Clinical Practice Guideline for the Treatment of Obstructive Sleep Apnea and Snoring with Oral Appliance Therapy: An Update for 2015

Abstract

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Upper Airway Stimulation for OSA

“…Oral appliance therapy currently has the most robust safety and effectiveness data of all second-line options, and most of our patients with adequate dentition are recommended a trial of an oral appliance after initial PAP failure. [13][14][15][16] However, at least half of patients with moderate to severe OSA are not sufficiently treated with an oral appliance alone. 17 Others are not candidates due to lack of adequate dentition or lack of insurance coverage, or they discontinue therapy due to discomfort, occlusal change, or other side effects.…”

Heat-moulded versus custom-made mandibular advancement devices for obstructive sleep apnoea: a randomised non-inferiority trial

“…There is consensus in the sleep community towards the abandonment of prefabricated, non-adjustable, over-the-counter ‘boil and bite’ appliances that are associated with lower rates of efficacy, fall out more easily during the night and suffer from poor tolerance and lower adherence 15–18. On the other end of the sophistication spectrum, two-piece custom-made, titratable MADs built by a qualified dentist still appear to be the gold standard according to clinical guidelines 18. However, these MADs require several weeks to be manufactured, are more expensive and their efficacy is still difficult to predict.…”

Fake it till you custom-make it: a non-inferior thermoplastic mandibular advancement device?

“…There are numerous device options which vary in sophistication and customisation. The current guideline for MAD therapy recommend a customised, titratable (allowing adjustment to level of mandibular protrusion) device, over a non-custom device 5. However, this is a guideline only, due to limited device comparison trials.…”