of a two-piece appliance with lateral Herbst attachments (OSA-Herbst) as used in previous studies. An OSA-Monobloc and an OSA-Herbst with equal protrusion were fitted in 24 obstructive sleep apnea patients unable to use continuous positive airway pressure (CPAP) therapy. After an adaptation period of 156 +/- 14 d (mean +/- SE), patients used the OSA-Monobloc, the OSA-Herbst, and no appliance in random order, using each appliance for 1 wk. Symptom scores were recorded and sleep studies were done at the end of each week. Several symptom scores were significantly improved with both appliances, but to a greater degree with the OSA-Monobloc. Epworth Sleepiness Scale scores were 8.8 +/- 0.7 with the OSA-Herbst, and 8.6 +/- 0.8 with the OSA-Monobloc devices, and 13.1 +/- 0.9 without therapy (p < 0.05 versus both appliances). The apnea/hypopnea index was 8.7 +/- 1.5/h with the OSA-Herbst and 7.9 +/- 1.6/h with the OSA-Monobloc device, and 22.6 +/- 3.1/h without therapy (p < 0.05 versus both appliances). Side effects were mild and of equal prevalence with both appliances. Fifteen patients preferred the OSA-Monobloc, eight patients had no preference, and one patient preferred the OSA-Herbst device (p < 0.008 versus OSA-Monobloc). We conclude that both the OSA-Herbst and the OSA-Monobloc are effective therapeutic devices for sleep apnea. The OSA-Monobloc relieved symptoms to a greater extent than the OSA-Herbst, and was preferred by the majority of patients on the basis of its simple application.

Our purpose was to investigate side effects of sleep apnea treatment by removable oral appliances (OA) that advance the mandible. In 22 patients suffering from obstructive sleep apnea (OSA), questionnaire evaluations, polysomnographies, cephalographies, and dental plaster casts were obtained before initiation of treatment with OA that fully covered both dental arches. Patients were reevaluated after 3 to 12 mo (questionnaires, polysomnographies) and 12 to 30 mo (questionnaires, cephalographies, plaster casts) during continuous treatment. Polysomnographies confirmed improved breathing by OA. All patients experienced persistent alleviation of symptoms after 12 to 30 mo and wished to continue treatment. Side effects were common but only mildly disturbing: mucosal dryness (86% of patients), tooth discomfort (59%), and hypersalivation (55%). Cephalographies revealed a decrease in the mean (+/- SE) upper incisors to maxillary plane angle from 102 +/- 2 degrees at baseline, to 101 +/- 2 degrees after 12 to 30 mo (p < 0.05). Overbite and overjet were also slightly (mean reduction < 1 mm) but significantly reduced. None of these side effects required discontinuation of treatment. OA are an effective therapy of obstructive sleep apnea. Mild side effects are common but rarely require intervention. Nevertheless, close follow-up during long-term therapy by OA is advisable in order to timely detect potentially relevant orthodontic changes.

Background: Removable oral appliances are employed to treat obstructive sleep apnea and snoring. In this review we summarize the current state of the art of this therapy. Methods: We performed a systematic review of the medical literature on the effectiveness, side effects and practical aspects of oral appliance therapy for sleep-disordered breathing. Results: Several randomized, controlled trials demonstrate the improvement of symptoms and sleep-related breathing disturbances in obstructive sleep apnea and snoring by oral appliances that advance the mandible. Side effects are common but usually transient and rarely severe. Conclusions: Mandibular advancement devices are a valuable treatment modality for obstructive sleep apnea and snoring. Dental and medical examinations at regular intervals and polysomnographic follow-up are important during long-term treatment to avoid potential adverse effects and to assure continued effectiveness.