Assessment of oral appliance for obstructive sleep apnea patients

Abstract

Although oral appliances (OAs) have become widely used for the management of obstructive sleep apnea (OSA), side effects of OAs are generally related to poor utilization. The purpose of the present study was to evaluate relationship between utilization and treatment efficacy of a boil‐and‐bite appliance for OSA patients. A total of 135 patients with OSA who had used an OAs were mailed a questionnaire to determine whether they were currently using the OA. If so, they were asked about OA use, improvement of signs and subjective symptoms, and utilization. Otherwise, they were asked to indicate why and when they quit using the OA. Results of overnight polysomnography (PSG) before and after treatment were reviewed. Of the 48 responding patients, 33 patients were currently using the OA. The most common complication was excessive salivation (n = 11). All indices from PSG excluding arousal index were significantly improved after treatment (p < 0.05). Thirty patients showed improved signs and subjective symptoms. Eight out of 12 subjects (66.7%) were successfully treated, achieving an apnea‐hypopnea index (AHI) < 10/h and >50% reduction in apnea‐hypopnea index. Of the 15 patients no longer using the OA, the primary reason for quitting was “no treatment effect” (n = 5). No indices from PSG recording differed between before and after treatment in the not‐using group. These results suggest that both subjective and objective signs and symptoms improved with use of the OA in the using group. However, no signs and subjective symptoms or indices of sleep quality differed between before and after treatment in the not‐using group. Device improvements are needed to achieve better treatment efficacy, and thus improve compliance. The present study evaluated relationship between utilization and treatment efficacy of a boil ‐and bite appliance for OSA patients. Device improvements are needed to achieve better treatment efficacy, thus improve compliance.

Self‐reported oral moistening disorders in obstructive sleep apnoea: A scoping review

“…In most publications, both drooling and xerostomia have been described as common side effects of MADs. 22,38,[55][56][57][58][59][60][61][62][63][64][65][66] The side effects are often mild and transient, and they improve as patients continue to use their appliance. 59,61,62…”

“…As described in the Results, oral appliance side effects like drooling and xerostomia are frequently reported. 22,38,[55][56][57][58][59][60][61][62][63][64][65][66] Surprisingly, many included studies showed that drooling and dry mouth due to the use of MAD are often mild 59,61,62 and can be decreased with regular use and fit adjustment. 66,82 Studies have shown that after 4-6 weeks of MAD wear, the majority of these side effects diminish.…”

“…83 However, the shape and design of the oral appliance may influence the severity and frequency of side effects. 56 Currently, there is no consensus about the optimal MAD design. Custom and noncustomised monoblock and duoblock designs with titrability and facilities for implementing lateral movements and increasing protrusion capabilities are among the design options.…”

The comparison of two different mandibular positions for oral appliance therapy in patients with obstructive sleep apnea

“…Patients who continued to use their OAs exhibited improved polysomnography (PSG) results and fewer subjective symptoms. However, hypersalivation, dry mouth, and pain and discomfort in the temporomandibular joint were reported as side effects (Makihara et al, 2016 ). The most common reasons for OA discontinuation were the associated side effects and the lack of treatment effectiveness (Makihara et al, 2016 ; McGown et al, 2001 ).…”

Over the Counter Oral Appliances: Cause for Concern?

“…A few research papers [4][5][6][7][8] do however address the topic of boil and bite appliances. It must be recognized that the patients involved in these studies had all been medically evaluated by sleep physicians and qualified dentists had examined them to make sure they would be good candidates for oral appliance therapy.…”