We found that patients with OSAS have a high risk of SB. In particular, this is the first report relating phasic-type SB to obstructive apnea events. This relationship suggests that improvement in OSAS might prevent exacerbations of SB.

Study Objectives: Mandibular advancement devices (MADs) may not be acceptable for use in patients with obstructive sleep apnea (OSA) when dental and/or temporomandibular joint side effects are likely. Tongue-stabilizing devices (TSDs) are a potential alternative to MAD therapy. We aimed to document the outcome of TSD treatment at a single multidisciplinary sleep center.Methods: OSA patients for whom MAD treatment was contraindicated due to dental and/or temporomandibular joint problems were prescribed a TSD. Follow-up overnight polysomnography (PSG) was performed with a TSD in place. Responders were defined as patients with a reduction in the apnea-hypopnea index (AHI) to less than 5 events/h as well as more than a 50% reduction in baseline AHI.Results: Of 551 patients who were referred for oral appliance therapy, 76 (100%) were prescribed a TSD. There were patients who were acclimatizing to TSD (n = 6; 8%), intolerant (n = 22; 29%), lost to follow-up (n = 26; 34%), and stopped using TSD by other reasons (n = 6; 8%). Of the 16 subjects (21%) who completed follow-up testing of PSG, the mean baseline AHI was reduced from 21.8 ± 8.6 to 9.3 ± 5.8 events/h (p < 0.01) with a TSD in place. The TSD improved AHI from 14.2 ± 2.9 to 2.1 ± 1.3 events/h in 5 responders (7%) (p < 0.01). Conclusions:The efficacy of the TSD was similar to that reported for MADs as long as the TSD was tolerated, especially in mild OSA patients. However, the high percentage of treatment dropout and/or lost to follow-up suggests the potential need for appliance redesign or modification to improve patients' adherence to therapy.

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