Oral appliances for obstructive sleep apnoea

Abstract

There is some limited evidence suggesting that oral appliance improves subjective sleepiness and sleep disordered breathing compared with a control. Nasal continuous positive airways pressure appears to be more effective in improving sleep disordered breathing than oral appliance. Until there is more definitive evidence on the effectiveness of oral appliances, it would appear to be appropriate to restrict oral appliance therapy to patients with sleep apnoea who are unwilling or unable to comply with continuous positive airways pressure therapy.

Long-term oral appliance therapy in obstructive sleep apnea syndrome: a controlled study on temporomandibular side effects

“…Standard treatment with continuous positive airway pressure (CPAP) is very effective in reducing symptoms [5,6]; however, because of the obtrusive nature of CPAP, patients may abandon or adhere poorly to this therapy [7]. Oral appliance therapy has been demonstrated an effective alternative in treating OSAS, especially in the mild and moderate spectrum of the disorder and in patients unwilling or unable to tolerate CPAP [8]. Oral appliances generally aim at relieving the upper airway obstructions by positioning the mandible in a forward and downward position [9].…”

Dental Side Effects of Mandibular Advancement Appliances – A 2-year Follow-up

“…Daneben wird eine relativ große Zahl von chirurgischen Verfahren angewandt, die von Weichteileingriffen am weichen Gaumen und der Uvula bis zur bignathen Umstellungsosteotomie der Kiefer reichen [27]. Bei leichtem bis mittelgradigem OSAS können Unterkieferprotrusionsschienen (UPS) angewendet werden [2,15]. Diese Verlagern den Unterkiefer nach anterior und öffnen den Biss.…”

Case Control Study in the Treatment of Obstructive Sleep-Disordered Breathing with a Mandibular Protrusive Appliance

“…Die mangelnde therapeutische Zuverlässigkeit dieser Behandlungsform, auftretende Nebenwirkungen im MundKiefer-Bereich und eine häufig berichtete subjektive Bevorzugung der Patienten einer Behandlung mit intraoraler Apparatur gegenüber der nachweislich zuverlässigeren CPAP-Anwendung hat Vorbehalte gegenüber diesem Therapieverfahren bei den Schlafmedizinern hervorgerufen [12]. Obwohl zahlreiche Einzelfallberichte und Studien zu dieser Behandlungsform vorliegen, wurde noch kein optimales Therapiekonzept vorgestellt, welches eine zuverlässige Erfolgsrate bei einer hohen Geräteakzeptanz sicherstellen konnte [27].…”

“…Factors that continue to detract from the appeal of oral protrusive appliance to sleep specialists are their therapeutic inconsistency, dental occlusal side effects, and frequent patient preference for oral appliances, although CPAP is the more reliable effective treatment option [12]. Though there are many case reports and studies describing the treatment, there is still no standardized treatment protocol reflecting high patient compliance and reliable therapeutic efficacy [27].…”