Long-term side effects of sleep apnea treatment with oral appliances: nature, magnitude and predictors of long-term changes

Hamoda, Mona M.; Almeida, Fernanda R.; Pliska, Benjamin T.

doi:10.1016/j.sleep.2018.12.012

Cited by 23 publications

(34 citation statements)

References 33 publications

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“…However, sometimes these symptoms are more severe and continuous, resulting in cessation of the therapy. The major long-term adverse effects are occlusal changes with prolonged MAD use, but these changes have not been reported as being related to treatment withdrawal [42][43][44][45][46][47][48]. Conversely, skeletal or postural changes were negligible.…”

Section: Side Effectsmentioning

confidence: 99%

Oral Appliances in Obstructive Sleep Apnea

Dieltjens

Vanderveken

2019

Healthcare

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Oral appliance therapy is increasingly prescribed as a non-invasive treatment option for patients diagnosed with obstructive sleep apnea. The custom-made titratable mandibular advancement devices (MAD) are the recommended type of oral appliances. Mandibular advancement devices are efficacious in reducing the severity of obstructive sleep apnea, however, only to a lesser extent than standard therapy using continuous positive airway pressure (CPAP). Although oral appliance therapy is known to reduce the severity of obstructive sleep apnea in most of the patients, one out of three patients still show negligible improvement under MAD therapy. Therefore, the selection of the appropriate candidates for this therapy is imperative and several upfront prediction tools are described. Overall, the health outcome of mandibular advancement device therapy is similar to that of CPAP, probably due to the inferior compliance of CPAP compared to MAD therapy, resulting in similar clinical effectiveness.

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Section: Side Effectsmentioning

confidence: 99%

Oral Appliances in Obstructive Sleep Apnea

Dieltjens

Vanderveken

2019

Healthcare

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“…4 Unfortunately, the use of CPAP masks is associated with several commonly occurring adverse effects, such as dry mouth, increased number of awakenings, blockedup nose, pressure intolerance, and air leakage, 5 which could be detrimental for compliance. 6 Dental side effects, which are common for oral appliance therapy, 7 are much less frequently reported by adult CPAP users. Tsuda et al 6 describe dental changes due to pressure of the nasal mask on the lip, thus causing a retrusion of the upper incisors.…”

Section: Discussionmentioning

confidence: 99%

“…All conditions were successfully under medical treatment (by means of dedicated pharmacotherapy); only his headache complaints, which were already present for many years, did not respond well to pharmacotherapy thus far. Other than the mentioned conditions, the patient received a diagnosis of severe obstructive sleep apnea (OSA) approximately 9 months earlier, with an apnea-hypopnea index (AHI) of 58 events/h, for which he received a nasal continuous positive airway pressure (nCPAP) device (AirSense 10 Elite, ResMed; mean [range] pressure = 7.5 [4][5][6][7][8][9][10][11][12] cm H 2 O).…”

Section: Report Of Casementioning

confidence: 99%

Nasal CPAP therapy associated with masticatory muscle myalgia

Lobbezoo

Koutris

et al. 2020

Journal of Clinical Sleep Medicine

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This case report describes a rare side effect associated with nasal continuous positive airway pressure (nCPAP), masticatory muscle myalgia. A 69-year-old man was referred to a clinic specializing in orofacial pain and dysfunction with complaints of pain in the area of the masseter muscles. He was diagnosed with severe obstructive sleep apnea (OSA) 9 months earlier, for which he received nCPAP. Six months ago, his pain complaints started. The pain was diagnosed as masticatory muscle myalgia, due to sleep-related tooth clenching and intense tongue thrusting. These activities were likely related to the patient's attempts to prevent leakage through the oral cavity of the airflow generated by the nCPAP device. The patient did not complain about leaking of the nasal mask itself. Considerable alleviation of the pain complaints as well as reduction of the clenching and thrusting behavior were achieved by substituting the nasal mask with a full face mask. Sleep medicine physicians should be aware of this possible side effect of nCPAP.

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“…Some bite changes are actually favourable and, in any case, often not noticed by the patient and considered subclinical [94]. There have now been studies that track the effects of oral appliance wear on bite changes in twenty years of use [95][96][97]. These studies show that tooth movements are continuous and relate to the duration and frequency of OA use and to the mandibular advancement level [95,96].…”

Section: Long-term Side Effectsmentioning

confidence: 99%

Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

Sutherland

Cistulli

2019

JCM

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Obstructive sleep apnoea (OSA) represents a significant global health burden, with impact on cardiometabolic health, chronic disease, productivity loss and accident risk. Oral appliances (OA) are an effective therapy for OSA and work by enlarging and stabilising the pharyngeal airway to prevent breathing obstructions during sleep. Although recommended in clinical guidelines for OSA therapy, they are often considered only as second-line therapy following positive airway pressure (PAP) therapy failure. There has been a long-standing barrier to selecting OA over PAP therapy due to the inability to be certain about the level of efficacy in individual OSA patients. A range of methods to select OSA patients for OA therapy, based on the outcome of a single sleep study night, have been proposed, although none has been widely validated for clinical use. Emergent health outcome data suggest that equivalent apnoea–hypopnea index reduction may not be necessary to produce the same health benefits of PAP. This may be related to the more favourable adherence to OA therapy, which can now be objectively verified. Data on longer term health outcomes are needed, and there are additional opportunities for device improvement and combination therapy approaches. OAs have an important role in precision care of OSA as a chronic disorder through a multi-disciplinary care team. Future studies on real-world health outcomes following OA therapy are needed.

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Long-term side effects of sleep apnea treatment with oral appliances: nature, magnitude and predictors of long-term changes

Cited by 23 publications

References 33 publications

Oral Appliances in Obstructive Sleep Apnea

Oral Appliances in Obstructive Sleep Apnea

Nasal CPAP therapy associated with masticatory muscle myalgia

Oral Appliance Therapy for Obstructive Sleep Apnoea: State of the Art

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