Oral Appliance Treatment for Obstructive Sleep Apnea: An Update

Abstract

Oral appliances (OA) have emerged as an alternative to continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) treatment. The most commonly used OA reduces upper airway collapse by advancing the mandible (OAm). There is a strong evidence base demonstrating OAm improve OSA in the majority of patients, including some with more severe disease. However OAm are not efficacious for all, with approximately one-third of patients experiencing no therapeutic benefit. OAm are generally well tolerated, although short-term adverse effects during acclimatization are common. Long-term dental changes do occur, but these are for the most part subclinical and do not preclude continued use. Patients often prefer OAm to gold-standard CPAP treatment. Head-to-head trials confirm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater efficacy does not necessarily translate into better health outcomes in clinical practice. Comparable effectiveness of OAm and CPAP has been attributed to higher reported nightly use of OAm, suggesting that inferiority in reducing apneic events may be counteracted by greater treatment adherence. Recently, significant advances in commercially available OAm technologies have been made. Remotely controlled mandibular positioners have the potential to identify treatment responders and the level of therapeutic advancement required in single night titration polysomnography. Objective monitoring of OAm adherence using small embedded temperature sensing data loggers is now available and will enhance clinical practice and research. These technologies will further enhance efficacy and effectiveness of OAm treatment for OSA.

Temporomandibular Disorders in Patients Undergoing Mandibular Advancement Device Therapy for Obstructive Sleep Apnea: A Systematic Review

“…This action changes the dimensions of the upper airway, including the hypopharynx, the oropharynx, and the nasopharynx, and imaging studies have shown that the upper airway space expands, most notably in the lateral dimension of the velopharyngeal region (Bondemark, 1999;Sutherland et al, 2014). It has been also hypothesized that MADs increase muscular tonus by increasing the passive muscle tension in the pharyngeal wall, thereby reducing the vibration of the soft tissues and the turbulent airflow (Hammond et al, 2007).…”

“…Although CPAP is highly efficacious in preventing upper airway collapse, providing a successful outcome in over 95 % of users, as many as 50 % of patients cannot tolerate the use of CPAP (Perez et al, 2013;Sutherland et al, 2014). Hence many patients look toward alternative treatment options, such as the use of a mandibular advancement device (MAD).…”

“…OSA, and resultant sleep fragmentation and oxygen desaturation, have been associated with daytime sleepiness, cognitive impairment, type 2 diabetes, cardiovascular disease, stroke, increased risk of motor vehicle accidents and can have significant effects on quality of life (Chen et al, 2008;Cunali et al, 2008;Sutherland et al, 2014;Vuorjoki-Ranta et al, 2014). It can affect 4% to 9% of the middle-aged population, and some studies report an incidence as high as 34% in men (Clark et al, 2000;Cunali et al, 2008).…”

“…The gold standard treatment for OSA is to pneumatically splint the upper airway during sleep using continuous positive airway pressure (CPAP) (Sutherland et al, 2014). Although CPAP is highly efficacious in preventing upper airway collapse, providing a successful outcome in over 95 % of users, as many as 50 % of patients cannot tolerate the use of CPAP (Perez et al, 2013;Sutherland et al, 2014).…”

“…Obstructive sleep apnea (OSA), a sleep disorder characterized by recurring collapse of the upper airway during sleep, is defined by the occurrence of five or more episodes of complete (apnea) or partial (hypopnea) upper airway obstruction per hour of sleep (Sutherland et al, 2014). OSA, and resultant sleep fragmentation and oxygen desaturation, have been associated with daytime sleepiness, cognitive impairment, type 2 diabetes, cardiovascular disease, stroke, increased risk of motor vehicle accidents and can have significant effects on quality of life (Chen et al, 2008;Cunali et al, 2008;Sutherland et al, 2014;Vuorjoki-Ranta et al, 2014).…”