Clinical guidelines for oral appliance therapy in the treatment of snoring and obstructive sleep apnoea

Abstract

The purpose of this review is to provide guidelines for the use of oral appliances (OAs) for the treatment of snoring and obstructive sleep apnoea (OSA) in Australia. A review of the scientific literature up to June 2012 regarding the clinical use of OAs in the treatment of snoring and OSA was undertaken by a dental and medical sleep specialists team consisting of respiratory sleep physicians, an otolaryngologist, orthodontist, oral and maxillofacial surgeon and an oral medicine specialist. The recommendations are based on the most recent evidence from studies obtained from peer reviewed literature. Oral appliances can be an effective therapeutic option for the treatment of snoring and OSA across a broad range of disease severity. However, the response to therapy is variable. While a significant proportion of subjects have a near complete control of the apnoea and snoring when using an OA, a significant proportion do not respond, and others show a partial response. Measurements of baseline and treatment success should ideally be undertaken. A coordinated team approach between medical practitioner and dentist should be fostered to enhance treatment outcomes. Ongoing patient follow-up to monitor treatment efficacy, OA comfort and side effects are cardinal to long-term treatment success and OA compliance.Keywords: Mandibular advancement splint, obstructive sleep apnoea, oral appliance, review, snoring.Abbreviations and acronyms: AASM = American Academy of Sleep Medicine; ADA = Australian Dental Association; AHI = apnoeahypopnoea index; ASA = Australasian Sleep Association; BMI = body mass index; CBCT = cone beam computed tomography; CT = computed tomography; ESS = Epworth Sleepiness Scale; MAS = mandibular advancement splints; OA = oral appliances; OSA = obstructive sleep apnoea; PSG = polysomnogram; SDB = sleep disordered breathing; TMD = temporomandibular disorder; TMJ = temporomandibular joint; TRD = tongue retaining device; TSD = tongue stabilizing device; UARS = upper airway resistance syndrome; UPPP = uvulopalatopharyngoplasty.

Treatment options for obstructive sleep apnea

“…19 Adherence to oral appliance therapy is difficult to track objectively and thus compare directly with rates of CPAP adherence. Thermosensors can be embedded into oral appliances to monitor device usage, 21 but presence of these sensors is not ubiquitous. Overall, the absolute difference between the mean subjective adherence rates for oral appliance users was 0.70 more hours per night than the objective adherence rates among CPAP users.…”

Dental Treatment for Paediatric Obstructive Sleep Apnea

“…Mandibular advancement (MA) with oral devices (OA), in particular mandibular advancement splints (MAS) in adults has been shown to be effective in treating OSA across a range of severity [72,73]. MAS are now recommended as a first line therapy for mild to moderate OSA and in more severe cases where CPAP is refused or is not able to be tolerated [74].…”

Obstructive sleep apnea in women

“…Az OSA-ban szenvedő betegek döntő többsége elhízott. Túlsúlyos betegek esetén a testsúly normalizálá-sa sok esetben a légzési zavarokat csökkentheti vagy megszünteti [49,50]. Ez azonban gyakran rendkívül nehéz és nagy kihívás a betegnek, ezért nagy jelentősége van a kezelőorvos támogatásának is.…”

“…Nők esetében gyakran alacsonyabb nyomás is elegendő, a hasonló súlyosságú OSA-ban szenvedő férfi akhoz képest [35]. A legújabb terápiás irányelv azt hangsúlyozza, hogy a betegeknél kezelésre adott válasz különböző lehet, az utánkövetés viszont minden esetben kiemelt fontossággal bír [50].…”