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Introduction:Since the previous parameter and review paper publication on oral appliances (OAs) in 2006, the relevant scientifi c literature has grown considerably, particularly in relation to clinical outcomes. The purpose of this new guideline is to replace the previous and update recommendations for the use of OAs in the treatment of obstructive sleep apnea (OSA) and snoring. Methods: The American Academy of Sleep Medicine (AASM) and American Academy of Dental Sleep Medicine (AADSM) commissioned a seven-member task force. A systematic review of the literature was performed and a modifi ed Grading of Recommendations Assessment, Development, and Evaluation (GRADE) process was used to assess the quality of evidence. The task force developed recommendations and assigned strengths based on the quality of the evidence counterbalanced by an assessment of the relative benefi t of the treatment versus the potential harms. The AASM and AADSM Board of Directors approved the fi nal guideline recommendations. Recommendations: 1. We recommend that sleep physicians prescribe oral appliances, rather than no therapy, for adult patients who request treatment of primary snoring (without obstructive sleep apnea). (STANDARD) 2. When oral appliance therapy is prescribed by a sleep physician for an adult patient with obstructive sleep apnea, we suggest that a qualifi ed dentist use a custom, titratable appliance over non-custom oral devices. (GUIDELINE) 3. We recommend that sleep physicians consider prescription of oral appliances, rather than no treatment, for adult patients with obstructive sleep apnea who are intolerant of CPAP therapy or prefer alternate therapy. (STANDARD) 4. We suggest that qualifi ed dentists provide oversightrather than no follow-up-of oral appliance therapy in adult patients with obstructive sleep apnea, to survey for dentalrelated side effects or occlusal changes and reduce their incidence. (GUIDELINE) 5. We suggest that sleep physicians conduct follow-up sleep testing to improve or confi rm treatment effi cacy, rather than conduct follow-up without sleep testing, for patients fi tted with oral appliances. (GUIDELINE) 6. We suggest that sleep physicians and qualifi ed dentists instruct adult patients treated with oral appliances for obstructive sleep apnea to return for periodic offi ce visitsas opposed to no follow-up-with a qualifi ed dentist and a sleep physician. (GUIDELINE) Conclusions: The AASM and AADSM expect these guidelines to have a positive impact on professional behavior, patient outcomes, and, possibly, health care costs. This guideline refl ects the state of knowledge at the time of publication and will require updates if new evidence warrants signifi cant changes to the current recommendations.

Pulmonary hypertension (PH) may complicate idiopathic pulmonary fibrosis (IPF) but the prevalence of PH in IPF remains undefined. The present authors sought to describe the prevalence of PH in IPF.The lung transplant registry for the USA (January 1995 to June 2004) was analysed and IPF patients who had undergone right heart catheterisation (RHC) were identified. PH was defined as a mean pulmonary arterial pressure (Ppa) o25 mmHg and severe PH as a Ppa .40 mmHg. Independent factors associated with PH were determined.Of the 3,457 persons listed, 2,525 (73.0%) had undergone RHC. PH affected 46.1% of subjects; ,9% had severe PH. Variables independently associated with mild-to-moderate PH were as follows: need for oxygen, pulmonary capillary wedge pressure (P _ pcw) and forced expiratory volume in one second (FEV1). Independent factors related to severe PH included the following: carbon dioxide tension, age, FEV1, P _ pcw, need for oxygen and ethnicity. A sensitivity analysis in subjects with P _ pcw ,15 mmHg did not appreciably alter the present findings.Pulmonary hypertension is common in idiopathic pulmonary fibrosis patients awaiting lung transplant, but the elevations in mean pulmonary arterial pressure are moderate. Lung volumes alone do not explain the pulmonary hypertension. Given the prevalence of pulmonary hypertension and its relationship with surrogate markers for quality of life (e.g. activities of daily living), future trials of therapies for this may be warranted.

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Each component of the 6-min walk independently predicted mortality in IPF with greater accuracy than spirometry. However, a composite of both parameters, the DSP, provides slightly greater accuracy and represents a novel measure for assessing survival in patients with IPF.