Oral appliances for obstructive sleep apnoea

Lim, Jessie Mei; Lasserson, TJ; Fleetham, John A.; Wright, John

doi:10.1002/14651858.cd004435.pub2

Cited by 127 publications

(144 citation statements)

References 53 publications

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“…The use of mandibular advancement devices (MAD) represents a therapeutic alternative worthy of evaluation, mainly for snorers and mild–moderate OSA patients (Lim et al ., ). Also, supine‐related OSA appears to be a predictor of treatment success with MAD (Marklund et al ., ) and positional patients (PP) respond better to MAD compared to non‐positional patients (NPP) even when controlling for Apnea–Hypopnea Index (AHI) (Chung et al ., ).…”

Section: Introductionmentioning

confidence: 97%

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Oksenberg

Gadoth

2013

Journal of Sleep Research

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Summary Obstructive sleep apnea (OSA) is a sleep disorder which has been gradually accepted as an important cause of increased morbidity and mortality. The treatment of moderate–severe OSA has improved dramatically since the introduction of continuous positive airway pressure (CPAP) devices; however, the adherence of patients to CPAP treatment is relatively low. Adherence appears to be even worse in patients with mild or asymptomatic OSA. The failure to identify and treat mildly symptomatic or asymptomatic OSA patients may be costly, as such patients comprise about 20% of the general adult population. OSA patients could be divided into positional and non‐positional patients. Positional patients show most of their breathing abnormalities while sleeping in the supine position. Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas. On the contrary, non‐positional patients suffer from breathing abnormalities in the supine and lateral postures, and as a consequence those are the most severe OSA patients for whom CPAP is the treatment of choice. In this paper we intend to argue that positional therapy, i.e. avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild–moderate OSA. Considering the fact that the vast majority of mild–moderate OSA patients are positional patients (between 65 and 87%), positional therapy may be a simple, cheap and effective solution for them. High‐quality research regarding this issue is needed to evaluate the real effectiveness of this mode of therapy.

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Section: Introductionmentioning

confidence: 97%

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Oksenberg

Gadoth

2013

Journal of Sleep Research

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“…During the last two decades, there has been increased interest in oral appliances (OA) as a treatment modality of OSA as it has shown good treatment effects (20, 21). The OA is used during the night and it protrudes the mandible and thereby opens the airway (22).…”

Section: Introductionmentioning

confidence: 99%

“…Oral appliances use at night during sleep reduces sleep apnoea induced hypoxia (23). Oral appliances is easy to use as it does not require electrical power, does not make any noise, and cross‐over studies have shown that patients prefer OA therapy to CPAP, which leads to good compliance (20, 24). The importance of treatment comfort for the patients should not be ignored.…”

Section: Introductionmentioning

confidence: 99%

Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance – a three‐year follow‐up

Andrén¹,

Sjöquist²,

Tegelberg³

2009

J of Oral Rehabilitation

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Obstructive sleep apnoea (OSA) is a highly prevalent sleep disorder; it affects 4% of males and 2% of females. Hypertension has been shown to occur in 28-57% of OSA patients. There is a steady increase in evidence linking OSA to long-term cardiovascular morbidity including hypertension. The purpose of this study was to investigate whether mandibular advancement oral appliance (OA) treatment of OSA affects the patient's blood pressure (BP) in a 3-month and a 3-year perspective. Twenty-nine consecutive patients, with verified OSA defined as apnoea index (AI) >5 per hour and/or apnoea/hypopnoea index (AHI) > or =10 per hour, received an OA as treatment. BP was measured on three occasions; before treatment, after 3 months of treatment, and after 3 years of treatment. BP was measured with an electronic blood pressure monitor. The treatment effect of OA was measured after 3 months by repeated somnographic registration while the patient was wearing the OA. A treatment response was defined as AHI < 10; this was achieved in 25 of 29 patients (86%) at the 3-month evaluation. Significant reductions in blood pressure were attained between baseline and the 3-month evaluation (P < 0.001) and these changes remained at the 3-year follow-up in both systolic BP of -15.4 +/- 18.7 mm Hg and diastolic BP of -10.3 +/- 10.0 mm Hg. OA therapy reduced blood pressure in both a 3-month and a 3-year perspective in patients with OSA.

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“…Mandibular repositioning appliances (MRAs) have been recommended for patients with mild‐to‐moderate symptomatic OSA who have good objective effects and for patients who do not tolerate continuous positive airway pressure (CPAP) (Kushida et al. , 2006; Lim et al. , 2006).…”

Section: Introductionmentioning

confidence: 99%

Long‐term effects of mandibular repositioning appliances on symptoms of sleep apnoea

Marklund¹,

Franklin

2007

Journal of Sleep Research

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SUMMARY Mandibular repositioning appliances (MRAs) reduce symptoms of obstructive sleep apnoea in the short term, but the long-term effects are unknown. Our objective was to evaluate the long-term symptomatic effects of custom-made MRAs and to identify the patients who will experience subjective benefits from treatment. A cohort of 260 consecutive patients treated with appliances for non-apnoeic snoring or sleep apnoea was followed up by a questionnaire and examination after an average of 5.4 years. The subjective effect was defined as good when complaints of daytime sleepiness occurred less than once a week. A total of 185 patients (71%) responded to the questionnaires. Of the respondents, 96 reported frequent use, 33 reported infrequent use, 26 reported discontinued treatment and 30 reported modified treatment. Mild cases (apnoeahypopnoea index [AHI] < 15) were likelier than more severe cases to continue treatment. Patients who had used MRAs reported fewer complaints of sleepiness, headaches and daytime naps. Frequent use (P = 0.001), few night-time awakenings before start of treatment (P = 0.02) and effective apnoea reduction during treatment of more severe cases (P = 0.02) correlated with a good subjective effect at long-term follow-up. Our conclusion is that custom-made MRAs reduce sleep apnoea symptoms in the long term. The mildest cases will experience the greatest long-term benefit. The reason is that non-apnoeic snorers and patients with a mild disease are more likely to continue treatment and that their long-term results with regard to excessive sleepiness are similar to patients with a more severe disease.

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Oral appliances for obstructive sleep apnoea

Cited by 127 publications

References 53 publications

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Are we missing a simple treatment for most adult sleep apnea patients? The avoidance of the supine sleep position

Effects on blood pressure after treatment of obstructive sleep apnoea with a mandibular advancement appliance – a three‐year follow‐up

Long‐term effects of mandibular repositioning appliances on symptoms of sleep apnoea

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