Oral Appliances for Snoring and Obstructive Sleep Apnea: A Review

Abstract

We conducted an evidence-based review of literature regarding use of oral appliances (OAs) in the treatment of snoring and obstructive sleep apnea syndrome (OSA) from 1995 until the present. Our structured search revealed 141 articles for systematic scrutiny, of which 87 were suitable for inclusion in the evidence base, including 15 Level I to II randomized controlled trials and 5 of these trials with placebo-controlled treatment. The efficacy of OAs was established for controlling OSA in some but not all patients with success (defined as no more than 10 apneas or hypopneas per hour of sleep) achieved in an average of 52% of treated patients. Effects on sleepiness and quality of life were also demonstrated, but improvements in other neurocognitive outcomes were not consistent. The mechanism of OA therapy is related to opening of the upper airway as demonstrated by imaging and physiologic monitoring. Treatment adherence is variable with patients reporting using the appliance a median of 77% of nights at 1 year. Minor adverse effects were frequent whereas major adverse effects were uncommon. Minor tooth movement and small changes in the occlusion developed in some patients after prolonged use, but the long-term dental significance of this is uncertain. In comparison to continuous positive airway pressure (CPAP), OAs are less efficacious in reducing the apnea hypopnea index (AHI), but OAs appear to be used more (at least by self report), and in many studies were preferred over CPAP when the treatments were compared. OAs have also been compared favorably to surgical modification of the upper airway (uvulopalatopharyngoplasty, UPPP). Comparisons between OAs of different designs have produced variable findings. The literature of OA therapy for OSA now provides better evidence for the efficacy of this treatment modality and considerable guidance regarding the frequency of adverse effects and the indications for use in comparison to CPAP and UPPP.

Sleep Apnea and Cardiovascular Disease

“…A recent analysis by the American Academy of Sleep Medicine reported oral appliances to be preferred over CPAP by many patients and to be successful in improving snoring, but only 52% were successful at relieving OSA (AHI Ͻ10). 329 Surgery continues to be a viable approach to apnea therapy in some patients, with most procedures designed to enlarge the pharyngeal airway or bypass the obstruction. 330 Tracheostomy was the first surgical procedure used in the treatment of apnea and, although effective, is rarely performed now because of its social stigma and discomfort.…”

Effect of laparoscopic Roux-en-Y gastric bypass surgery on obstructive sleep apnea in a Chinese population with obesity and T2DM

“…might limit the therapeutic value for OSA patients over the long term. Oral appliances are generally viewed as being less efficacious than treatment with CPAP [7,8]. Moreover, 6-86 % of patients who used oral appliances have been reported to experience adverse effects, including dryness of the tongue and throat, pain in the teeth and jaw, and insomnia [7,9].…”

“…Oral appliances are generally viewed as being less efficacious than treatment with CPAP [7,8]. Moreover, 6-86 % of patients who used oral appliances have been reported to experience adverse effects, including dryness of the tongue and throat, pain in the teeth and jaw, and insomnia [7,9]. Various surgical techniques of the upper airway have been used to treat OSA, although the use of surgery for this condition remains somewhat controversial and is associated with limited and unpredictable efficacy that may diminish over the long term [10][11][12].…”

Snoring and the role of the GDP: British Society of Dental Sleep Medicine (BSDSM) pre-treatment screening protocol

“…The BMI is calculated by dividing the patients weight in kilograms by their height in metres squared), non-somnoBasic patient assessment as above (1) Snorer with ESS <10 lent snorers with an ESS <10 and no relevant OSA/medical history. The second, more experienced (and suitably trained) practitioner would provide ambulatory screening using the advanced protocol (Figs 1-3) for both those patients with an ESS of <10 and a positive OSA/medical history, and those with a moderate ESS (10)(11)(12)(13)(14)(15). It is important to note that while an ESS >10 may indicate OSAHS, it may also be due to lifestyle issues such as shift work, too little sleep time, sleep disturbance from babies, or a noisy environment.…”