Oral appliance treatment of 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 (OA m ). There is a strong evidence base demonstrating OA m improve OSA in the majority of patients, including some with more severe disease. However OA m are not effi cacious for all, with approximately one-third of patients experiencing no therapeutic benefi t. OA m 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 OA m to gold-standard CPAP treatment. Head-to-head trials confi rm CPAP is superior in reducing OSA parameters on polysomnography; however, this greater effi cacy does not necessarily translate into better health outcomes in clinical practice. O bstructive sleep apnea (OSA) is a common sleep disorder characterized by recurring collapse of the upper airway during sleep, resulting in sleep fragmentation and oxygen desaturation. OSA is defi ned as the occurrence of 5 or more episodes of complete (apnea) or partial (hypopnea) upper airway obstruction per hour of sleep (apnea-hypopnea index [AHI]) and is estimated to occur in around 24% of middleaged men and 9% of women.1 Daytime symptoms such as sleepiness, cognitive impairment, and effects on quality of life require appropriate treatment. Furthermore the association of OSA with increased risk of motor vehicle accidents, cardiovascular morbidity, and all-cause mortality emphasize the need for effective long-term treatment. 2,3The gold standard treatment for OSA is to pneumatically splint open the upper airway during sleep using continuous positive airway pressure (CPAP). Although CPAP is highly effi cacious in preventing upper airway collapse, patient acceptance, tolerance, and adherence is often low, thereby reducing effectiveness. 4 Hence, there is a major need for effective alternative treatments.

The Comparison of CPAP and Oral Appliances in Treatment of Patients With OSA: A Systematic Review and Meta-analysis

“…29 A previous Cochrane review 8 showed that OAs were less effective than CPAP in reducing AHI and improving minimum S pO 2 during sleep; however, subjects seemed to be more adherent to OAs than CPAP in a small part of the included trials. So the prior Cochrane review led to the conclusion that CPAP seemed to be more effective than OAs in improving sleep-disordered breathing, but the difference in symptoms between these 2 treatments was not significant.…”

Obstructive Sleep Apnea and Mandibular Advancement Splints: Occlusal Effects and Progression of Changes Associated with a Decade of Treatment

“…Initial transient effects may include excess salivation or mouth dryness, temporomandibular joint and dental discomfort and irritation of intra-oral tissues. 11 The skeletal and dental changes that occur after prolonged MAS treatment have been previously described in terms of appliance design, amount of mandibular protrusion, and duration of wear.…”

Non-CPAP therapies in obstructive sleep apnoea: mandibular advancement device therapy

“…MADs may also be used in patients with more severe disease who do not respond to or who fail treatment attempts with CPAP. Some studies have suggested that the efficacy of MADs in modifying the health risks associated with OSA is somewhat similar to that of CPAP [9]. The treatment effect of MADs has to be verified in a renewed sleep apnoea recording with the device in all patients with OSA [7], since patients may have a suboptimal treatment response.…”